To investigate the long-term influence of erythrocyte transfusion on cerebral oxygenation in patients with severe traumatic brain injury.
Prospective and observational study.
Neurotrauma intensive care unit of trauma center level I.
Sixty consecutive, hemodynamically stable patients with severe traumatic brain injury, pretransfusion hemoglobin < 100 g/l, non-bleeding and monitored through intracranial pressure and brain tissue partial pressure of oxygen (PtiO2) catheters were included.
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 h after transfusion) were recorded, including: PtiO2, cerebral perfusion pressure (CPP), end-tidal CO2, peripheral saturation of oxygen, temperature, hemoglobin, lactate and PaO2/FiO2 ratio. Transfusion was associated with an increase in PtiO2 during a 6-h period, with a peak at 3 h (26.2%; p = 0.0001) in 78.3% of the patients. No relationship was observed between PtiO2, CPP and hemoglobin increments. The relative increment in PtiO2 at hour 3 was only correlated with baseline PtiO2 (r2 0.166; p = 0.001). All of the patients with basal PtiO2 < 15 mmHg showed an increment in PtiO2 versus 74.5% of patients with basal PtiO2 ≥ 15 mmHg (p < 0.01, hour 3).
Erythrocyte transfusion is associated with a variable and prolonged increment of cerebral tissue oxygenation in anemic patients with severe traumatic brain injury. Low baseline PtiO2 levels (< 15 mmHg) could define those patients who benefit the most from erythrocyte transfusion.
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cerebral perfusion pressure
- EtCO2 :
- FiO2 :
oxygen inspired fraction
- PaO2 :
oxygen arterial pressure
- PtiO2 :
Brain tissue oxygen pressure
traumatic brain injury
- StO2 :
peripheral saturation assessed by pulse oximetry
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Supported by Spanish Government funds (Fondo de Investigación Sanitaria: Proyecto de Investigación PI 040296; Convenio específico de colaboración entre el Instituto de Salud Carlos III y la comunidad autónoma andaluza, fundación “Progreso y Salud”. BOE 31, resolución 1907, año 2006).
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Leal-Noval, S.R., Rincón-Ferrari, M.D., Marin-Niebla, A. et al. Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury. Intensive Care Med 32, 1733–1740 (2006). https://doi.org/10.1007/s00134-006-0376-2
- Brain hypoxia
- Cerebral oxygenation
- Red blood cells
- Severe brain injury