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. 2022 Feb 1;50(2):173-182.
doi: 10.1097/CCM.0000000000005393.

Transfusion-Associated Delirium in Children: No Difference Between Short Storage Versus Standard Issue RBCs

Chani Traube  1 , Marisa Tucci  2 , Marianne E Nellis  1 , K Leslie Avery  3 , Patrick S McQuillen  4 , Julie C Fitzgerald  5 , Jennifer A Muszynski  6 , Jill M Cholette  7 , Adam J Schwarz  8 , Erika L Stalets  9   10 , Maureen A Quaid  11 , Sheila J Hanson  12 , Jacques Lacroix  13 , Ron W Reeder  14 , Philip C Spinella  15 ; Transfusion-Associated Delirium ABC-PICU Study Group
Affiliations

Transfusion-Associated Delirium in Children: No Difference Between Short Storage Versus Standard Issue RBCs

Chani Traube et al. Crit Care Med. .

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.

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Conflict of interest statement

Drs. Traube, Nellis, Avery, McQuillen, Fitzgerald, and Spinella received support for article research from the National Institutes of Health (NIH). Dr. Nellis’ institution received funding from the National Heart, Lung, and Blood Institute. Dr. McQuillen’s institution received funding from the National Institute of Child Health and Human Development. Dr. Fitzgerald’s institution received funding from the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Muszynski’s institution received funding from Washington University at St. Louis. Dr. Hanson’s institution received funding from the NIH. Dr. Lacroix’s institution received funding from the Canadian Institutes of Health Research. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.. Multivariable analysis of clinical factors related to delirium/coma development within 3 days following red blood cell transfusion.
This Forest plot demonstrates increased risk for delirium/coma in transfused patients who had altered cognitive status (as measured by existing delirium or coma at time of transfusion), and/or exposure to opiates and benzodiazepines. However, there was no independent relationship between the storage-age of the transfused blood and subsequent delirium/coma. Analyses were adjusted for patient age and existing organ dysfunction (as measured by the PELOD-2) at time of transfusion. [PELOD: pediatric logistic organ dysfunction; RBC: red blood cells].
See this image and copyright information in PMC

References

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    1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. n.d.
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