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Critical Care
Published in: Critical Care 6/2001

Open Access 01-12-2001 | Research

Red blood cell transfusion does not increase oxygen consumption in critically ill septic patients

Authors: Constantino J Fernandes Jr, Nelson Akamine, Fernando VC De Marco, José AM De Souza, Sofia Lagudis, Elias Knobel

Published in: Critical Care | Issue 6/2001

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Abstract

Background

Red blood cell (RBC) transfusion is commonly used to increase oxygen transport in patients with sepsis. However it does not consistently increase oxygen uptake at either the whole-body level, as calculated by the Fick method, or within individual organs, as assessed by gastric intra-mucosal pH.

Aim

This study evaluates the hemodynamic and oxygen utilization effects of hemoglobin infusion on critically ill septic patients.

Methods

Fifteen septic patients undergoing mechanical ventilation whose hemoglobin was <10 g% were eligible. Ten patients (APACHE II: 25.5 ± 7.6) received an infusion of 1 unit of packed RBC over 1 h while sedated and paralyzed. The remaining five control patients (APACHE II: 24.3 ± 6.0) received a 5% albumin solution (500 ml) over 1 h. Hemodynamic data, gastric tonometry and calorimetry were obtained prior to and immediately after RBC transfusion or 5% albumin infusion.

Results

Transfusion of RBC was associated with an improvement in left ventricular systolic work index (38.6 ± 12.6 to 41.1 ± 13.0 g/min/m2; P = 0.04). In the control group there was no significant change in the left ventricular systolic work index (37.2 ± 14.3 to 42.2 ± 18.9 g/min/m2). An increase in pulmonary vascular resistance index (203 ± 58 to 238 ± 49 dyne/cm5/m2; P = 0.04) was also observed, while no change was produced by colloid infusion (237 ± 87.8 to 226.4 ± 57.8 dyne/cm5/m2). Oxygen utilization did not increase either by Fick equation or by indirect calorimetry in either group. Gastric intramucosal pH increased only in the control group but did not reach statistical significance.

Conclusion

Hemoglobin increase does not improve either global or regional oxygen utilization in anemic septic patients. Furthermore, RBC transfusion may hamper right ventricular ejection by increasing the pulmonary vascular resistance index.
Literature
1.
Task Force of the American College of Critical Care Medicine, Society of Critical Care Medicine: Practice parameters for hemodynamic support of sepsis in adult patients in sepsis. Crit Care Med 1999, 27: 639-660.CrossRef
2.
Rashkin MC, Bosken C, Baughman RP: Oxygen delivery in critically ill patients: relationship to blood lactate and survival. Chest 1985, 87: 580-584.CrossRefPubMed
3.
Weg JG: Oxygen transport in adult respiratory distress syndrome and other acute circulatory problems: relationship of oxygen delivery and oxygen consumption. Crit Care Med 1991, 19: 650-657.CrossRefPubMed
4.
Ronco JJ, Phang PT, Walley KR, Wiggs B, Fenwick JC, Russel JA: Oxygen consumption is independent of changes in oxygen delivery in severe adult respiratory distress syndrome. Am Rev Respir Dis 1991, 143: 1267-1273.CrossRefPubMed
5.
Bartlett RH, Dechert RE: Oxygen kinetics: pitfalls in clinical research. J Crit Care 1990, 5: 77-80.CrossRef
6.
Marik P, Sibbald W: Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 1993, 269: 3024-3029. 10.1001/jama.269.23.3024CrossRefPubMed
7.
Society of Critical Care Medicine Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Crit Care Med 1992, 20: 864-874.CrossRef
8.
Creteur J, De Backer D, Vincent JL: Monitoring gastric mucosal carbon dioxide pressure using gas tonometry: in vitro and in vivo validation studies. Anesthesiology 1997, 87: 504-510. 10.1097/00000542-199709000-00008CrossRefPubMed
9.
Ronco JJ, Phang PT: Validation of an indirect calorimeter to measure oxygen consumption in critically ill patients. J Crit Care 1991, 6: 36-41.CrossRef
10.
Knaus WA, Draper EA, Wagner DP, Zimmerman JE: APACHE II: a severity of disease classification system. Crit Care Med 1985, 13: 818-829.CrossRefPubMed
11.
Sugerman HJ, Davidson DT, Vibul S, Delivoria-Papadopoulos M, Miller LD, Oski FA: The basis of defective oxygen delivery from stored blood. Surg Gynecol Obstet 1970, 131: 733-741.PubMed
12.
Apstein CS, Dennis RC, Briggs L, Vogeli WM, Fracer J, Valeri CR: Effect of erythrocyte storage and oxyhemoglobin affinity changes on cardiac function. Am J Physiol 1985, 285(suppl): H508-H515.
13.
Epstein CD, Peerless JR, Martin JE, Malangoni MA: Comparison of methods of measurements of oxygen consumption in mechanically ventilated patients with multiple trauma: the Fick method versus indirect calorimetry. Crit Care Med 2000, 28: 1363-1369. 10.1097/00003246-200005000-00017CrossRefPubMed
14.
15.
Marik PE: Gastric intramucosal pH: a better predictor of multi-organ dysfunction syndrome than oxygen-derived variables in patients with sepsis. Chest 1993, 104: 225-229.CrossRefPubMed
16.
Doglio GR, Pusajo JF, Egurrola A, Bonfigli GC, Parra C, Vetere L, Hernandez MS, Palizas F, Gutierrez G: Gastric mucosal pH as a prognostic index of mortality in critically ill patients. Crit Care Med 1992, 19: 1037-1040.CrossRef
17.
Fink MP: Gastrointestinal mucosal injury in experimental models of shock, trauma and sepsis. Crit Care Med 1991, 19: 627-641.CrossRefPubMed
18.
Mythen MG, Webb AR: The role of gut mucosal hypoperfusion in the pathogenesis of post-operative organ dysfunction. Intensive Care Med 1994, 20: 203-209.CrossRefPubMed
19.
Nelson D, Beyer C, Samsel R, Wood LD, Schumacker PT: Pathologic supply dependence of systemic and intestinal O 2 uptake during bacteremia in the dog. J Appl Physiol 1987, 63: 1487-1489.PubMed
20.
Dietrich KA, Contrad SA, Herbert 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.CrossRefPubMed
21.
Argwal JB, Paltoo R, Palmer WH: Relative viscosity of blood at varying hematocrits in pulmonary circulation. J Appl Physiol 1970, 29: 866-871.
22.
Lamke LO, Liljedahl SO: Plasma volume changes after infusion of various plasma expanders. Resuscitation 1976, 5: 85-92.CrossRefPubMed
23.
Shoemaker WC: Comparisons of the relative effectiveness of whole blood transfusions and various types of fluid therapy in resuscitation. Crit Care Med 1976, 4: 71-78.CrossRefPubMed
24.
Cochrane Injuries Group Albumin Reviewers: Human albumin administration in critically ill patients: systematic review of randomized controlled trials. Br Med J 1998, 317: 235-240.CrossRef
25.
26.
Boldt J, Mueller M, Menges T, Papsdorf M, Hempelmann G: Influence of different volume therapy regimens on regulators of circulation in the critically ill. Br J Anaesthiol 1996, 77: 480-487.CrossRef
27.
Boldt J, Mueller M, Heesen M: Influence of different volume therapies and pentoxifyline infusion on circulating soluble adhesion molecules in critically ill patients. Crit Care Med 1996, 24: 385-391. 10.1097/00003246-199603000-00005CrossRefPubMed
28.
Boldt J, Heesen M, Mueller M, Papsdorf M, Hempelmann G: The effects of albumin versus hydroxyethyl starch solution on cardiorespiratory and circulatory variables in critically ill patients. Anesth Analg 1996, 83: 254-261.PubMed
29.
Forrest DM, Baigorri F, Chittock DR, Spinelli JJ, Russell JA: Volume expansion using pentastarch does not change gastric arterial CO 2 gradient or gastric intramucosal pH in patients who have sepsis syndrome. Crit Care Med 2000, 28: 2254-2258.CrossRefPubMed
30.
Marik PE, Iglesias J: Would the colloid detractors please sit down! Crit Care Med 2000, 28: 2652-2654.CrossRefPubMed
31.
Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E, The Transfusion Requirements in Critical Care Investigators for the Canadian Critical Care Trials Group: A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. N Engl J Med 1999, 340: 409-417. 10.1056/NEJM199902113400601CrossRefPubMed
32.
Bacher A, Mayer N, Rajek AM, Haider W: Acute normovolaemic haemodilution does not aggravate gastric mucosal acidosis during cardiac surgery. Intensive Care Med 1998, 24: 313-321. 10.1007/s001340050573CrossRefPubMed
Metadata
Title
Red blood cell transfusion does not increase oxygen consumption in critically ill septic patients
Authors
Constantino J Fernandes Jr
Nelson Akamine
Fernando VC De Marco
José AM De Souza
Sofia Lagudis
Elias Knobel
Publication date
01-12-2001
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2001
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc1070

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