Factors Associated With Brain Tissue Oxygenation Changes After RBC Transfusion in Acute Brain Injury Patients.
Journal
Critical care medicine
ISSN: 1530-0293
Titre abrégé: Crit Care Med
Pays: United States
ID NLM: 0355501
Informations de publication
Date de publication:
01 06 2022
01 06 2022
Historique:
pubmed:
9
2
2022
medline:
28
5
2022
entrez:
8
2
2022
Statut:
ppublish
Résumé
Anemia is common after acute brain injury and can be associated with brain tissue hypoxia. RBC transfusion (RBCT) can improve brain oxygenation; however, predictors of such improvement remain unknown. We aimed to identify the factors associated with PbtO2 increase (greater than 20% from baseline value) after RBCT, using a generalized mixed model. This is a multicentric retrospective cohort study (2012-2020). This study was conducted in three European ICUs of University Hospitals located in Belgium, Switzerland, and Austria. All patients with acute brain injury who were monitored with brain tissue oxygenation (PbtO2) catheters and received at least one RBCT. Patients received at least one RBCT. PbtO2 was recorded before, 1 hour, and 2 hours after RBCT. We included 69 patients receiving a total of 109 RBCTs after a median of 9 days (5-13 d) after injury. Baseline hemoglobin (Hb) and PbtO2 were 7.9 g/dL [7.3-8.7 g/dL] and 21 mm Hg (16-26 mm Hg), respectively; 2 hours after RBCT, the median absolute Hb and PbtO2 increases from baseline were 1.2 g/dL [0.8-1.8 g/dL] (p = 0.001) and 3 mm Hg (0-6 mm Hg) (p = 0.001). A 20% increase in PbtO2 after RBCT was observed in 45 transfusions (41%). High heart rate (HR) and low PbtO2 at baseline were independently associated with a 20% increase in PbtO2 after RBCT. Baseline PbtO2 had an area under receiver operator characteristic of 0.73 (95% CI, 0.64-0.83) to predict PbtO2 increase; a PbtO2 of 20 mm Hg had a sensitivity of 58% and a specificity of 73% to predict PbtO2 increase after RBCT. Lower PbtO2 values and high HR at baseline could predict a significant increase in brain oxygenation after RBCT.
Identifiants
pubmed: 35132018
doi: 10.1097/CCM.0000000000005460
pii: 00003246-202206000-00023
doi:
Substances chimiques
Oxygen
S88TT14065
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e539-e547Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
Déclaration de conflit d'intérêts
The authors have disclosed that they do not have any potential conflicts of interest.
Références
Sampson TR, Dhar R, Diringer MN: Factors associated with the development of anemia after subarachnoid hemorrhage. Neurocrit Care 2010; 12:4–9
Kumar MA, Rost NS, Snider RW, et al.: Anemia and hematoma volume in acute intracerebral hemorrhage. Crit Care Med 2009; 37:1442–1447
Carlson AP, Schermer CR, Lu SW: Retrospective evaluation of anemia and transfusion in traumatic brain injury. J Trauma 2006; 61:567–571
Lelubre C, Bouzat P, Crippa IA, et al.: Anemia management after acute brain injury. Crit Care 2016; 20:152
Weiskopf RB, Kramer JH, Viele M, et al.: Acute severe isovolemic anemia impairs cognitive function and memory in humans. Anesthesiology 2000; 92:1646–1652
Ramaekers VT, Casaer P, Daniels H, et al.: The influence of blood transfusion on brain blood flow autoregulation among stable preterm infants. Early Hum Dev 1992; 30:211–220
Taccone FS, Citerio G; Participants in the International Multi-disciplinary Consensus Conference on Multimodality Monitoring: Advanced monitoring of systemic hemodynamics in critically ill patients with acute brain injury. Neurocrit Care 2014; 21(Suppl 2):S38–S63
Bruder N, Cohen B, Pellissier D, et al.: The effect of hemodilution on cerebral blood flow velocity in anesthetized patients. Anesth Analg 1998; 86:320–324
Sekhon MS, McLean N, Henderson WR, et al.: Association of hemoglobin concentration and mortality in critically ill patients with severe traumatic brain injury. Crit Care 2012; 16:R128
Oddo M, Milby A, Chen I, et al.: Hemoglobin concentration and cerebral metabolism in patients with aneurysmal subarachnoid hemorrhage. Stroke 2009; 40:1275–1281
Oddo M, Levine JM, Kumar M, et al.: Anemia and brain oxygen after severe traumatic brain injury. Intensive Care Med 2012; 38:1497–1504
Leal-Noval SR, Muñoz-Serrano Á, Arellano-Orden V, et al.: Effects of red blood cell transfusion on long-term disability of patients with traumatic brain injury. Neurocrit Care 2016; 24:371–380
Warner MA, O’Keeffe T, Bhavsar P, et al.: Transfusions and long-term functional outcomes in traumatic brain injury. J Neurosurg 2010; 113:539–546
Boutin A, Moore L, Lauzier F, et al.: Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: A multicentre cohort study. BMJ Open 2017; 7:e014472
Kramer AH, Gurka MJ, Nathan B, et al.: Complications associated with anemia and blood transfusion in patients with aneurysmal subarachnoid hemorrhage. Crit Care Med 2008; 36:2070–2075
Kramer AH, Zygun DA, Bleck TP, et al.: Relationship between hemoglobin concentrations and outcomes across subgroups of patients with aneurysmal subarachnoid hemorrhage. Neurocrit Care 2009; 10:157–165
Springer MV, Schmidt JM, Wartenberg KE, et al.: Predictors of global cognitive impairment 1 year after subarachnoid hemorrhage. Neurosurgery 2009; 65:1043–1050
Zygun DA, Nortje J, Hutchinson PJ, et al.: The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury. Crit Care Med 2009; 37:1074–1078
Smith MJ, Stiefel MF, Magge S, et al.: Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med 2005; 33:1104–1108
East JM, Viau-Lapointe J, McCredie VA: Transfusion practices in traumatic brain injury. Curr Opin Anaesthesiol 2018; 31:219–226
Carney N, Totten AM, O’Reilly C, et al.: Guidelines for the management of severe traumatic brain injury, Fourth Edition. Neurosurgery 2017; 80:6–15
Connolly ES Jr, Rabinstein AA, Carhuapoma JR, et al.; American Heart Association Stroke Council; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology: Guidelines for the management of aneurysmal subarachnoid hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2012; 43:1711–1737
Hemphill JC III, Greenberg SM, Anderson CS, et al.; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology: Guidelines for the management of spontaneous intracerebral hemorrhage: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46:2032–2060
Le Roux P, Menon DK, Citerio G, et al.; Neurocritical Care Society; European Society of Intensive Care Medicine: Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care: A statement for healthcare professionals from the Neurocritical Care Society and the European Society of Intensive Care Medicine. Intensive Care Med 2014; 40:1189–1209
Le Gall JR, Lemeshow S, Saulnier F: A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993; 270:2957–2963
Teasdale G, Jennett B: Assessment of coma and impaired consciousness. A practical scale. Lancet 1974; 2:81–84
Jennett B, Bond M: Assessment of outcome after severe brain damage. Lancet 1975; 1:480–484
Rose JC, Neill TA, Hemphill JC III: Continuous monitoring of the microcirculation in neurocritical care: An update on brain tissue oxygenation. Curr Opin Crit Care 2006; 12:97–102
Soehle M, Jaeger M, Meixensberger J: Online assessment of brain tissue oxygen autoregulation in traumatic brain injury and subarachnoid hemorrhage. Neurol Res 2003; 25:411–417
Nielsen ND, Martin-Loeches I, Wentowski C: The effects of red blood cell transfusion on tissue oxygenation and the microcirculation in the intensive care unit: A systematic review. Transfus Med Rev 2017; 31:205–222
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
Leal-Noval SR, Rincón-Ferrari MD, Marin-Niebla A, et al.: Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury: A preliminary study. Intensive Care Med 2006; 32:1733–1740
Figaji AA, Zwane E, Kogels M, et al.: The effect of blood transfusion on brain oxygenation in children with severe traumatic brain injury. Pediatr Crit Care Med 2010; 11:325–331
Kurtz P, Helbok R, Claassen J, et al.: The effect of packed red blood cell transfusion on cerebral oxygenation and metabolism after subarachnoid hemorrhage. Neurocrit Care 2016; 24:118–121
Leal-Noval SR, Muñoz-Gómez M, Arellano-Orden V, et al.: Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit Care Med 2008; 36:1290–1296
Francoeur CL, Mayer SA: Management of delayed cerebral ischemia after subarachnoid hemorrhage. Crit Care 2016; 20:277
Dhar R, Zazulia AR, Derdeyn CP, et al.: RBC transfusion improves cerebral oxygen delivery in subarachnoid hemorrhage. Crit Care Med 2017; 45:653–659
Hosmann A, Schnackenburg P, Rauscher S, et al.: Brain tissue oxygen response as indicator for cerebral lactate levels in aneurysmal subarachnoid hemorrhage patients. J Neurosurg Anesthesiol 2020 Jul 21. [online ahead of print]
Veldeman M, Albanna W, Weiss M, et al.: Invasive neuromonitoring with an extended definition of delayed cerebral ischemia is associated with improved outcome after poor-grade subarachnoid hemorrhage. J Neurosurg 2020; 134:1527–1534
Chen HI, Stiefel MF, Oddo M, et al.: Detection of cerebral compromise with multimodality monitoring in patients with subarachnoid hemorrhage. Neurosurgery 2011; 69:53–63
Bardt TF, Unterberg AW, Härtl R, et al.: Monitoring of brain tissue PO2 in traumatic brain injury: Effect of cerebral hypoxia on outcome. Acta Neurochir Suppl 1998; 71:153–156
Porter WB, James GW III: The heart in anemia. Circulation 1953; 8:111–116
Fantini S, Sassaroli A, Tgavalekos KT, et al.: Cerebral blood flow and autoregulation: Current measurement techniques and prospects for noninvasive optical methods. Neurophotonics 2016; 3:031411
Yamal JM, Rubin ML, Benoit JS, et al.: Effect of hemoglobin transfusion threshold on cerebral hemodynamics and oxygenation. J Neurotrauma 2015; 32:1239–1245