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Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury

A preliminary study

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Abstract

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 < 100 g/l, non-bleeding and monitored through intracranial pressure and brain tissue partial pressure of oxygen (PtiO2) 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 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).

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 PtiO2 levels (< 15 mmHg) could define those patients who benefit the most from erythrocyte transfusion.

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Abbreviations

CPP:

cerebral perfusion pressure

EtCO2 :

end-tidal CO2,

FiO2 :

oxygen inspired fraction

ICP:

Intracranial pressure

PaO2 :

oxygen arterial pressure

PtiO2 :

Brain tissue oxygen pressure

TBI:

traumatic brain injury

StO2 :

peripheral saturation assessed by pulse oximetry

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Acknowledgements

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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Correspondence to Santiago Ramón Leal-Noval.

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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

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Keywords

  • Brain hypoxia
  • Cerebral oxygenation
  • Erythrocytes
  • Neurotrauma
  • PtiO2
  • Red blood cells
  • Severe brain injury
  • Transfusion