The International Observational Study Investigators are looking at mechanical ventilation (MV) discontinuation practices internationally in intensive care units (ICU). The goal of the study is to characterize practice variation in weaning critically ill adults from invasive MV, as well as the influence of selected discontinuation strategies on important outcomes. Each ICU will be asked to collect data on at least 10 consecutive discontinuation events – one event (e.g., tracheostomy, direct extubation, initial successful spontaneous breathing trial) per patient receiving invasive ventilation for at least 24 hours and all patients who die before any attempt at MV discontinuation. Those interested in participating should email email@example.com.
Although anemia may cause an increase in morbidity and mortality rates in critically ill pediatric patients, transfusion of packed red blood cells (pRBCs) carries significant risks, which have also been demonstrated in pediatric cardiac surgery patients. However, studies related to these risks have had problems with confounding and the use of pRBCs that were not leukoreduced. Kneyber et al address these concerns in their study testing whether transfusion of leukocyte-depleted pRBCs within the first 48 hours after cardiac surgery would be independently associated with prolonged duration of mechanical ventilation. Results were published in the March 2013 issue of Pediatric Critical Care Medicine.
Kneyber and colleagues retrospectively analyzed data from 335 children between the ages of 0 months to 18 years who underwent cardiac surgery between 2007 and 2010. Of these subjects, 111 were transfused, 86 of them within the first 48 hours of admission to the pediatric intensive care unit. The author then compared the outcomes of these 86 patients to those of the 249 who were not transfused within 48 hours. Patients who received pRBCs within the first 48 hours had a longer duration of ventilation and inotropic support, longer ICU stay, and a higher rate of ventilator-associated pneumonia. However, after adjusting for the severity of illness, the transfusion of pRBCs within the first 48 hours remained independently associated with only the prolonged duration of mechanical ventilation. This study provides more evidence against arbitrary decisions to transfuse blood products. Prospective studies are necessary to determine which transfusion triggers will provide more benefit than cost. Read the full Concise Critical Appraisal.