Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury: A preliminary study

Abstract

Objective: To investigate the long-term influence of erythrocyte transfusion on cerebral oxygenation in patients with severe traumatic brain injury. Design: Prospective and observational study. Setting: Neurotrauma intensive care unit of trauma center level I. Patients: Sixty consecutive, hemodynamically stable patients with severe traumatic brain injury, pretransfusion hemoglobin < 100 g/l, non-bleeding and monitored through intracranial pressure and brain tissue partial pressure of oxygen (PtiO 2) catheters were included. Interventions: Transfusion of 1-2 units of red blood cells. Measurements and results: Ten sets of variables (pretransfusion, end of transfusion, and 1, 2, 3, 4, 5, 6, 12 and 24 h after transfusion) were recorded, including: PtiO2, cerebral perfusion pressure (CPP), end-tidal CO2, peripheral saturation of oxygen, temperature, hemoglobin, lactate and PaO2/FiO2 ratio. Transfusion was associated with an increase in PtiO2 during a 6-h period, with a peak at 3 h (26.2%; p = 0.0001) in 78.3% of the patients. No relationship was observed between PtiO2, CPP and hemoglobin increments. The relative increment in PtiO2 at hour 3 was only correlated with baseline PtiO2 (r2 0.166; p = 0.001). All of the patients with basal PtiO2 < 15 mmHg showed an increment in PtiO2 versus 74.5% of patients with basal PtiO2 ≥ 15 mmHg (p < 0.01, hour 3). Conclusions: Erythrocyte transfusion is associated with a variable and prolonged increment of cerebral tissue oxygenation in anemic patients with severe traumatic brain injury. Low baseline PtiO2 levels (< 15 mmHg) could define those patients who benefit the most from erythrocyte transfusion. © 2006 Springer-Verlag.