Blood Transfusions May Have Limited Effect on Muscle Oxygenation After Total Knee Arthroplasty
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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.
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.
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]).
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.
Keywordsblood transfusion muscle tissue oxygenation total knee arthroplasty near-infrared spectroscopy
We would like to thank the Anna Maria and Stephen Kellen Career Development Award (Memtsoudis) and the Department of Anesthesia at Hospital for Special Surgery for funding this study. The study was also supported by the Clinical and Translational Science Center at Weill Medical College—Cornell University through grant number UL1 TR000457-06 for the use of REDCap.
Conflict of Interest:
Stavros G. Memtsoudis, MD, PhD, FCCP, Thomas Danninger, MD, Ottokar Stundner, MD, Daniel Yoo, MB, Federico P. Girardi, MD, Isabelle Kao, BS, Kara G. Fields, MS, and Michael K. Urban, MD, PhD have declared that they have no conflict of interest. Friedrich Boettner, MD reports grants and personal fees from Smith and Nephew and personal fees and other from Orthodevelopment, outside the work. Stephen O. Heard, MD reports non-financial support and other from Reflectance Medical, during the study. J. Matthias Walz, MD, FCCP reports other from Reflectance Medical, during the study.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was obtained from all patients for being included in the study.
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