Victoria A McCredie1, Simone Piva2, Marlene Santos3, Wei Xiong4, Airton Leonardo de Oliveira Manoel5, Andrea Rigamonti6,7, Gregory M T Hare3,6,8, Martin G Chapman9,6, Andrew J Baker3,6,7. 1. Department of Critical Care Medicine, Sunnybrook Health Sciences Center, 2075 Bayview Ave, Room D108, Toronto, ON, M4N 3M5, Canada. Victoria.McCredie@sunnybrook.ca. 2. Division of Neuroanesthesia and Neurointensive Care, Department of Anesthesia, Intensive Care and Perioperative Medicine, University of Brescia at Spedali Civili, Brescia, Italy. 3. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. 4. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada. 5. Department of Medical Imaging, Interventional Neuroradiology, St. Michael's Hospital, Toronto, ON, Canada. 6. Department of Anesthesia, University of Toronto, Toronto, ON, Canada. 7. Department of Critical Care Medicine, St. Michael's Hospital, Toronto, ON, Canada. 8. Department of Physiology, University of Toronto, Toronto, ON, Canada. 9. Department of Critical Care Medicine, Sunnybrook Health Sciences Center, 2075 Bayview Ave, Room D108, Toronto, ON, M4N 3M5, Canada.
Abstract
BACKGROUND: There are a range of opinions on the benefits and thresholds for the transfusion of red blood cells in critically ill patients with traumatic brain injury (TBI) and an urgent need to understand the neurophysiologic effects. The aim of this study was to examine the influence of red blood cell transfusions on cerebral tissue oxygenation (SctO2) in critically ill TBI patients. METHODS: This prospective observational study enrolled consecutive TBI patients with anemia requiring transfusion. Cerebral tissue oxygen saturation (SctO2) was measured noninvasively with bilateral frontal scalp probes using near-infrared spectroscopy (NIRS) technology. Data were collected at baseline and for 24 h after transfusion. The primary outcome was the applicability of a four-wavelength near-infrared spectrometer to monitor SctO2 changes during a transfusion. Secondary outcomes included the correlation of SctO2 with other relevant physiological variables, the dependence of SctO2 on baseline hemoglobin and transfusion, and the effect of red blood cell transfusion on fractional tissue oxygen extraction. RESULTS: We enrolled 24 patients with severe TBI, of which five patients (21 %) were excluded due to poor SctO2 signal quality from large subdural hematomas and bifrontal decompressive craniectomies. Twenty transfusions were monitored in 19 patients. The mean pre- and post-transfusion hemoglobin concentrations were significantly different [74 g/L (SD 8 g/L) and 84 g/L (SD 9 g/L), respectively; p value <0.0001]. Post-transfusion SctO2 was not significantly greater than pre-transfusion SctO2 [left-side pre-transfusion 69 % (SD 7) vs. post-transfusion 70 % (SD 10); p = 0.68, and right-side pre-transfusion 69 % (SD 5) vs. post-transfusion 71 % (SD 7); p = 0.11]. In a multivariable mixed linear analysis, mean arterial pressure was the only variable significantly associated with a change in SctO2. CONCLUSIONS: The bifrontal method of recording changes in NIRS signal was not able to detect a measurable impact on SctO2 in this sample of patients receiving red blood cell transfusion therapy in a narrow but conventionally relevant, range of anemia.
BACKGROUND: There are a range of opinions on the benefits and thresholds for the transfusion of red blood cells in critically ill patients with traumatic brain injury (TBI) and an urgent need to understand the neurophysiologic effects. The aim of this study was to examine the influence of red blood cell transfusions on cerebral tissue oxygenation (SctO2) in critically ill TBIpatients. METHODS: This prospective observational study enrolled consecutive TBIpatients with anemia requiring transfusion. Cerebral tissue oxygen saturation (SctO2) was measured noninvasively with bilateral frontal scalp probes using near-infrared spectroscopy (NIRS) technology. Data were collected at baseline and for 24 h after transfusion. The primary outcome was the applicability of a four-wavelength near-infrared spectrometer to monitor SctO2 changes during a transfusion. Secondary outcomes included the correlation of SctO2 with other relevant physiological variables, the dependence of SctO2 on baseline hemoglobin and transfusion, and the effect of red blood cell transfusion on fractional tissue oxygen extraction. RESULTS: We enrolled 24 patients with severe TBI, of which five patients (21 %) were excluded due to poor SctO2 signal quality from large subdural hematomas and bifrontal decompressive craniectomies. Twenty transfusions were monitored in 19 patients. The mean pre- and post-transfusion hemoglobin concentrations were significantly different [74 g/L (SD 8 g/L) and 84 g/L (SD 9 g/L), respectively; p value <0.0001]. Post-transfusion SctO2 was not significantly greater than pre-transfusion SctO2 [left-side pre-transfusion 69 % (SD 7) vs. post-transfusion 70 % (SD 10); p = 0.68, and right-side pre-transfusion 69 % (SD 5) vs. post-transfusion 71 % (SD 7); p = 0.11]. In a multivariable mixed linear analysis, mean arterial pressure was the only variable significantly associated with a change in SctO2. CONCLUSIONS: The bifrontal method of recording changes in NIRS signal was not able to detect a measurable impact on SctO2 in this sample of patients receiving red blood cell transfusion therapy in a narrow but conventionally relevant, range of anemia.
Authors: Santiago Ramón Leal-Noval; María Dolores Rincón-Ferrari; Ana Marin-Niebla; Aurelio Cayuela; Victoria Arellano-Orden; Antonio Marín-Caballos; Rosario Amaya-Villar; Carmen Ferrándiz-Millón; Francisco Murillo-Cabeza Journal: Intensive Care Med Date: 2006-09-22 Impact factor: 17.440
Authors: Gillian S McHugh; Doortje C Engel; Isabella Butcher; Ewout W Steyerberg; Juan Lu; Nino Mushkudiani; Adrián V Hernández; Anthony Marmarou; Andrew I R Maas; Gordon D Murray Journal: J Neurotrauma Date: 2007-02 Impact factor: 5.269
Authors: Matthew A Warner; Terence O'Keeffe; Premal Bhavsar; Rashmi Shringer; Carol Moore; Caryn Harper; Christopher J Madden; Ravi Sarode; Larry M Gentilello; Ramon Diaz-Arrastia Journal: J Neurosurg Date: 2010-09 Impact factor: 5.115
Authors: David J Davies; Zhangjie Su; Michael T Clancy; Samuel J E Lucas; Hamid Dehghani; Ann Logan; Antonio Belli Journal: J Neurotrauma Date: 2015-04-17 Impact factor: 5.269
Authors: Jane Topolovec-Vranic; Marlene Santos; Andrew J Baker; Orla M Smith; Karen E A Burns Journal: Can Respir J Date: 2014-06-10 Impact factor: 2.409
Authors: Mypinder S Sekhon; Donald E Griesdale; Marek Czosnyka; Joseph Donnelly; Xia Liu; Marcel J Aries; Chiara Robba; Andrea Lavinio; David K Menon; Peter Smielewski; Arun K Gupta Journal: Neurocrit Care Date: 2015-10 Impact factor: 3.210
Authors: Kyle Chin; Melina P Cazorla-Bak; Elaine Liu; Linda Nghiem; Yanling Zhang; Julie Yu; David F Wilson; Sergei A Vinogradov; Richard E Gilbert; Kim A Connelly; Roger G Evans; Andrew J Baker; C David Mazer; Gregory M T Hare Journal: Can J Anaesth Date: 2020-11-10 Impact factor: 5.063
Authors: Alexander P Vlaar; Simon Oczkowski; Sanne de Bruin; Marije Wijnberge; Massimo Antonelli; Cecile Aubron; Philippe Aries; Jacques Duranteau; Nicole P Juffermans; Jens Meier; Gavin J Murphy; Riccardo Abbasciano; Marcella Muller; Akshay Shah; Anders Perner; Sofie Rygaard; Timothy S Walsh; Gordon Guyatt; J C Dionne; Maurizio Cecconi Journal: Intensive Care Med Date: 2020-01-07 Impact factor: 17.440