Skip to main content
Key Specialties
Anesthesiology Cardiology Dermatology Diabetology Endocrinology Gastroenterology General Medicine Geriatrics Hematology Infectious Diseases Internal Medicine Nephrology Neurology Obstetrics and Gynecology Oncology Pediatrics Psychiatry Radiology Respiratory Medicine Rheumatology Surgery Urology
Congress Coverage
ASH 2024 Annual Meeting 2024 ESMO Congress 2024 ERS Congress 2024 EASD Congress 2024 ESC Congress 2024 EAN Congress 2024 ASCO Annual Meeting 2024 ACC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote series | Spotlight on menopause

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.

Published: Thursday 12th December 2024
ADVANCED SEARCH
Log in
Top
Annals of Intensive Care
Published in:

Open Access 01-12-2024 | Central Nervous System Trauma | Review

Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Authors: Xiang Yuan, Sen Zhang, Jun Wan, Cheng Chen, Peng Wang, Shijie Fan, Yuyang Liu, Jingxian Yang, Jiayi Hou, Qiaoyu You, Xiao Li, Kuilin Li, Ziyan Xiang, Yang Rao, Yu Zhang

Published in: Annals of Intensive Care | Issue 1/2024

Login to get access

Abstract

Background

The effects of restrictive versus liberal transfusion strategies in critically ill patients with traumatic brain injury (TBI) and anemia, particularly in adult patients with moderate to severe TBI, remain inconclusive. Therefore, this systematic review and meta-analysis aim to evaluate the comparative impact of restrictive and liberal red blood cell transfusion strategies among critically ill adult patients with moderate to severe TBI.

Methods

We conducted a search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from their inception through October 20, 2024, to identify randomized controlled trials that compared restrictive (transfusions at a hemoglobin level of ≤ 7 g/dL) and liberal (transfusions at a hemoglobin level of ≤ 9–10 g/dL) transfusion strategies in adult patients with TBI. The primary outcome was mortality, with secondary outcomes including an unfavorable neurological outcome at six months, as determined by the Glasgow Outcome Scale (GOS < 4; or Glasgow Outcome Scale-Extended [GOSE] < 6), and the number of units of packed red blood cells (pRBCs) transfused.

Results

Five randomized controlled trials involving 1,528 patients were included in the analysis. The results showed that restrictive transfusion, compared to liberal transfusion, had no impact on mortality (RR 1.00, 95% CI 0.80 to 1.24, I2 = 0%) or unfavorable neurological outcome at 6 months (RR 1.06, 95% CI 0.94 to 1.20, I2 = 47%). Restrictive transfusion was associated with a reduction in the number of units of pRBCs transfused (MD -2.62, 95% CI -3.33 to -1.90, I2 = 63%).

Conclusion

In patients with TBI, a restrictive transfusion strategy did not reduce the risk of mortality or unfavorable neurological outcome compared with a liberal transfusion strategy.
Appendix
Available only for authorised users
Literature
1.
Guglielmi A, Graziano F, Bogossian EG, et al. Haemoglobin values, transfusion practices, and long-term outcomes in critically ill patients with traumatic brain injury: a secondary analysis of CENTER-TBI. Crit Care. 2024;28(1):199.
2.
Lelubre C, Bouzat P, Crippa IA, et al. Anemia management after acute brain injury. Crit Care. 2016;20(1):152.
3.
Van Beek JG, Mushkudiani NA, Steyerberg EW, et al. Prognostic value of admission laboratory parameters in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24(2):315–28.CrossRefPubMed
4.
Warner MA, O’Keeffe T, Bhavsar P, et al. Transfusions and long-term functional outcomes in traumatic brain injury. J Neurosurg. 2010;113(3):539 – 46.
5.
Carson JL, Stanworth SJ, Dennis JA, et al. Transfusion thresholds for guiding red blood cell transfusion. Cochrane Database Syst Rev. 2021;12(12):Cd002042.PubMed
6.
Carson JL, Stanworth SJ, Guyatt G, et al. Red blood cell transfusion: 2023 AABB International guidelines. JAMA. 2023;330(19):1892–902.CrossRefPubMed
7.
Montgomery EY, Barrie U, Kenfack YJ, et al. Transfusion guidelines in traumatic Brain Injury: a systematic review and Meta-analysis of the currently available evidence. Neurotrauma Rep. 2022;3(1):554–68.CrossRefPubMedPubMedCentral
8.
Turgeon AF, Fergusson DA, Clayton L, et al. Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. N Engl J Med. 2024.
9.
Taccone FS, Rynkowski Bittencourt C, Møller K, et al. Restrictive vs Liberal Transfusion Strategy in Patients With Acute Brain Injury: The TRAIN Randomized Clinical Trial. Jama. 2024.
10.
Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Bmj. 2021;372:n71.
11.
Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet1975. p. 480-4.
12.
Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. Bmj. 2019;366:l4898.
13.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924–6.CrossRefPubMedPubMedCentral
14.
Egger M, Davey Smith G, Schneider M, et al. Bias in meta-analysis detected by a simple, graphical test. Bmj. 1997;315(7109):629 – 34.
15.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics. 1994;50(4):1088 – 101.
16.
Gobatto ALN, Link MA, Solla DJ, et al. Transfusion requirements after head trauma: a randomized feasibility controlled trial. Crit Care. 2019;23(1):89.
17.
McIntyre LA, Fergusson DA, Hutchison JS, et al. Effect of a liberal versus restrictive transfusion strategy on mortality in patients with moderate to severe head injury. Neurocrit Care. 2006;5(1):4–9.
18.
Robertson CS, Hannay HJ, Yamal JM, et al. Effect of erythropoietin and transfusion threshold on neurological recovery after traumatic brain injury: a randomized clinical trial. JAMA. 2014;312(1):36–47.CrossRefPubMedPubMedCentral
19.
Turgeon AF, Fergusson DA, Clayton L, et al. Liberal or Restrictive Transfusion Strategy in patients with traumatic brain Injury. N Engl J Med. 2024;391(8):722–35.CrossRefPubMed
20.
Yu Y, Fu Y, Li W, et al. Red blood cell transfusion in neurocritical patients: a systematic review and meta-analysis. BMC Anesthesiol. 2024;24(1):106.
21.
Smith MJ, Stiefel MF, Magge S, et al. Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med. 2005;33(5):1104–8.CrossRefPubMed
22.
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(3):1074-8.
23.
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(11):1733-40.
24.
Zilberberg MD, Carter C, Lefebvre P, et al. Red blood cell transfusions and the risk of acute respiratory distress syndrome among the critically ill: a cohort study. Crit Care. 2007;11(3):R63.
25.
26.
Carson JL, Hill S, Carless P, et al. Transfusion triggers: a systematic review of the literature. Transfus Med Rev. 2002;16(3):187–99.CrossRefPubMed
27.
Johnston IH, Johnston JA, Jennett B. Intracranial-pressure changes following head injury. Lancet. 1970;2(7670):433–6.CrossRefPubMed
28.
Zhang C, Zhou L, Zhang K, et al. Brain tissue oxygen pressure combined with intracranial pressure monitoring may improve clinical outcomes for patients with severe traumatic brain injury: a systemic review and meta-analysis. PeerJ. 2024;12:e18086.
29.
Vigué B, Ract C, Benayed M, et al. Early SjvO2 monitoring in patients with severe brain trauma. Intensive Care Med. 1999;25(5):445–51.CrossRefPubMed
30.
Chesnut R, Aguilera S, Buki A, et al. A management algorithm for adult patients with both brain oxygen and intracranial pressure monitoring: the Seattle International severe traumatic brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2020;46(5):919–29.CrossRefPubMedPubMedCentral
31.
Turgeon AF, Fergusson DA, Clayton L, et al. Haemoglobin transfusion threshold in traumatic brain injury optimisation (HEMOTION): a multicentre, randomised, clinical trial protocol. BMJ Open. 2022;12(10):e067117.CrossRefPubMedPubMedCentral
Metadata
Title
Efficacy of restrictive versus liberal transfusion strategies in patients with traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials
Authors
Xiang Yuan
Sen Zhang
Jun Wan
Cheng Chen
Peng Wang
Shijie Fan
Yuyang Liu
Jingxian Yang
Jiayi Hou
Qiaoyu You
Xiao Li
Kuilin Li
Ziyan Xiang
Yang Rao
Yu Zhang
Publication date
01-12-2024
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2024
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-024-01411-1

Other articles of this Issue 1/2024

Correction: COVID-19 associated pulmonary aspergillosis in critically-ill patients: a prospective multicenter study in the era of Delta and Omicron variants

Organ crosstalk and dysfunction in Sepsis: harnessing emerging biotechnologies for future breakthroughs

Hospital-acquired bloodstream infections in critically ill cirrhotic patients: a post-hoc analysis of the EUROBACT-2 international cohort study

  • Open Access
  • Research

Positive end-expiratory pressure and left ventricular function are key factors affecting right ventricular to pulmonary arterial coupling

Conservative versus liberal oxygen therapy for intensive care unit patients: meta-analysis of randomized controlled trials

  • Open Access
  • Review

Heterogeneous impact of Sighs on mortality in patients with acute hypoxemic respiratory failure: insights from the PROTECTION study

  • Open Access
  • Research