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Clinical Trials for the Treatment of Sepsis pp 191–206Cite as

Role of RBC Transfusion Therapy in Sepsis

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Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 19))

Abstract

Sepsis is a clinical syndrome that arises because of an inappropriate and excessive host inflammatory response. Recent work has demonstrated that this syndrome is also characterized by the development of quantifiable injury in both the lungs and extra-pulmonary organs. This process is clinically expressed as Multiple Organ Dysfunction Syndrome (MODS). Sepsis is also a hypermetabolic state, where tissue O2 needs may be markedly increased. In this context, research has linked the widespread tissue injury typical of this syndrome with an inability to match tissue O2 delivery (D02) with these elevated tissue O2 needs. Thus, the emergence of metabolic dysregulation of tissue O2 availability in sepsis may contribute to the genesis of MODS [1]. For example, mortality in septic patients has been positively correlated with elevated arterial lactates [2] and “pathologic” VO2/DO2 dependency has been demonstrated both in animal [3] and clinical [4] studies of sepsis. As short term increases in arterial lactate and evidence of “pathologic” VO2/ DO2 dependency are regarded as evidence for underlying tissue ischemia [1, 5], it seems probable that MODS complicating sepsis reflects, in whole or in part, the summative effects of tissue injury on a hypoxic-ischemic basis.

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References

  1. Bersten AD, Sibbald WJ (1989) Circulatory disturbances in multiple systems organ failure. Crit Care Clinics 5: 233–254

    CAS  Google Scholar 

  2. Rashkin MC, Bosken C, Baughman RP (1985) Oxygen delivery in critically ill patients. Relationship to blood lactate and survival. Chest 87: 580–584

    Article  PubMed  CAS  Google Scholar 

  3. Nelson DP, Samsel RW, Wood LDH, Schumacker PT (1988) Pathological supply dependence of systemic and intestinal 02 uptake during endotoxemia. J Appl Physiol 64: 2410–2419

    PubMed  CAS  Google Scholar 

  4. Haupt MT, Gilbert EM, Carlson RW (1985) Fluid loading increases oxygen consumption in septic patients with lactic acidosis. Am Rev Respir Dis 131: 912–916

    PubMed  CAS  Google Scholar 

  5. Hersch M, Gnidec AD, Bersten AD, Troster M, Rutledge FS, Sibbald WJ (1990) Histologic and ultrastructural changes in non-pulmonary organs during early hyperdynamic sepsis. Surgery 107: 397–410

    PubMed  CAS  Google Scholar 

  6. Tuchschmidt J, Fried J, Astiz M, Rackow E (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102: 216–220

    Article  PubMed  CAS  Google Scholar 

  7. Shoemaker WC, Appel PL, Kram HB, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94: 1176–1186

    Article  PubMed  CAS  Google Scholar 

  8. Cane RD (1990) Hemoglobin: How much is enough? Crit Care Med 18: 1046–1047

    Article  PubMed  CAS  Google Scholar 

  9. Weg JG (1991) Oxygen transport in adult respiratory distress syndrome and other acute circulatory problems: Relationship of oxygen delivery and oxygen consumption. Crit Care Med 19: 650–657

    Article  PubMed  CAS  Google Scholar 

  10. Greenberg AG (1990) To transfuse or not to transfuse — That is the question? Crit Care Med 18: 1045

    Article  Google Scholar 

  11. Office of Medical Applications for Research, NIH (1988) Perioperative cell transfusion. JAMA 260: 1700

    Google Scholar 

  12. Welch GH, Meehan KR, Goodnough LT (1992) Prudent strategies for elective red blood cell transfusion. Ann Intern Med 117: 441–442

    Google Scholar 

  13. American College of Physicians (1992) Practice strategies for elective red blood cell transfusion. Ann Intern Med 116: 403–406

    Google Scholar 

  14. Fan FC, Chen RYZ, Schuessler GB, Chien S (1980) Effects of hematocrit variations on regional hemodynamics and oxygen transport in the dog. Am J Physiol 238: H545–622

    PubMed  CAS  Google Scholar 

  15. Jan KM, Chien S (1977) Effect of hematocrit variations on coronary hemodynamics and oxygen utilization. Am J Physiol 233: H106–113

    PubMed  CAS  Google Scholar 

  16. Berstein D, Teitel DF (1990) Myocardial and systemic oxygen utilization during severe hypoxia in ventilated lambs. Am J Physiol 258: H1856–1864

    Google Scholar 

  17. Lipowsky HH, Firrell JC (1986) Microvascular hemodynamics during systemic hemod- ilution and hemoconcentration. Am J Physiol 250 (Heart Circ Physiol 19): H908–H922

    PubMed  CAS  Google Scholar 

  18. Kiel JW, Shepherd AP (1989) Optimal hematocrit for canine gastric oxygenation. Am J Physiol 256: H472–H477

    PubMed  CAS  Google Scholar 

  19. King SE, Cain SM (1987) Regional 02 uptake during hypoxia and recovery in hyper- metabolic dogs. J Appl Physiol 63: 381–386

    PubMed  CAS  Google Scholar 

  20. Ognibene FF, Parker MM, Natanson CN, Parrillo JE (1988) Depressed left ventricular performance. Response to volume infusion in patients with sepsis and septic shock. Chest 93: 903–910

    Google Scholar 

  21. Bersten A, Gnidec A, Rutledge FS, Sibbiald WJ (1990) Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows. Am Rev Respir Dis 141: 1198–1208

    PubMed  CAS  Google Scholar 

  22. Martin CM, Yaghi A, Sibbald WJ, McCormack D, Paterson NAM (1993) Differential impairment of vascular reactivity of small pulmonary and systemic arteries in a rat model of hyperdynamic sepsis. Am Rev Respir Dis 148: 164–172

    Article  PubMed  CAS  Google Scholar 

  23. Shumaker PT, Samsel RW (1989) Oxygen delivery and uptake by peripheral tissues: Physiology and pathophysiology. Crit Care Clinics 5: 255–269

    Google Scholar 

  24. Fox GA, Bersten A, Lam C, Neal A, Rutledge F, Imman K, Sibbald WJ (1994) The hematocrit modifies the circulatory control of systemic and myocardial oxygen utilization in septic sheep. Crit Care Med (in press)

    Google Scholar 

  25. Morisaki H, Bloos F, Cross L, et al (1992) Colloid infusion preserves microvascular integrity better than crystalloid in hyperdynamic sepsis. Crit Care Med 20:4 (Suppl); S 101

    Google Scholar 

  26. Bloos MF, Neal A, Pitt A, Martiin CM, Ellis CG, Sibbald WJ (1993) The 02 dissociation curve in hyperdynamic septic sheep. Clin Invest Med 16 (Suppl): 157

    Google Scholar 

  27. Lorente JA, Landin L, De Pablo R, Renes E, Rodriguez-Diaz R, Liste D (1993) Effects of blood transfusion on oxygen transport variables in severe sepsis. Crit Care Med 21: 1312–1318

    Article  PubMed  CAS  Google Scholar 

  28. Marik PE, Sibbald WJ (1993) Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269: 3024–3029

    Article  PubMed  CAS  Google Scholar 

  29. Dietrick KA, Conrad SA, Hebert CA, Levy GL, Romero MD (1990) Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated non-surgical patients. Crit Care Med 18: 940–944

    Article  Google Scholar 

  30. Babineau TJ, Dzik WH, Borlase BC, Baxter JK, Bistrian BR, Benotti PN (1992) Re- evaluation of current transfusion practices in patients in surgical intensive care units. Am J Surg 164: 22–25

    Article  PubMed  CAS  Google Scholar 

  31. Fenwick JC, Dodeck PM, Ronco JJ, Phang PT, Wiggs B, Russell JA (1990) Increased concentrations of plasma lactate predict pathologic dependence of oxygen consumption on oxygen delivery in patients with adult respiratory distress syndrome. J Crit Care 5: 81–86

    Article  Google Scholar 

  32. Steffes CP, Bender JS, Levison MA (1991) Blood transfusion and oxygen consumption in surgical sepsis. Crit Care Med 19: 512–517

    Article  PubMed  CAS  Google Scholar 

  33. Lucking SE, Williams TM, Chaten FC, Metz RI, Mickell JJ (1990) Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and low oxygen extraction. Crit Care Med 18: 1316–1319

    Article  PubMed  CAS  Google Scholar 

  34. Mink RB, Pollack MM (1990) Effect of blood transfusion on oxygen consumption in pediatric septic shock. Crit Care Med 18: 1087–1091

    Article  PubMed  CAS  Google Scholar 

  35. Nacht A (1992) The use of blood products in shock. Crit Care Clinics 8: 255–291

    CAS  Google Scholar 

  36. Gottlieb T (1993) Hazards of bacterial contamination of blood products. Anaesth Intensive Care 21: 20–23

    PubMed  CAS  Google Scholar 

  37. Malouf M, Glanville AR (1993) Blood transfusion related adult respiratory distress syndrome. Anaesth Intensive Care 21: 44–49

    PubMed  CAS  Google Scholar 

  38. Bone RC, Fisher CJ Jr, Clemmer TP, Slotman GJ, Metz CA, Balk RA (1987) A controlled clinical trial of high-dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 317: 653–658

    Article  PubMed  CAS  Google Scholar 

  39. Calandra T, Glauser MP, Schellekens J, Verhoef J (1988) Treatment of gram-negative septic shock with human IgG antibody to Escherichia coli J5: A prospective, double- blind, randomized trial. J Infect Dis 158: 312–319

    Article  PubMed  CAS  Google Scholar 

  40. Ziegler EJ, Fisher CJ Jr, Sprung CL, et al (1991) Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group. N Engl J Med 324: 429–436

    Article  PubMed  CAS  Google Scholar 

  41. Greenman RL, Schein RM, Martin MA, et al and The XOMA Sepsis Study Group, (1991) A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of gram-negative sepsis. JAMA 266: 1097–1102

    Article  PubMed  CAS  Google Scholar 

  42. Bone RC, Fisher CJ Jr, Clemmer TP, et al and the Methylprednisolone Severe Sepsis Study Group (1989) Sepsis syndrome: A valid clinical entity. Crit Care Med 17: 389–393

    Article  PubMed  CAS  Google Scholar 

  43. Clemmer TP, Fisher CJ Jr, Bone RC, et al and The Methylprednisolone Severe Sepsis Study Group (1992) Hypothermia in the sepsis syndrome and clinical outcome. Crit Care Med 20: 1395–1401

    Article  PubMed  CAS  Google Scholar 

  44. Slotman GJ, Fisher CJ Jr, Bone RC, et al and The Methylprednisolone Severe Sepsis Study Group (1993) Detrimental effects of high-dose methylprednisolone sodium succinate on serum concentrations of hepatic and renal function indicators in severe sepsis and septic shock. Crit Care Med 21: 191–195

    Article  PubMed  CAS  Google Scholar 

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Authors
  1. W. J. Sibbald
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  2. G. S. Doig
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  3. H. Morisaki
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Editor information

Editors and Affiliations

  1. Department of Critical Care, Victoria Hospital, 375 South Street, N6A 4G5, London, Ontario, Canada

    W. J. Sibbald

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© 1995 Springer-Verlag Berlin Heidelberg

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Sibbald, W.J., Doig, G.S., Morisaki, H. (1995). Role of RBC Transfusion Therapy in Sepsis. In: Vincent, JL., Sibbald, W.J. (eds) Clinical Trials for the Treatment of Sepsis. Update in Intensive Care and Emergency Medicine, vol 19. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-79224-3_12

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  • DOI: https://doi.org/10.1007/978-3-642-79224-3_12

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-79226-7

  • Online ISBN: 978-3-642-79224-3

  • eBook Packages: Springer Book Archive

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