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The Acute Effect of Packed Red Blood Cell Transfusion in Mechanically Ventilated Children after the Norwood Operation

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Abstract

Packed red blood cell (PRBC) transfusions are commonly administered in pediatric patients following the Norwood operation. This study was conducted to determine the effect of PRBC transfusions on hemodynamic parameters in pediatric patients with single-ventricle physiology and parallel circulation. A single-center, retrospective chart review was conducted. Pediatric patients admitted to the cardiac intensive care unit after Norwood operation between 2017 and 2018 were identified. Hemodynamic parameters were collected within a four-hour period before and after a PRBC transfusion. Univariate analyses using paired t tests were conducted to compare blood gas values before and after PRBC transfusion. Next, multivariate regression analyses were conducted to model the impact of transfusion volume, change in hemoglobin levels, and change in FiO2 on the change in PaO2 and PaCO2. These analyses included data from 33 eligible patients who received a PRBC transfusion following a Norwood operation. The hemoglobin levels (p < 0.01) and the PaO2/FiO2 ratio (p = 0.04) were significantly increased, while arterial lactate levels (p = 0.03) were significantly decreased following the transfusion. Transfusion for a pre-transfusion hemoglobin of 12.4 g/dL appears to provide greatest reduction in lactate, used as a surrogate marker for systemic oxygen delivery. No significant changes were found in arterial pH, PaO2, and PaCO2. PRBC transfusions following the Norwood operation may be a useful intervention to increase systemic oxygen delivery, improving PaO2/FiO2 ratio and improving serum lactate. The benefits of PRBC transfusions must be weighed against previously identified risks on a patient-specific basis. Further studies are warranted to further delineate the effects of such transfusions in this population.

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Funding

This study did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiology, Advocate Children’s Hospital, Chicago, IL, USA

    Riddhi D. Patel, Julia Weld, Brian Lee, Joshua Wong & Rohit S. Loomba

  2. Department of Pediatrics, Chicago Medical School/Rosalind Franklin University of Medicine and Science, Chicago, IL, USA

    Rohit S. Loomba

  3. Section of Critical Care Medicine and Cardiology, Texas Children’s Hospital, Houston, TX, USA

    Saul Flores

  4. Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Saul Flores

  5. Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico

    Enrique G. Villarreal & Juan S. Farias

Authors
  1. Riddhi D. Patel
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  2. Julia Weld
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  3. Saul Flores
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  4. Enrique G. Villarreal
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  5. Juan S. Farias
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  6. Brian Lee
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  7. Joshua Wong
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  8. Rohit S. Loomba
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Contributions

RSL, SF, and EGV contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JSF, JW, BL, and JW. The first draft of the manuscript was written by RDP and EGV, and JSF commented on previous versions of the manuscript. All authors read and approved the final manuscript. Reviewing and editing were done by RSL and SF.

Corresponding author

Correspondence to Enrique G. Villarreal.

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The authors declare that they have no conflict of interest.

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The Study have been approved by the appropriate institutional ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Patel, R.D., Weld, J., Flores, S. et al. The Acute Effect of Packed Red Blood Cell Transfusion in Mechanically Ventilated Children after the Norwood Operation. Pediatr Cardiol 43, 401–406 (2022). https://doi.org/10.1007/s00246-021-02735-6

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  • DOI: https://doi.org/10.1007/s00246-021-02735-6

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