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Platelet Transfusion Practices in Critically Ill Children.

ABSTRACT: OBJECTIVES:Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children. DESIGN:Prospective cohort study. SETTING:Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017. PATIENTS:Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Over 6 weeks, 16,934 patients were eligible, and 559 received at least one platelet transfusion (prevalence, 3.3%). The indications for transfusion included prophylaxis (67%), minor bleeding (21%), and major bleeding (12%). Thirty-four percent of prophylactic platelet transfusions were prescribed when the platelet count was greater than or equal to 50?×?10 cells/L. The median (interquartile range) change in platelet count post transfusion was 48?×?10 cells/L (17-82?×?10 cells/L) for major bleeding, 42?×?10 cells/L (16-80?×?10 cells/L) for prophylactic transfusions to meet a defined threshold, 38?×?10 cells/L (17-72?×?10 cells/L) for minor bleeding, and 25?×?10 cells/L (10-47?×?10 cells/L) for prophylaxis in patients at risk of bleeding from a device. Overall ICU mortality was 25% but varied from 18% to 35% based on indication for transfusion. Upon adjusted analysis, total administered platelet dose was independently associated with increased ICU mortality (odds ratio for each additional 1?mL/kg platelets transfused, 1.002; 95% CI, 1.001-1.003; p = 0.005). CONCLUSIONS:The majority of platelet transfusions are given as prophylaxis to nonbleeding children, and significant variation in platelet thresholds exists. Studies are needed to clarify appropriate indications, with focus on prophylactic transfusions.

SUBMITTER: Nellis ME

PROVIDER: S-EPMC6476545 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Platelet Transfusion Practices in Critically Ill Children.

Nellis Marianne E ME Karam Oliver O Mauer Elizabeth E Cushing Melissa M MM Davis Peter J PJ Steiner Marie E ME Tucci Marisa M Stanworth Simon J SJ Spinella Philip C PC

Critical care medicine 20180801 8

<h4>Objectives</h4>Little is known about platelet transfusions in pediatric critical illness. We sought to describe the epidemiology, indications, and outcomes of platelet transfusions among critically ill children.<h4>Design</h4>Prospective cohort study.<h4>Setting</h4>Multicenter (82 PICUs), international (16 countries) from September 2016 to April 2017.<h4>Patients</h4>Children ages 3 days to 16 years prescribed a platelet transfusion in the ICU during screening days.<h4>Interventions</h4>Non ...[more]

PMID: 29727368

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Project description:BackgroundEarly mobilization of adults receiving intensive care improves health outcomes, yet little is known about mobilization practices in paediatric intensive care units (PICUs). We aimed to determine the prevalence of and factors associated with physical rehabilitation in PICUs across Europe.MethodsA 2-day, cross-sectional, multicentre point prevalence study was conducted in May and November 2018. The primary outcome was the prevalence of physical therapy (PT)- or occupational therapy (OT)-provided mobility. Clinical data and data on patient mobility, potential mobility safety events, and mobilization barriers were prospectively collected in patients admitted for ≥72 h.ResultsData of 456 children admitted to one of 38 participating PICUs from 15 European countries were collected (456 patient days); 70% were under 3 years of age. The point prevalence of PT- and/or OT-provided mobility activities was 39% (179/456) (95% CI 34.7-43.9%) during the patient days, with significant differences between European regions. Nurses were involved in 72% (924/1283) of the mobility events; in the remaining 28%, PT/OT, physicians, family members, or other professionals were involved. Of the factors studied, family presence was most strongly positively associated with out-of-bed mobilization (aOR 7.83, 95% CI 3.09-19.79). Invasive mechanical ventilation with an endotracheal tube was negatively associated with out-of-bed mobility (aOR 0.28, 95% CI 0.12-0.68). Patients were completely immobile on 25% (115/456) of patient days. Barriers to mobilization were reported on 38% of patient days. The most common reported patient-related barriers were cardiovascular instability (n = 47, 10%), oversedation (n = 39, 9%), and medical contraindication (n = 37, 8%). Potential safety events occurred in 6% of all documented mobilization events.ConclusionTherapists are infrequently consulted for mobilization of critically ill children in European PICUs. This study highlights the need for a systematic and interdisciplinary mobilization approach for critically ill children.

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Platelet Transfusion Practices in Critically Ill Children.

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Platelet Transfusion Practices in Critically Ill Children.

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