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Critical Care
Published in: Critical Care 5/2009

Open Access 01-10-2009 | Research

Near-infrared spectroscopy technique to evaluate the effects of red blood cell transfusion on tissue oxygenation

Authors: Jacques Creteur, Ana Paula Neves, Jean-Louis Vincent

Published in: Critical Care | Special Issue 5/2009

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Abstract

Introduction

The aim of this study was to evaluate the effects of red blood cell (RBC) transfusions on muscle tissue oxygenation, oxygen metabolism and microvascular reactivity in critically ill patients using near-infrared spectroscopy (NIRS) technology.

Methods

This prospective, observational study included 44 consecutive patients hospitalized in the 31-bed, medical-surgical intensive care unit of a university hospital with anemia requiring red blood cell transfusion. Thenar tissue oxygen saturation (StO2) and muscle tissue hemoglobin index (THI) were measured using a tissue spectrometer (InSpectra™ Model 325; Hutchinson Technology Inc., Hutchinson, MN, USA). A vaso-occlusive test was performed before and 1 hour after RBC transfusion by rapid inflation of a pneumatic cuff around the upper arm. The following variables were recorded: THI, the StO2 desaturation slope during the occlusion (%/minute) and the StO2 upslope of the reperfusion phase following the ischemic period (%/second). Muscle oxygen consumption (NIR VO2; arbitrary units) was calculated as the product of the inverse StO2 desaturation slope and the mean THI over the first minute of arterial occlusion.

Results

Blood transfusion resulted in increases in hemoglobin (from 7.1 (6.7 to 7.7) to 8.4 (7.1 to 9) g/dl; P < 0.01) and in oxygen delivery (from 306 (259 to 337) to 356 (332 to 422) ml/minute/m2; P < 0.001). However, systemic VO2 was unchanged. RBC transfusion did not globally affect NIRS-derived variables, but there was considerable interindividual variation. Changes in the StO2 upslope of the reperfusion phase after transfusion were negatively correlated with baseline StO2 upslope of the reperfusion phase (r2 = 0.42; P < 0.0001). Changes in NIR VO2 after transfusion were also negatively correlated with baseline NIR VO2 (r2 = 0.48; P = 0.0015). There were no correlations between RBC storage time and changes in StO2 slope or NIR VO2.

Conclusions

Muscle tissue oxygenation, oxygen consumption and microvascular reactivity are globally unaltered by RBC transfusion in critically ill patients. However, muscle oxygen consumption and microvascular reactivity can improve following transfusion in patients with alterations of these variables at baseline.
Literature
1.
Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D: Anemia and blood transfusion in critically ill patients. JAMA 2002, 288: 1499-1507. 10.1001/jama.288.12.1499CrossRefPubMed
2.
Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ: The CRIT Study: anemia and blood transfusion in the critically ill - current clinical practice in the United States. Crit Care Med 2004, 32: 39-52. 10.1097/01.CCM.0000104112.34142.79CrossRefPubMed
3.
Corwin HL, Parsonnet KC, Gettinger A: RBC transfusion in the ICU. Is there a reason? Chest 1995, 108: 767-771. 10.1378/chest.108.3.767CrossRefPubMed
4.
5.
Marik PE, Sibbald WJ: Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993, 269: 3024-3029. 10.1001/jama.269.23.3024CrossRefPubMed
6.
Walsh TS, McArdle F, McLellan SA, Maciver C, Maginnis M, Prescott RJ, McClelland DB: Does the storage time of transfused red blood cells influence regional or global indexes of tissue oxygenation in anemic critically ill patients? Crit Care Med 2004, 32: 364-371. 10.1097/01.CCM.0000108878.23703.E0CrossRefPubMed
7.
Dietrich KA, Conrad SA, Hebert CA, Levy GL, Romero MD: Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 1990, 18: 940-944. 10.1097/00003246-199009000-00007CrossRefPubMed
8.
Lorente JA, Landin L, De Pablo R, Renes E, Rodriguez-Diaz R, Liste D: Effects of blood transfusion on oxygen transport variables in severe sepsis. Crit Care Med 1993, 21: 1312-1318.CrossRefPubMed
9.
Vamvakas EC, Carven JH: Length of storage of transfused red cells and postoperative morbidity in patients undergoing coronary artery bypass graft surgery. Transfusion 2000, 40: 101-109. 10.1046/j.1537-2995.2000.40010101.xCrossRefPubMed
10.
Hebert PC, Chin-Yee I, Fergusson D, Blajchman M, Martineau R, Clinch J, Olberg B: A pilot trial evaluating the clinical effects of prolonged storage of red cells. Anesth Analg 2005, 100: 1433-1438. 10.1213/01.ANE.0000148690.48803.27CrossRefPubMed
11.
Purdy FR, Tweeddale MG, Merrick PM: Association of mortality with age of blood transfused in septic ICU patients. Can J Anaesth 1997, 44: 1256-1261. 10.1007/BF03012772CrossRefPubMed
12.
Creteur J: Muscle StO 2 in critically ill patients. Curr Opin Crit Care 2008, 14: 361-366. 10.1097/MCC.0b013e3282fad4e1CrossRefPubMed
13.
De Backer D, Creteur J, Silva E, Vincent JL: Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 2003, 31: 1659-1667. 10.1097/01.CCM.0000063045.77339.B6CrossRefPubMed
14.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13: 818-829. 10.1097/00003246-198510000-00009CrossRefPubMed
15.
Vincent JL, Moreno R, Takala J, Willatts S, de Mendonca A, Bruining H, Reinhart CK, Suter PM, Thijs LG: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996, 22: 707-710. 10.1007/BF01709751CrossRefPubMed
16.
Skarda DE, Mulier KE, Myers DE, Taylor JH, Beilman GJ: Dynamic near-infrared spectroscopy measurements in patients with severe sepsis. Shock 2007, 27: 348-353. 10.1097/01.shk.0000239779.25775.e4CrossRefPubMed
17.
Mancini DM, Bolinger L, Li H, Kendrick K, Chance B, Wilson JR: Validation of near-infrared spectroscopy in humans. J Appl Physiol 1994, 77: 2740-2747.PubMed
18.
Sakr Y, Chierego M, Piagnerelli M, Verdant C, Dubois MJ, Koch M, Creteur J, Gullo A, Vincent JL, De Backer D: Microvascular response to red blood cell transfusion in patients with severe sepsis. Crit Care Med 2007, 35: 1639-1644. 10.1097/01.CCM.0000269936.73788.32CrossRefPubMed
19.
Piagnerelli M, Zouaoui BK, Brohee D, Vereerstraeten A, Piro P, Vincent JL, Vanhaeverbeek M: Assessment of erythrocyte shape by flow cytometry techniques. J Clin Pathol 2007, 60: 549-554. 10.1136/jcp.2006.037523PubMedCentralCrossRefPubMed
20.
Friedlander MH, Simon R, Machiedo GW: The relationship of packed cell transfusion to red blood cell deformability in systemic inflammatory response syndrome patients. Shock 1998, 9: 84-88. 10.1097/00024382-199802000-00002CrossRefPubMed
21.
Ho J, Sibbald WJ, Chin-Yee IH: Effects of storage on efficacy of red cell transfusion: when is it not safe? Crit Care Med 2003, 31: S687-S697. 10.1097/01.CCM.0000099349.17094.A3CrossRefPubMed
22.
Peck CC, Moore GL, Bolin RB: Adenine in blood preservation. Crit Rev Clin Lab Sci 1981, 13: 173-212. 10.3109/10408368109106447CrossRefPubMed
23.
Raat NJ, Verhoeven AJ, Mik EG, Gouwerok CW, Verhaar R, Goedhart PT, de Korte D, Ince C: The effect of storage time of human red cells on intestinal microcirculatory oxygenation in a rat isovolemic exchange model. Crit Care Med 2005, 33: 39-45. 10.1097/01.CCM.0000150655.75519.02CrossRefPubMed
24.
Lelubre C, Piagnerelli M, Vincent JL: Association between duration of storage of red blood cells and morbidity and mortality in adult patients: myth or reality? Transfusion 2009, 49: 1384-1394. 10.1111/j.1537-2995.2009.02211.xCrossRefPubMed
25.
Fernandes CJ Jr, Akamine N, De Marco FV, De Souza JA, Lagudis S, Knobel E: Red blood cell transfusion does not increase oxygen consumption in critically ill septic patients. Crit Care 2001, 5: 362-367. 10.1186/cc1070PubMedCentralCrossRefPubMed
26.
Leal-Noval SR, Munoz-Gomez M, Arellano-Orden V, Marin-Caballos A, Amaya-Villar R, Marin A, Puppo-Moreno A, Ferrandiz-Millon C, Flores-Cordero JM, Murillo-Cabezas F: Impact of age of transfused blood on cerebral oxygenation in male patients with severe traumatic brain injury. Crit Care Med 2008, 36: 1290-1296. 10.1097/CCM.0b013e3181692dfcCrossRefPubMed
27.
Piagnerelli M, Silva E, Garrido A, Lambermont M, Knobel E, Vincent JL, De Backer D: Age of red blood cell transfusions in critically ill patients: comparison of two opposite transfusion policies. Intensive Care Med 2003, 29: 660-661. 10.1007/s00134-003-1783-2CrossRefPubMed
28.
Vallet B: Vascular reactivity and tissue oxygenation. Intensive Care Med 1998, 24: 3-11. 10.1007/s001340050507CrossRefPubMed
29.
De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL: Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002, 166: 98-104. 10.1164/rccm.200109-016OCCrossRefPubMed
30.
De Backer D, Creteur J, Dubois MJ, Sakr Y, Vincent JL: Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 2004, 147: 91-99. 10.1016/j.ahj.2003.07.006CrossRefPubMed
31.
Jhanji S, Lee C, Watson D, Hinds C, Pearse RM: Microvascular flow and tissue oxygenation after major abdominal surgery: association with post-operative complications. Intensive Care Med 2009, 35: 671-677. 10.1007/s00134-008-1325-zCrossRefPubMed
32.
Creteur J, Carollo T, Soldati G, Buchele G, De Backer D, Vincent JL: The prognostic value of muscle StO 2 in septic patients. Intensive Care Med 2007, 33: 1549-1556. 10.1007/s00134-007-0739-3CrossRefPubMed
33.
Pohl U, Busse R: Hypoxia stimulates release of endothelium-derived relaxant factor. Am J Physiol 1989, 256: H1595-H1600.PubMed
34.
Curtis SE, Vallet B, Winn MJ, Caufield JB, King CE, Chapler CK, Cain SM: Role of the vascular endothelium in O 2 extraction during progressive ischemia in canine skeletal muscle. J Appl Physiol 1995, 79: 1351-1360.PubMed
35.
Greenberg B, Kishiyama S: Endothelium-dependent and -independent responses to severe hypoxia in rat pulmonary artery. Am J Physiol 1993, 265: H1712-H1720.PubMed
36.
Vallet B, Curtis SE, Winn MJ, King CE, Chapler CK, Cain SM: Hypoxic vasodilation does not require nitric oxide (EDRF/NO) synthesis. J Appl Physiol 1994, 76: 1256-1261. 10.1063/1.357854CrossRefPubMed
37.
Landry DW, Oliver JA: The pathogenesis of vasodilatory shock. N Engl J Med 2001, 345: 588-595. 10.1056/NEJMra002709CrossRefPubMed
38.
Cosby K, Partovi KS, Crawford JH, Patel RP, Reiter CD, Martyr S, Yang BK, Waclawiw MA, Zalos G, Xu X, Huang KT, Shields H, Kim-Shapiro DB, Schechter AN, Cannon RO III, Gladwin MT: Nitrite reduction to nitric oxide by deoxyhemoglobin vasodilates the human circulation. Nat Med 2003, 9: 1498-1505. 10.1038/nm954CrossRefPubMed
39.
Jia L, Bonaventura C, Bonaventura J, Stamler JS: S-nitrosohaemoglobin: a dynamic activity of blood involved in vascular control. Nature 1996, 380: 221-226. 10.1038/380221a0CrossRefPubMed
40.
Ellsworth ML: The red blood cell as an oxygen sensor: what is the evidence? Acta Physiol Scand 2000, 168: 551-559. 10.1046/j.1365-201x.2000.00708.xCrossRefPubMed
41.
Crookes BA, Cohn SM, Bloch S, Amortegui J, Manning R, Li P, Proctor MS, Hallal A, Blackbourne LH, Benjamin R, Soffer D, Habib F, Schulman CI, Duncan R, Proctor KG: Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma 2005, 58: 806-813. 10.1097/01.TA.0000158269.68409.1CCrossRefPubMed
42.
Desjardins C, Duling BR: Heparinase treatment suggests a role for the endothelial cell glycocalyx in regulation of capillary hematocrit. Am J Physiol 1990, 258: H647-H654.PubMed
43.
Klitzman B, Duling BR: Microvascular hematocrit and red cell flow in resting and contracting striated muscle. Am J Physiol 1979, 237: H481-H490.PubMed
44.
Sarelius IH, Duling BR: Direct measurement of microvessel hematocrit, red cell flux, velocity, and transit time. Am J Physiol 1982, 243: H1018-H1026.PubMed
45.
Doerschug KC, Delsing AS, Schmidt GA, Haynes WG: Impairments in microvascular reactivity are related to organ failure in human sepsis. Am J Physiol Heart Circ Physiol 2007, 293: H1065-H1071. 10.1152/ajpheart.01237.2006CrossRefPubMed
46.
van Beekvelt MC, Borghuis MS, van Engelen BG, Wevers RA, Colier WN: Adipose tissue thickness affects in vivo quantitative near-IR spectroscopy in human skeletal muscle. Clin Sci (Lond) 2001, 101: 21-28. 10.1042/CS20000247CrossRef
Metadata
Title
Near-infrared spectroscopy technique to evaluate the effects of red blood cell transfusion on tissue oxygenation
Authors
Jacques Creteur
Ana Paula Neves
Jean-Louis Vincent
Publication date
01-10-2009
Publisher
BioMed Central
Published in
Critical Care / Issue Special Issue 5/2009
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc8009

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