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

• Published in: Neurocritical care Vol. 26; no. 2; pp. 247 - 255
• Main Authors: McCredie, Victoria A., Piva, Simone, Santos, Marlene, Xiong, Wei, de Oliveira Manoel, Airton Leonardo, Rigamonti, Andrea, Hare, Gregory M. T., Chapman, Martin G., Baker, Andrew J.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.04.2017; Springer Nature B.V
• Subjects: Adult; Aged; Anemia; Blood banks; Blood pressure; Brain Injuries, Traumatic - diagnostic imaging; Brain Injuries, Traumatic - metabolism; Brain Injuries, Traumatic - therapy; Coma; Critical Care Medicine; Critical Illness - therapy; Data collection; Erythrocyte Transfusion - methods; Female; Hemoglobin; Humans; Intensive; Internal Medicine; Ischemia; Male; Medicine; Medicine & Public Health; Middle Aged; Neurology; Original Article; Outcome Assessment (Health Care); Oxygen Consumption - physiology; Oxygen saturation; Patients; Physiology; Severity of Illness Index; Spectroscopy, Near-Infrared; Spectrum analysis; Trauma; Traumatic brain injury; Variables; United States > US; Brain tissue oxygenation; Traumatic brain injury; Transfusion; Oximetry
• ISSN: 1541-6933; 1556-0961
• DOI: 10.1007/s12028-016-0310-6

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 (SctO 2 ) in critically ill TBI patients. Methods This prospective observational study enrolled consecutive TBI patients with anemia requiring transfusion. Cerebral tissue oxygen saturation (SctO 2 ) 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 SctO 2 changes during a transfusion. Secondary outcomes included the correlation of SctO 2 with other relevant physiological variables, the dependence of SctO 2 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 SctO 2 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 SctO 2 was not significantly greater than pre-transfusion SctO 2 [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 SctO 2 . Conclusions The bifrontal method of recording changes in NIRS signal was not able to detect a measurable impact on SctO 2 in this sample of patients receiving red blood cell transfusion therapy in a narrow but conventionally relevant, range of anemia.