HSS Journal ®

, Volume 11, Issue 2, pp 136–142 | Cite as

Blood Transfusions May Have Limited Effect on Muscle Oxygenation After Total Knee Arthroplasty

  • Stavros G. Memtsoudis
  • Thomas Danninger
  • Ottokar Stundner
  • Daniel Yoo
  • Federico P. Girardi
  • Friedrich Boettner
  • Isabelle Kao
  • Kara G. Fields
  • Michael K. Urban
  • Stephen O. Heard
  • J. Matthias Walz
Original Article

Abstract

Background

Traditionally, blood transfusions in the perioperative setting are used to maintain adequate delivery of nutrients and oxygen to organs. However, the effect of blood administration on tissue oxygenation in the perioperative setting remains poorly understood.

Questions/Purposes

The aim of this study was to determine changes in muscle tissue oxygenation saturation (SmO2) in response to perioperative blood transfusions.

Patients and Methods

Patients undergoing total knee arthroplasty were enrolled. SmO2, continuous hemoglobin (SpHb), stroke volume (SV), cardiac index, and standard hemodynamic parameters including heart rate (HR), mean arterial blood pressure (MAP), and arterial oxygen saturation (SO2) were recorded. To assess fluid responsiveness, a passive leg raise (PLR) test was performed before the transfusions were started.

Results

Twenty-eight patients were included in the analysis. Mean (±SD) SmO2 before transfusion was 63.18 ± 10.04%, SpHb was 9.27 ± 1.16 g/dl, and cardiac index was 2.62 ± 0.75 L/min/m2. A significant increase during the course of blood transfusion was found for SmO2 (+3.44 ± 5.81% [95% confidence interval (CI) 1.04 to 5.84], p = 0.007), SpHb (0.74 ± 0.92 g/dl [95% CI 0.35 to 1.12], p < 0.001), and cardiac index (0.38 ± 0.51 L/min/m2 [95% CI 0.15 to 0.60], p = 0.002), respectively. However, the correlation between SmO2 and SpHb over the course of the transfusion was negligible (ρ = 0.25 [95% CI −0.03 to 0.48]). A similar lack of correlation was found when analyzing data of those patients who showed a positive leg raise test before the start of the transfusion (ρ = 0.37 [95% CI −0.11 to 0.84]).

Conclusion

We detected a statistically significant increase in SmO2 during the course of a single unit blood transfusion compared to baseline. However, there was no evidence of a correlation between longitudinal SmO2 and SpHb measurements.

Keywords

blood transfusion muscle tissue oxygenation total knee arthroplasty near-infrared spectroscopy 

Supplementary material

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References

  1. 1.
    Adams RCLJ. Anesthesia in cases of poor surgical risk: Some suggestions for decreasing the risk. Surg Gynecol Obstet. 1942; 74: 1011-1015.Google Scholar
  2. 2.
    Almizraq R, Tchir JD, Holovati JL, et al. Storage of red blood cells affects membrane composition, microvesiculation, and in vitro quality. Transfusion. 2013. doi:10.1111/trf.12080.Google Scholar
  3. 3.
    American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: An updated report by the American society of anesthesiologists task force on perioperative blood transfusion and adjuvant therapies. Anesthesiology. 2006; 105: 198-208.CrossRefGoogle Scholar
  4. 4.
    Beekley AC, Martin MJ, Nelson T, et al. Continuous noninvasive tissue oximetry in the early evaluation of the combat casualty: A prospective study. J Trauma. 2010; 69(Suppl 1): S14-S25. doi:10.1097/TA.0b013e3181e42326.PubMedCrossRefGoogle Scholar
  5. 5.
    Carson JL, Carless PA, Hebert PC. Transfusion thresholds and other strategies for guiding allogeneic red blood cell transfusion. Cochrane Database Syst Rev. 2012; 4, CD002042. doi:10.1002/14651858.CD002042.pub3.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Carson JL, Terrin ML, Noveck H, et al. Liberal or restrictive transfusion in high-risk patients after hip surgery. N Engl J Med. 2011; 365: 2453-2462. doi:10.1056/NEJMoa1012452.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Creteur J, Neves AP, Vincent JL. Near-infrared spectroscopy technique to evaluate the effects of red blood cell transfusion on tissue oxygenation. Crit Care. 2009; 13(Suppl 5): S11. doi:10.1186/cc8009.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Donati A, Damiani E, Luchetti MM, et al. Microcirculatory effects of the transfusion of leukodepleted or non-leukodepleted red blood cells in septic patients: A pilot study. Crit Care. 2014; 18: R33. doi:10.1186/cc13730.PubMedCentralPubMedCrossRefGoogle Scholar
  9. 9.
    Hamlett A, Ryan L, Serrano-Trespalacios P, et al. Mixed models for assessing correlation in the presence of replication. J Air Waste Manag Assoc. 2003; 53: 442-450.PubMedCrossRefGoogle Scholar
  10. 10.
    Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42: 377-381.PubMedCentralPubMedCrossRefGoogle Scholar
  11. 11.
    Ma Y, Mazumdar M, Memtsoudis SG. Beyond repeated-measures analysis of variance: Advanced statistical methods for the analysis of longitudinal data in anesthesia research. Reg Anesth Pain Med. 2012; 37: 99-105. doi:10.1097/AAP.0b013e31823ebc74.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    McFarland JG. Perioperative blood transfusions: Indications and options. Chest. 1999; 115: 113S-121S.PubMedCrossRefGoogle Scholar
  13. 13.
    Monnet X, Rienzo M, Osman D, et al. Passive leg raising predicts fluid responsiveness in the critically ill. Crit Care Med. 2006; 34: 1402-1407. doi:10.1097/01.CCM.0000215453.11735.06.PubMedCrossRefGoogle Scholar
  14. 14.
    Roberson RS, Lockhart E, Shapiro NI, et al. Impact of transfusion of autologous 7- versus 42-day-old AS-3 red blood cells on tissue oxygenation and the microcirculation in healthy volunteers. Transfusion. 2012; 52: 2459-2464. doi:10.1111/j.1537-2995.2012.03615.x.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Sadaka F, Aggu-Sher R, Krause K, O'Brien J, Armbrecht ES, Taylor RW. The effect of red blood cell transfusion on tissue oxygenation and microcirculation in severe septic patients. Ann Intensive Care. 2011;1:46-5820-1-46. doi:10.1186/2110-5820-1-46.
  16. 16.
    Sakr Y, Chierego M, Piagnerelli M, et al. Microvascular response to red blood cell transfusion in patients with severe sepsis. Crit Care Med. 2007; 35: 1639-1644. doi:10.1097/01.CCM.0000269936.73788.32.PubMedCrossRefGoogle Scholar
  17. 17.
    Soller BR, Idwasi PO, Balaguer J, et al. Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass. Crit Care Med. 2003; 31: 2324-2331. doi:10.1097/01.CCM.0000086999.21673.6A.PubMedCrossRefGoogle Scholar
  18. 18.
    Soller BR, Yang Y, Soyemi OO, et al. Noninvasively determined muscle oxygen saturation is an early indicator of central hypovolemia in humans. J Appl Physiol. 2008; 104: 475-481. doi:10.1152/japplphysiol.00600.2007.PubMedCrossRefGoogle Scholar
  19. 19.
    Stehling L, Zauder HL. Acute normovolemic hemodilution. Transfusion. 1991; 31: 857-868.PubMedCrossRefGoogle Scholar
  20. 20.
    Stundner O, Chiu YL, Sun X, et al. Comparative perioperative outcomes associated with neuraxial versus general anesthesia for simultaneous bilateral total knee arthroplasty. Reg Anesth Pain Med. 2012; 37: 638-644. doi:10.1097/AAP.0b013e31826e1494.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    US Department of Health and Human Services. The 2011 national blood collection and utilization survey report; 2011.Google Scholar
  22. 22.
    Wahr JA, Tremper KK, Diab M. Pulse oximetry. Respir Care Clin N Am. 1995; 1: 77-105.PubMedGoogle Scholar
  23. 23.
    Zeger SL, Liang KY, Albert PS. Models for longitudinal data: A generalized estimating equation approach. Biometrics. 1988; 44: 1049-1060.PubMedCrossRefGoogle Scholar

Copyright information

© Hospital for Special Surgery 2015

Authors and Affiliations

  • Stavros G. Memtsoudis
    • 1
  • Thomas Danninger
    • 3
  • Ottokar Stundner
    • 3
  • Daniel Yoo
    • 1
  • Federico P. Girardi
    • 2
  • Friedrich Boettner
    • 2
  • Isabelle Kao
    • 4
  • Kara G. Fields
    • 5
  • Michael K. Urban
    • 1
  • Stephen O. Heard
    • 6
  • J. Matthias Walz
    • 6
  1. 1.Department of AnesthesiologyHospital for Special SurgeryNew YorkUSA
  2. 2.Department of OrthopedicsHospital for Special SurgeryNew YorkUSA
  3. 3.Department of AnesthesiologyState Hospital of SalzburgSalzburgAustria
  4. 4.College of MedicineSUNY Downstate Medical CenterNew YorkUSA
  5. 5.Healthcare Research InstituteHospital for Special SurgeryNew YorkUSA
  6. 6.Department of AnesthesiologyUMass Memorial Medical CenterWorcesterUSA

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