Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury : A preliminary study.

Editorial: Intensive Care Med
Fecha: 01/11/2006
Leal-Noval SR, Rincon-Ferrari MD, Marin-Niebla A, Cayuela A, Arellano-Orden V, Marin-Caballos A, Amaya-Villar R, Ferrandiz-Millon C, Murillo-Cabeza F.

OBJECTIVE: To investigate the long-term influence of erythrocyte transfusion on cerebral oxygenation in patients with severe traumatic brain injury. DESIGN: Prospective and observational study. SETTING: Neurotrauma intensive care unit of trauma center level I. PATIENTS: Sixty consecutive, hemodynamically stable patients with severe traumatic brain injury, pretransfusion hemoglobin[Symbol: see text]<[Symbol: see text]100[Symbol: see text]g/l, non-bleeding and monitored through intracranial pressure and brain tissue partial pressure of oxygen (PtiO(2)) catheters were included. INTERVENTIONS: Transfusion of 1-2 units of red blood cells. MEASUREMENTS AND RESULTS: Ten sets of variables (pretransfusion, end of transfusion, and 1, 2, 3, 4, 5, 6, 12 and 24[Symbol: see text]h after transfusion) were recorded, including: PtiO(2), cerebral perfusion pressure (CPP), end-tidal CO(2), peripheral saturation of oxygen, temperature, hemoglobin, lactate and PaO(2)/FiO(2) ratio. Transfusion was associated with an increase in PtiO(2) during a 6-h period, with a peak at 3[Symbol: see text]h (26.2%; p[Symbol: see text]=[Symbol: see text]0.0001) in 78.3% of the patients. No relationship was observed between PtiO(2), CPP and hemoglobin increments. The relative increment in PtiO(2) at hour 3 was only correlated with baseline PtiO(2) (r(2) 0.166; p[Symbol: see text]=[Symbol: see text]0.001). All of the patients with basal PtiO(2)[Symbol: see text]<[Symbol: see text]15[Symbol: see text]mmHg showed an increment in PtiO(2) versus 74.5% of patients with basal PtiO(2)[Symbol: see text]>/=[Symbol: see text]15[Symbol: see text]mmHg (p[Symbol: see text]<[Symbol: see text]0.01, hour 3). CONCLUSIONS: Erythrocyte transfusion is associated with a variable and prolonged increment of cerebral tissue oxygenation in anemic patients with severe traumatic brain injury. Low baseline PtiO(2) levels (<[Symbol: see text]15[Symbol: see text]mmHg) could define those patients who benefit the most from erythrocyte transfusion.

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