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The Impact of Red Blood Cell Transfusion on Cerebral Tissue Oxygen Saturation in Severe Traumatic Brain Injury

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Abstract

Background

There are a range of opinions on the benefits and thresholds for the transfusion of red blood cells in critically ill patients with traumatic brain injury (TBI) and an urgent need to understand the neurophysiologic effects. The aim of this study was to examine the influence of red blood cell transfusions on cerebral tissue oxygenation (SctO2) in critically ill TBI patients.

Methods

This prospective observational study enrolled consecutive TBI patients with anemia requiring transfusion. Cerebral tissue oxygen saturation (SctO2) was measured noninvasively with bilateral frontal scalp probes using near-infrared spectroscopy (NIRS) technology. Data were collected at baseline and for 24 h after transfusion. The primary outcome was the applicability of a four-wavelength near-infrared spectrometer to monitor SctO2 changes during a transfusion. Secondary outcomes included the correlation of SctO2 with other relevant physiological variables, the dependence of SctO2 on baseline hemoglobin and transfusion, and the effect of red blood cell transfusion on fractional tissue oxygen extraction.

Results

We enrolled 24 patients with severe TBI, of which five patients (21 %) were excluded due to poor SctO2 signal quality from large subdural hematomas and bifrontal decompressive craniectomies. Twenty transfusions were monitored in 19 patients. The mean pre- and post-transfusion hemoglobin concentrations were significantly different [74 g/L (SD 8 g/L) and 84 g/L (SD 9 g/L), respectively; p value <0.0001]. Post-transfusion SctO2 was not significantly greater than pre-transfusion SctO2 [left-side pre-transfusion 69 % (SD 7) vs. post-transfusion 70 % (SD 10); p = 0.68, and right-side pre-transfusion 69 % (SD 5) vs. post-transfusion 71 % (SD 7); p = 0.11]. In a multivariable mixed linear analysis, mean arterial pressure was the only variable significantly associated with a change in SctO2.

Conclusions

The bifrontal method of recording changes in NIRS signal was not able to detect a measurable impact on SctO2 in this sample of patients receiving red blood cell transfusion therapy in a narrow but conventionally relevant, range of anemia.

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Acknowledgments

This work is supported by grants from Physicians’ Services Incorporated Foundation and St. Michael’s Trauma-Neuro Research Group.

Author Contribution

V.A.M. contributed to the literature search, study design, data analysis, data interpretation, writing, critical revision, and final approval. S.P. contributed to the literature search, study design, data interpretation, critical revision, and final approval. M.S. contributed to the data collection, critical revision, and final approval. W.X. contributed to the data analysis, data interpretation, critical revision, and final approval. A.L.D.O.M. contributed to data collection, critical revision, and final approval. A.R. contributed to the study design, data interpretation, critical revision, and final approval. G.M.H. contributed to the study design, data interpretation, critical revision, and final approval. M.G.C. contributed to the data interpretation, critical revision, and final approval. A.J.B. contributed to the study design, data analysis, data interpretation, writing, critical revision, and final approval.

Funding/Support

This work was supported by grants from the Physicians’ Services Incorporated Foundation and St. Michael’s Trauma-Neuro Research Group. Caster Medical Systems supplied the foresight cerebral tissue oximetry monitors during the study period. We separately purchased all the probes for study use. Rainbow® pulse co-oximetry monitors were provided by Masimo Canada, and probes were purchased for each study patient. All funding and support sources were not involved in the collection, analysis, and interpretation of data.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Sunnybrook Health Sciences Center, 2075 Bayview Ave, Room D108, Toronto, ON, M4N 3M5, Canada

    Victoria A. McCredie & Martin G. Chapman

  2. Division of Neuroanesthesia and Neurointensive Care, Department of Anesthesia, Intensive Care and Perioperative Medicine, University of Brescia at Spedali Civili, Brescia, Italy

    Simone Piva

  3. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, ON, Canada

    Marlene Santos, Gregory M. T. Hare & Andrew J. Baker

  4. Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, M4N 3M5, Canada

    Wei Xiong

  5. Department of Medical Imaging, Interventional Neuroradiology, St. Michael’s Hospital, Toronto, ON, Canada

    Airton Leonardo de Oliveira Manoel

  6. Department of Anesthesia, University of Toronto, Toronto, ON, Canada

    Andrea Rigamonti, Gregory M. T. Hare, Martin G. Chapman & Andrew J. Baker

  7. Department of Critical Care Medicine, St. Michael’s Hospital, Toronto, ON, Canada

    Andrea Rigamonti & Andrew J. Baker

  8. Department of Physiology, University of Toronto, Toronto, ON, Canada

    Gregory M. T. Hare

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  1. Victoria A. McCredie
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  2. Simone Piva
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  3. Marlene Santos
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  4. Wei Xiong
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Correspondence to Victoria A. McCredie.

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McCredie, V.A., Piva, S., Santos, M. et al. The Impact of Red Blood Cell Transfusion on Cerebral Tissue Oxygen Saturation in Severe Traumatic Brain Injury. Neurocrit Care 26, 247–255 (2017). https://doi.org/10.1007/s12028-016-0310-6

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  • DOI: https://doi.org/10.1007/s12028-016-0310-6

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