RESUMEN
BACKGROUND: Hypotension is a well-known predictor of mortality in pediatric trauma patients. However, it is unknown whether the mortality rate is higher in patients with traumatic brain injury (TBI) than in those without TBI. We hypothesized that systemic hypotension increases mortality in pediatric patients with TBI more than it does in pediatric patients with extracranial injuries only. METHODS: Multivariate logistic regression was used to determine the relationship between hypotension and the risk of death. Patients were then divided into 2 groups: TBI and No-TBI and the model was applied separately to each group. RESULTS: Overall mortality was 2%. After adjusting for confounding variables, hypotension remained a strong independent predictor of mortality. However, the increased risk of death was similar in patients with and without TBI. CONCLUSION: Hypotension is an important predictor of death in pediatric trauma patients. The increased risk of death associated with hypotension is similar with or without traumatic brain injury.
Asunto(s)
Lesiones Encefálicas/epidemiología , Hipotensión/epidemiología , Adolescente , Área Bajo la Curva , Lesiones Encefálicas/mortalidad , Niño , Preescolar , Femenino , Humanos , Hipotensión/mortalidad , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Oportunidad Relativa , Medición de RiesgoRESUMEN
PURPOSE OF REVIEW: Liberal transfusion of blood products may be associated with a worse clinical outcome, including in-hospital mortality. This review focuses on the mechanisms by which transfusions may result in an increased risk of bacterial infection. RECENT FINDINGS: The association between blood transfusion and worse outcome has been attributed to suppression of the recipient's immune function, the so called transfusion-related immunomodulation effect, as well as changes that may occur as blood ages. Despite several attempts to identify the mechanism by which transfusion worsens outcomes, this mechanism, as well as the role of leukoreduction in the mitigation of transfusion-related immunomodulation, have yet to be demonstrated. Bacterial contamination of the blood supply has become a serious problem in the past 20 years, and is currently the second leading cause of transfusion-associated death. Since the implementation of specific platelet transfusion protocols, the incidence of morbidity and mortality caused by infected platelet units appears to be markedly reduced. SUMMARY: Transfusion of blood and blood products can be life-saving interventions. Consequences of transfusion may ultimately result in worse outcomes. More research will be required in order to identify indications and practices that optimize outcomes of surgical patients who require a blood transfusion.