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Theses

Transfusions de plasma en réanimation pédiatrique

Abstract : Plasma transfusions are frequently used to treat or prevent bleeding in critically ill children. However, little is known about the proper indications. Observational data both in children and adults indicate that plasma transfusions are associated with increased morbidity and mortality, except in massively bleeding patients. Adult data suggest that plasma transfusions have little effect on coagulation tests and that a large proportion of plasma transfusions are not given according to the international recommendations.The objective of this thesis is to perform four preliminary studies that will allow designing the protocol of a randomized controlled trial. This trial will evaluate the cost-benefit relationship of plasma transfusion strategies in critically ill children.The first study in this thesis, an observational study in 101 centers, concluded that plasma was often transfused to non-bleeding children and that plasma transfusions had little effect on coagulation tests. The second study showed that the different types of plasma products had different clinical effects, in terms of morbidity and mortality. The third study showed that unfounded beliefs on plasma’s ability to prevent or stop bleeding influenced the prescription of plasma transfusions. The fourth study showed that measuring the severity of the disease with a multiple-organ dysfunction score was appropriate in a sub-population of critically ill children requiring plasma transfusion.These four studies allowed designing the protocol for the randomized controlled trial, comparing plasma transfusion strategies.
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Submitted on : Thursday, December 14, 2017 - 11:47:06 AM
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Oliver Karam. Transfusions de plasma en réanimation pédiatrique. Médecine humaine et pathologie. Université du Droit et de la Santé - Lille II, 2017. Français. ⟨NNT : 2017LIL2S002⟩. ⟨tel-01663721⟩

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