Transfusion-associated delirium in children: No difference between short storage versus standard issue RBCs

Chani Traube, Division of Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY.
Marisa Tucci, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada.
Marianne E. Nellis, Division of Critical Care Medicine, Department of Pediatrics, Weill Cornell Medical College, New York, NY.
K Leslie Avery, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL.
Patrick S. McQuillen, Department of Pediatrics, University of California San Francisco, San Francisco, CA.
Julie C. Fitzgerald, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Jennifer A. Muszynski, Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.
Jill M. Cholette, Department of Pediatrics, University of Rochester, Golisano Children's Hospital, Rochester, NY.
Adam J. Schwarz, Critical Care, CHOC Children's Hospital, Orange, CA.
Erika L. Stalets, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Maureen A. Quaid, Advocate Aurora HealthFollow
Sheila J. Hanson, Department of Pediatrics and Children's Wisconsin, Critical Care Section, Medical College of Wisconsin, Milwaukee, WI.
Jacques Lacroix, Division of Pediatric Critical Care, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada.
Ron W. Reeder, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Philip C. Spinella, Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.

Affiliations

Advocate Children's Hospital

Abstract

Objectives: Primary objective is to determine if transfusion of short storage RBCs compared with standard issue RBCs reduced risk of delirium/coma in critically ill children. Secondary objective is to assess if RBC transfusion was independently associated with delirium/coma.

Design: This study was performed in two stages. First, we compared patients receiving either short storage or standard RBCs in a multi-institutional prospective randomized controlled trial. Then, we compared all transfused patients in the randomized controlled trial with a single-center cohort of nontransfused patients matched for confounders of delirium/coma.

Setting: Twenty academic PICUs who participated in the Age of Transfused Blood in Critically Ill Children trial.

Patients: Children 3 days to 16 years old who were transfused RBCs within the first 7 days of admission.

Interventions: Subjects were randomized to either short storage RBC study arm (defined as RBCs stored for up to seven days) or standard issue RBC study arm. In addition, subjects were screened for delirium prior to transfusion and every 12 hours after transfusion for up to 3 days.

Measurements and main results: Primary outcome measure was development of delirium/coma within 3 days of initial transfusion. Additional outcome measures were dose-response relationship between volume of RBCs transfused and delirium/coma, and comparison of delirium/coma rates between transfused patients and individually matched nontransfused patients. We included 146 subjects in the stage I analysis; 69 were randomized to short storage RBCs and 77 to standard issue. There was no significant difference in delirium/coma development between study arms (79.5% vs 70.1%; p = 0.184). In the stage II analysis, adjusted odds for delirium in the transfused cohort was more than eight-fold higher than in the nontransfused matched cohort, even after controlling for hemoglobin (adjusted odds ratio, 8.9; CI, 2.8-28.4; p < 0.001).

Conclusions: RBC transfusions (and not anemia) are independently associated with increased odds of subsequent delirium/coma. However, storage age of RBCs does not affect delirium risk.

Document Type

Article

PubMed ID

35100190

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