Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Neurocritical Care
Published in: Neurocritical Care 2/2017

01-04-2017 | Original Article

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

Authors: Victoria A. McCredie, Simone Piva, Marlene Santos, Wei Xiong, Airton Leonardo de Oliveira Manoel, Andrea Rigamonti, Gregory M. T. Hare, Martin G. Chapman, Andrew J. Baker

Published in: Neurocritical Care | Issue 2/2017

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Zauner A, Daugherty WP, Bullock MR, Warner DS. Brain oxygenation and energy metabolism: part I-biological function and pathophysiology. Neurosurgery. 2002;51:289–301 (discussion 2).PubMed
2.
Chesnut RM, Marshall LF, Klauber MR, et al. The role of secondary brain injury in determining outcome from severe head injury. J Trauma. 1993;34:216–22.CrossRefPubMed
3.
McHugh GS, Engel DC, Butcher I, et al. Prognostic value of secondary insults in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007;24:287–93.CrossRefPubMed
4.
Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. X. Brain oxygen monitoring and thresholds. J Neurotrauma. 2007;24(Suppl 1):S65–70.PubMed
5.
Bratton SL, Chestnut RM, Ghajar J, et al. Guidelines for the management of severe traumatic brain injury. I. Blood pressure and oxygenation. J Neurotrauma. 2007;24(Suppl 1):S7–13.PubMed
6.
Kiraly LN, Underwood S, Differding JA, Schreiber MA. Transfusion of aged packed red blood cells results in decreased tissue oxygenation in critically injured trauma patients. J Trauma. 2009;67:29–32.CrossRefPubMed
7.
Salim A, Hadjizacharia P, DuBose J, et al. Role of anemia in traumatic brain injury. J Am Coll Surg. 2008;207:398–406.CrossRefPubMed
8.
Warner MA, O’Keeffe T, Bhavsar P, et al. Transfusions and long-term functional outcomes in traumatic brain injury. J Neurosurg. 2010;113:539–46.CrossRefPubMed
9.
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;5:4–9.CrossRefPubMed
10.
Boutin A, Chasse M, Shemilt M, et al. Red blood cell transfusion in patients with traumatic brain injury: a systematic review and meta-analysis. Transfus Med Rev. 2016;30:15–24.CrossRefPubMed
11.
Zygun DA, Nortje J, Hutchinson PJ, Timofeev I, Menon DK, Gupta AK. The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury. Crit Care Med. 2009;37:1074–8.CrossRefPubMed
12.
Smith MJ, Stiefel MF, Magge S, et al. Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med. 2005;33:1104–8.CrossRefPubMed
13.
Topolovec-Vranic J, Santos M, Baker AJ, Smith OM, Burns KE. Deferred consent in a minimal-risk study involving critically ill subarachnoid hemorrhage patients. Can Respir J J Can Thorac Soc. 2014;21:293–6.
14.
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ (Clinical research ed). 2007;335:806–8.CrossRef
15.
Brain Trauma F, American Association of Neurological S, Congress of Neurological S. Guidelines for the management of severe traumatic brain injury. J Neurotrauma 2007;24(suppl 1):S1–106.
16.
Wardle SP, Yoxall CW, Weindling AM. Determinants of cerebral fractional oxygen extraction using near infrared spectroscopy in preterm neonates. J Cereb Blood Flow Metab. 2000;20:272–9.CrossRefPubMed
17.
Watzman HM, Kurth CD, Montenegro LM, Rome J, Steven JM, Nicolson SC. Arterial and venous contributions to near-infrared cerebral oximetry. Anesthesiology. 2000;93:947–53.CrossRefPubMed
18.
Colquhoun DA, Tucker-Schwartz JM, Durieux ME, Thiele RH. Non-invasive estimation of jugular venous oxygen saturation: a comparison between near infrared spectroscopy and transcutaneous venous oximetry. J Clin Monit Comput. 2012;26:91–8.CrossRefPubMed
19.
Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986;1:307–10.CrossRefPubMed
20.
Kenward MG, Roger JH. Small sample inference for fixed effects from restricted maximum likelihood. Biometrics. 1997;53:983–97.CrossRefPubMed
21.
Leal-Noval SR, Rincon-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;32:1733–40.CrossRefPubMed
22.
Nortje J, Gupta AK. The role of tissue oxygen monitoring in patients with acute brain injury. Br J Anaesth. 2006;97:95–106.CrossRefPubMed
23.
Rosenthal G, Hemphill JC 3rd, Manley G. Brain tissue oxygen tension is more indicative of oxygen diffusion than oxygen delivery and metabolism in patients with traumatic brain injury. Crit Care Med. 2009;37:379–80.CrossRefPubMed
24.
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;24:118–21.CrossRefPubMed
25.
Sekhon MS, Griesdale DE, Czosnyka M, et al. The effect of red blood cell transfusion on cerebral autoregulation in patients with severe traumatic brain injury. Neurocrit Care. 2015;23:210–6.CrossRefPubMed
26.
Davies DJ, Su Z, Clancy MT, et al. Near-infrared spectroscopy in the monitoring of adult traumatic brain injury: a review. J Neurotrauma. 2015;32:933–41.CrossRefPubMedPubMedCentral
Metadata
Title
The Impact of Red Blood Cell Transfusion on Cerebral Tissue Oxygen Saturation in Severe Traumatic Brain Injury
Authors
Victoria A. McCredie
Simone Piva
Marlene Santos
Wei Xiong
Airton Leonardo de Oliveira Manoel
Andrea Rigamonti
Gregory M. T. Hare
Martin G. Chapman
Andrew J. Baker
Publication date
01-04-2017
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2017
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-016-0310-6

Other articles of this Issue 2/2017

Neurocritical Care 2/2017 Go to the issue

Translational Research

Progesterone Provides the Pleiotropic Neuroprotective Effect on Traumatic Brain Injury Through the Nrf2/ARE Signaling Pathway

Original Article

The Safety and Effectiveness of Intravenous Lacosamide for Refractory Status Epilepticus in the Critically Ill

Original Article

ABCC8 Single Nucleotide Polymorphisms are Associated with Cerebral Edema in Severe TBI

Review Article

Mechanisms of Global Cerebral Edema Formation in Aneurysmal Subarachnoid Hemorrhage

Practical Pearl

Takotsubo Cardiomyopathy in Traumatic Brain Injury

Original Article

Risk of Hyponatremia in Patients with Aneurysmal Subarachnoid Hemorrhage Treated with Exogenous Vasopressin Infusion