PedsCrit Red Blood Cell Transfusion in Critical Illness with Dr. Jennifer Muszynski (2/2)
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Feb 23, 2026 Jennifer Muszynski, a pediatric intensivist and transfusion immunology researcher, and Kailey Remien, a pediatric critical care fellow focused on data science and health equity, discuss RBC transfusion in critical illness. They cover transfusion timing in septic shock, balancing perfusion versus oxygenation in ARDS, higher hemoglobin targets for severe TBI, and nuanced thresholds on ECMO and cyanotic single-ventricle physiology.
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Use Physiology Over Numbers In Septic Shock
- Do use physiologic markers, not just hemoglobin, to decide transfusion in septic shock.
- Jennifer Muszynski recommends targeting Hgb ≈9–10 when vasoactive needs rise and lactate/SvO2 suggest impaired oxygen delivery.
Don't Transfuse ARDS For Oxygenation Alone
- Avoid reflex transfusion for ARDS solely to improve oxygenation without signs of inadequate delivery.
- Jennifer Muszynski and Kailey Remien prefer a threshold near Hgb 7 and use lactate,SvO2, organ function to guide decisions.
Target Higher Hemoglobin For Severe TBI
- Consider higher hemoglobin goals for acute severe TBI with intracranial hypertension.
- Jennifer Muszynski aims for Hgb ≈9–10 and uses brain-specific monitoring (brain tissue oxygenation, TCD) rather than systemic lactate/SvO2.