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The Effect of Red Blood Cell Transfusion on Cerebral Autoregulation in Patients with Severe Traumatic Brain Injury

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Abstract

Background

Red blood cell (RBC) transfusion is associated with inconsistent changes in brain tissue oxygenation (PbO2). Previous studies have failed to consider alterations in cerebral autoregulation. Our objective was to investigate the effect of RBC transfusion on cerebral autoregulation, as measured by pressure reactivity index (PRx).

Methods

Retrospective analysis of 28 severe traumatic brain injury (TBI) patients from a prospective registry between 2007 and 2014. We recorded hemoglobin (Hb) concentration, intracranial pressure, PbO2, cerebral perfusion pressure, PRx, and cerebral lactate/pyruvate ratio for 6 h before and after RBC transfusion. We also recorded body temperature, PaO2, PCO2, pH, and fraction of inspired oxygen. Subgroups of normoxia (PbO2 >20 mmHg) and hypoxia (PbO2 <20 mmHg) prior to transfusion were defined a priori.

Results

The median age was 36 years [interquartile range (IQR) 27–49], 32 % were female. The median admission Glasgow Coma score was 5 (IQR 4–9) and injury severity score was 16 (IQR 9–21). Overall, mean Hb concentration [80 g/L (SD 7) to 89 g/L (SD 8), p < 0.001] and PbO2 increased [23.5 mmHg (SD 8) to 25.0 mmHg (SD 9), p = 0.033] following transfusion. PRx increased post-transfusion [0.028 (SD 0.29) to 0.11 (SD 0.24), p = 0.034], indicating worsening cerebrovascular pressure reactivity. In patients with mean PbO2 >20 mmHg pre-transfusion (n = 20), the PRx increased significantly [−0.052 (SD 0.24) to 0.079 (SD 0.22), p = 0.007] but did not change in patients with PbO2 <20 mmHg: PRx [0.22 (SD 0.34) to 0.18 (SD 0.30), p = 0.36].

Conclusion

RBC transfusion in severe TBI patients results in worsening PRx, indicating impaired cerebral autoregulation.

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Acknowledgments

We would like to acknowledge the Addenbrooke’s neurocritical care unit staff for their assistance. Additionally, we would like to acknowledge Mrs. Karyn McMurray from the Addenbrooke’s blood services for her assistance in patient identification.

Conflict of interest

Mypinder S. Sekhon, Donald E. Griesdale, Joseph Donnelly, Xia Liu, Marcel J. Aries, Chiara Robba, Andrea Lavinio, David K. Menon, Peter Smielewski, Arun K. Gupta have no conflict of interest. Marek Czosnyka and Peter Smielewski are co-founders of the ICM+ software (www.neurosurg.cam.ac.uk/icmplus) and receives licensing fees (Cambridge Enterprise Ltd, UK).

Ethical standards

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Authors and Affiliations

  1. Division of Critical Care Medicine, Department of Medicine, Vancouver General Hospital, University of British Columbia, West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Mypinder S. Sekhon & Donald E. Griesdale

  2. Neurocritical Care Unit, Addenbrooke’s Hospital, Cambridge University Hospitals Trust, Cambridge University, Box 1, Hills Road, Cambridge, CB2 0QQ, UK

    Marek Czosnyka, Joseph Donnelly, Xia Liu, Marcel J. Aries, Chiara Robba, Andrea Lavinio, David K. Menon, Peter Smielewski & Arun K. Gupta

  3. Critical Care Medicine, Vancouver General Hospital, Room 2438, Jim Pattison Pavilion, 2nd Floor, 855 West 12th Avenue, Vancouver, BC, V5Z 1M9, Canada

    Mypinder S. Sekhon

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  1. Mypinder S. Sekhon
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Corresponding author

Correspondence to Mypinder S. Sekhon.

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Drs Gupta and Smielewski are denoted as co-senior authors for this manuscript.

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Sekhon, M.S., Griesdale, D.E., Czosnyka, M. et al. The Effect of Red Blood Cell Transfusion on Cerebral Autoregulation in Patients with Severe Traumatic Brain Injury. Neurocrit Care 23, 210–216 (2015). https://doi.org/10.1007/s12028-015-0141-x

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