Red Blood Cell Transfusion in Pediatric Acute Respiratory Distress Syndrome

In the patient with ARDS, as lung function deteriorates, RBC transfusion is often prescribed in an effort to increase oxygen delivery. Though transfusion can increase oxygen delivery, RBC transfusion is associated with worsened markers of lung function and with adverse clinical outcomes in critically ill adults and children, and preclinical data suggest that RBC products can directly injure pulmonary cells and worsen lung function by a variety of mechanisms. This chapter outlines clinical studies of RBC transfusion in pediatric ARDS (PARDS), reviews RBC transfusion-related pathophysiology as it relates to the patient with PARDS, and highlights opportunities for future research to guide optimum transfusion strategies for critically ill children with PARDS.