1. Outcomes Related to the Use of Frozen Plasma or Pooled Solvent/detergent-treated Plasma in Critically Ill Children
- Author
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Anna Camporesi, Oliver Karam, Guillaume Mortamet, Antonio Perez Ferrer, Jesus Lopez-Herce, Maria-Helena Perez, Edward Vincent S. Faustino, Maraya Camazine, Marc-Andre Dugas, Joe Brierley, Arash Afshari, Alexandra Dinis, David Inwald, Division of Critical Care, Department of Pediatrics, Washington University in Saint Louis (WUSTL), Pediatric Intensive Care Unit, Geneva University Hospital, Geneva, Switzerland, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille, Division of Pediatric Critical Care Medicine, Department of Pediatrics, CHC, Division of Pediatric Critical Care Medicine, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, NHS Blood and Transplant/Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Unité Mixte de Recherche Epidémiologique et de Surveillance Transport Travail Environnement (UMRESTTE UMR T9405), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE)
- Subjects
Male ,medicine.medical_specialty ,health care facilities, manpower, and services ,Detergents ,Blood Component Transfusion ,CHILDREN ,030204 cardiovascular system & hematology ,Critical Care and Intensive Care Medicine ,Intensive Care Units, Pediatric ,03 medical and health sciences ,Blood Component Transfusion/methods ,0302 clinical medicine ,Interquartile range ,Secondary analysis ,Severity of illness ,medicine ,Humans ,EPIDEMIOLOGY ,Solvent detergent plasma ,International Normalized Ratio ,Prospective Studies ,Prospective cohort study ,Preschool ,Child ,Pediatric ,ddc:618 ,PLASMA ,Critically ill ,business.industry ,Infant ,030208 emergency & critical care medicine ,Odds ratio ,3. Good health ,Surgery ,Intensive Care Units ,Critical Illness/mortality ,Logistic Models ,Treatment Outcome ,ENFANT ,Anesthesia ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Solvents ,Female ,CRITICAL ILLNESS ,SOLVENT DETERGENT PLASMA ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Fresh frozen plasma ,business - Abstract
OBJECTIVE: To determine if the use of fresh frozen plasma/frozen plasma 24 hours compared to solvent detergent plasma is associated with international normalized ratio reduction or ICU mortality in critically ill children.DESIGN: This is an a priori secondary analysis of a prospective, observational study. Study groups were defined as those transfused with either fresh frozen plasma/frozen plasma 24 hours or solvent detergent plasma. Outcomes were international normalized ratio reduction and ICU mortality. Multivariable logistic regression was used to determine independent associations.SETTING: One hundred one PICUs in 21 countries.PATIENTS: All critically ill children admitted to a participating unit were included if they received at least one plasma unit during six predefined 1-week (Monday to Friday) periods. All children were exclusively transfused with either fresh frozen plasma/frozen plasma 24 hours or solvent detergent plasma.INTERVENTIONS: None.MEASUREMENTS AND MAIN RESULTS: There were 443 patients enrolled in the study. Twenty-four patients (5%) were excluded because no plasma type was recorded; the remaining 419 patients were analyzed. Fresh frozen plasma/frozen plasma 24 hours group included 357 patients, and the solvent detergent plasma group included 62 patients. The median (interquartile range) age and weight were 1 year (0.2-6.4) and 9.4 kg (4.0-21.1), respectively. There was no difference in reason for admission, severity of illness score, pretransfusion international normalized ratio, or lactate values; however, there was a difference in primary indication for plasma transfusion (p < 0.001). There was no difference in median (interquartile range) international normalized ratio reduction, between fresh frozen plasma/frozen plasma 24 hours and solvent detergent plasma study groups, -0.2 (-0.4 to 0) and -0.2 (-0.3 to 0), respectively (p = 0.80). ICU mortality was lower in the solvent detergent plasma versus fresh frozen plasma/frozen plasma 24 hours groups, 14.5% versus 29.1%%, respectively (p = 0.02). Upon adjusted analysis, solvent detergent plasma transfusion was independently associated with reduced ICU mortality (odds ratio, 0.40; 95% CI, 0.16-0.99; p = 0.05).CONCLUSIONS: Solvent detergent plasma use in critically ill children may be associated with improved survival. This hypothesis-generating data support a randomized controlled trial comparing solvent detergent plasma to fresh frozen plasma/frozen plasma 24 hours.
- Published
- 2017