Early Hemodynamic Changes as Predictors of Mortality after Packed Red Blood Cells Transfusion in Critically Ill Children

Objectives: to evaluate effects of packed red blood cells (PRBCs) transfusion on some hemodynamic responses and its relation to patient mortality Patients: 64 critically ill infants and children were included in the study admitted to in Pediatric Intensive Care Unit (PICU) and required PRBCs transfusion10 mL/kg. Methods: Heart rate (HR), mean arterial blood pressure (MABP), blood hemoglobin (Hb) and hematocrite value (HCT) were measured for conventional hemodynamic(HD) monitoring .Trans-esophageal measurement of stroke volume (SV), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR) and systemic vascular resistance index (SVRI) before and 2 hours after PRBCs transfusion were also performed. Results: CI at a cut-off value >1.9 had the highest sensitivity while CO, SV and SVR at a cut-off values (>1.5, >12.2 and ≤ 3081 respectively) had the highest specificity for prediction of mortality among patients before start of treatment..CO at a cut-off value ≤ 12.5 and CI at a cut-off value ≤ 14.5 had the highest sensitivity while all parameters had low specificity for prediction of mortality among patients after PRBCs transfusion, while SV, SVR and SVRI were less sensitive (38.46%, 38.46%,53.85% and 40% respectively). Conclusions: CI had the highest sensitivity and CO, SV and SVRI had the highest specificity for prediction of mortality among patients before start of PRBCs transfusion. CO and CI had the highest sensitivity for prediction of mortality among patients after PRBCs transfusion.