Transfusion Thresholds in Patients With Neurological Injury: Balancing Oxygen Delivery and Risk

Transfusion strategies in neurocritical care require a delicate and nuanced balance between optimizing oxygen delivery to the injured brain and minimizing transfusion-associated risks. Although restrictive transfusion protocols are widely adopted in critical care, their applicability to patients wit...

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Bibliographic Details
Published inJournal of neurosurgical anesthesiology Vol. 37; no. 3; p. 265
Main Authors Rathmell, Cara, Vacas, Susana
Format Journal Article
LanguageEnglish
Published United States 01.07.2025
Subjects
Blood Transfusion - methods
Brain Injuries - therapy
Critical Care - methods
Humans
Nervous System Diseases - therapy
Oxygen
Transfusion Reaction
restrictive transfusion
transfusion thresholds
subarachnoid hemorrhage
traumatic brain injury
transfusion
neurological outcomes
hemoglobin
cerebral oxygenation
neurocritical care
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Summary:Transfusion strategies in neurocritical care require a delicate and nuanced balance between optimizing oxygen delivery to the injured brain and minimizing transfusion-associated risks. Although restrictive transfusion protocols are widely adopted in critical care, their applicability to patients with neurological injury remains the subject of debate. Anemia may exacerbate cerebral hypoxia, potentially worsening neurological outcomes, yet transfusion carries risks such as thrombosis, immune modulation, and increased intracranial pressure. Studies comparing liberal and restrictive transfusion strategies in neurocritical care have yielded mixed results, with most settling on the noninferiority of a restrictive approach while still considering a higher threshold for particular subgroups. This focused review will examine the current evidence on transfusion strategies in neurocritically ill patients and highlight key areas for future research.
ISSN:1537-1921
DOI:10.1097/ANA.0000000000001039