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Objective To investigate the safety and effects of a restrictive red blood cell (RBC) transfusion strategy in pediatric cardiac surgery patients. Design Randomized controlled trial. Setting Pediatric ICU in an academic tertiary care center, Leiden University Medical Center, Leiden, The Netherlands. Patients One hundred seven patients with non-cyanotic congenital heart defects between 6 weeks and 6 years of age. One hundred three patients underwent corrective surgery on cardiopulmonary bypass. Interventions Prior to surgery patients were randomly assigned to one of two groups with specific RBC transfusion thresholds: Hb 10.8 g/dl (6.8 mmol/l) and Hb 8.0 g/dl (5.0 mmol/l). Measurements Length of stay in hospital (primary outcome), length of stay in PICU, duration of ventilation (secondary outcome), incidence of adverse events and complications related to randomization (intention to treat analysis). Results In the restrictive transfusion group, mean volume of transfused RBC was 186 (±70) ml per patient and in the liberal transfusion group 258 (±87) ml per patient, (95 % CI 40.6-104.6), p < 0.001. Length of hospital stay was shorter in patients with a restrictive RBC transfusion strategy: median 8 (IQR 7-11) vs. 9 (IQR 7-14) days, p = 0.047. All other outcome measures and incidence of adverse effects were equal in both RBC transfusion groups. Cost of blood products for the liberal transfusion group was 438.35 (±203.39) vs. 316.27 (±189.96) euros (95 % CI 46.61-197.51) per patient in the restrictive transfusion group, p = 0.002. Conclusions For patients with a non-cyanotic congenital heart defect undergoing elective cardiac surgery, a restrictive RBC transfusion policy (threshold of Hb 8.0 g/dl) during the entire perioperative period is safe, leads to a shorter hospital stay and is less expensive., Author(s): D. H. de Gast-Bakker [sup.1], R. B. P. de Wilde [sup.1] [sup.6], M. G. Hazekamp [sup.2], V. Sojak [sup.2], J. J. Zwaginga [sup.3] [sup.4], R. Wolterbeek [sup.5], E. de [...]

Purpose We conducted a retrospective cohort study in an academic tertiary care center to characterize ventilator-associated pneumonia (VAP) in pediatric patients after cardiac surgery in The Netherlands. Methods All patients following cardiac surgery and mechanically ventilated for [greater than or equal to]24 h were included. The primary outcome was development of VAP. Secondary outcomes were duration of mechanical ventilation and length of ICU stay. Results A total of 125 patients were enrolled. Their mean age was 16.5 months. The rate of VAP was 17.1/1,000 mechanical ventilation days. Frequently found organisms were Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus and Pseudomonas aeruginosa. Patients with VAP had longer duration of ventilation and longer ICU stay. Risk factors associated with the development of VAP were a PRISM III score of [greater than or equal to]10 and transfusion of fresh frozen plasma. Conclusion The mean VAP rate in this population is higher than that reported in general pediatric ICU populations. Children with VAP had a prolonged need for mechanical ventilation and a longer ICU stay., Author(s): P. P. Roeleveld [sup.1], D. Guijt [sup.1], E. J. Kuijper [sup.2], M. G. Hazekamp [sup.3], R. B. P. de Wilde [sup.1], E. de Jonge [sup.1] Author Affiliations: (1) grid.10419.3d, [...]