50 Studies Every Pediatrician Should Know, p. 120-124
DOI: 10.1093/med/9780190204037.003.0018
Massachusetts Medical Society, New England Journal of Medicine, 16(356), p. 1609-1619
DOI: 10.1056/nejmoa066240
Elsevier, Year Book of Pediatrics, (2009), p. 59-61
DOI: 10.1016/s0084-3954(08)79241-8
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Background: The optimal hemoglobin threshold for erythrocyte transfusions in critically ill children is unknown. We hypothesized that a restrictive transfusion strategy of using packed red cells that were leukocyte-reduced before storage would be as safe as a liberal transfusion strategy, as judged by the outcome of multiple-organ dysfunction. Methods: In this noninferiority trial, we enrolled 637 stable, critically ill children who had hemoglobin concentrations below 9.5 g per deciliter within 7 days after admission to an intensive care unit. We randomly assigned 320 patients to a hemoglobin threshold of 7 g per deciliter for red-cell transfusion (restrictive-strategy group) and 317 patients to a threshold of 9.5 g per deciliter (liberal-strategy group). Results: Hemoglobin concentrations were maintained at a mean (±SD) level that was 2.1±0.2 g per deciliter lower in the restrictive-strategy group than in the liberal-strategy group (lowest average levels, 8.7±0.4 and 10.8±0.5 g per deciliter, respectively; P