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Effects of red blood cell transfusion on global oxygenation in anemic critically ill patients
Author(s) -
Themelin Nicolas,
Biston Patrick,
Massart Jacqueline,
Lelubre Christophe,
Piagnerelli Michaël
Publication year - 2021
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.16284
Subject(s) - medicine , hemoglobin , intensive care unit , anesthesia , oxygenation , cardiac index , blood transfusion , oxygenation index , critically ill , cardiac output , hemodynamics
Background Consensus for transfusion in intensive care unit (ICU) patients recommends a restrictive strategy, based on a hemoglobin (Hb) concentration of 7 g/dL. Red blood cell (RBC) transfusion is used to prevent tissue hypoxia by improving oxygen transport (DO 2 ) and therefore oxygen consumption (VO 2 ). We studied the effects of RBC transfusion on systemic oxygenation parameters reflecting systemic oxygen extraction (EO 2 = DO 2 /VO 2 ): S(c)vO 2 , lactate level, venous‐to‐arterial carbon dioxide difference (Pv‐aCO 2 ), and cardiac index/EO 2 (CI/EO 2 ) and evaluated their usefulness in guiding transfusion decisions in ICU patients. Study Design and Methods Prospectively, all adult patients transfused were included except those with active bleeding or without a jugular or subclavian catheter. We measured O 2 parameters before and after transfusion. Patients were a priori grouped according to their initial S(c)vO 2 (< or ≥ 70%), treatment with vasopressors, cardiac function, and septic status. Results A total of 62 patients received 105 RBC transfusions. For all, mean arterial pressure (77 [69‐88] to 81 [73‐91] mm Hg), Hb concentration (7.4 [7.0‐7.8] to 8.4 [7.7‐8.9] g/dL) and S(c)vO 2 (65% [59%‐73%] to 69% [62%‐75%]) increased after transfusion (all P < .001). S(c)vO 2 improved after transfusion only when initial S(c)vO 2 was less than 70% (62% [56%‐65%] to 66% [61%‐71%]; P < .001). In this group, Pv‐aCO 2 , lactate concentrations, and CI/EO 2 did not change after transfusion. Cardiac function, sepsis, or vasopressor therapy did not affect these results. Conclusions Among systemic O 2 parameters, only a S(c)vO 2 < 70% in anemic ICU patients improves after transfusion. As S(c)vO 2 can reflect a DO 2 /VO 2 imbalance, it could be helpful when combined with the Hb concentration to decide whether to transfuse. However, the benefit on outcome should be further studied.