Research Article
Volume 5 Issue 7 - 2021
Effect of Erythrocyte Transfusion on Hemodynamic and Oxygenation Parameters in ICU Patients
Ahlem Trifi*, Asma Mehdi, Yosr Touil, Foued Daly, Cyrine Abdennebi, Sami Abdellatif and Salah Ben Lakhal
Medical Intensive Care Unit, University Hospital Center La Rabta and Faculty of Medicine, University Tunis, El Manar, Tunis, Tunisia
*Corresponding Author: Ahlem Trifi, Medical Intensive Care Unit, University Hospital Center La Rabta and Faculty of Medicine, University Tunis, El Manar, Tunis, Tunisia.
Received: June 07, 2021; Published: June 30, 2021




Abstract

Objective: To investigate the effects of erythrocyte transfusion (ET) on systemic hemodynamic and oxygenation variables in ICU patients with non-hemorrhagic anemia.

Methods: A cross-sectional study with a comparative approach on paired series (before versus after ET) conducted in the medical intensive care unit (ICU) of the Rabta University Hospital Center, Tunis-Tunisia during a period of 1 year (July 2019 - July 2020). Were included, patients receiving ET for non-hemorrhagic anemia. Hemodynamic and oxygenation parameters were obtained using cardiac Ultrasound-Doppler coupled with arterial and central venous gases. All parameters were taken just before ET and compared with those taken 2 hours after ET. Secondly, the analysis was adjusted according to the presence or not of septic shock.

Results: 50 ET were studied in 36 patients. The transfusion of 1 RBC induced: a significant increase in Hb (from 6,8 to 7,9 g/dl, p < 10-3), in CaO2 (from 9.2 to 10.5 ml/dl, p < 10-3) and in ScVO2 (from 73.5% to 78%, p = 0.002) with a significant decrease in CO (from 5.77 to 4.7 l/mn, p = 0.009). The increase in Hb and CaO2 did not increase O2 delivery (DO2: from 526 to 514 ml/mn, p = 0.68) that it was related to the decrease in CO. Also, lactates level not changed. In patients with septic shock, it was revealed a significant decrease in CO and DO2 without change in ScVO2.

Conclusion: Despite the raise in Hb and CaO2 after ET, DO2 did not increase due to the decrease in CO resulting from the blood hyper-viscosity. In patients with septic shock, DO2 even decreased.

Keywords: Red Blood Cells; Transfusion; Cardiac Output; Haematosis; Intensive Care

References

  1. Astin R., et al. “Anaemia secondary to critical illness: an unexplained phenomenon”. Extreme Physiology and Medicine (2014): 4.
  2. Corwin HL., et al. “The Crit study: anemia and blood transfusion in the critically ill-current clinical practice in the United States”. Critical Care Medicine (2004): 39-52.
  3. Vincent JL., et al. “Anemia and blood transfusion in critically ill patients”. The Journal of the American Medical Association (2002): 1499-1507.
  4. Ahsen N., et al. “Important role of non diagnostic blood loss and blunted erythropoietic response in the anemia of medical intensive care patients”. Critical Care Medicine (2001): 2630-2639.
  5. Weiss G., et al. “Anemia of chronic disease”. The New England Journal of Medicine (2005): 1011-1023.
  6. Hayden SJ., et al. “Anemia in critical illness: insights into etiology, consequences, and management”. American Journal of Respiratory and Critical Care Medicine (2012): 1049-1057.
  7. Hébert PC., et al. “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”. The New England Journal of Medicine (1999): 409-417.
  8. Corwin HL., et al. “Efficacy and safety of epoetin alfa in critically ill patients”. The New England Journal of Medicine (2007): 965-976.
  9. Cavalcante Dos Santos., et al. “How have red blood transfusion practices changed in critically ill patients? A comparison of the ICON and ABC studies conducted 13 years apart”. Transfusion (2020): 2801-2806.
  10. Hébert PC., et al. “Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group”. American Journal of Respiratory and Critical Care Medicine (1997): 1618-1623.
  11. Wu WC., et al. “Blood transfusion in elderly patients with acute myocardial infarction”. The New England Journal of Medicine (2001): 1230-1236.
  12. Gestion et prévention de l’anémie (hors hémorragie aigüe) chez le patient adulte de soins critiques Recommandations Formalisées d’Experts”. SFAR, SRLF (2019).
  13. Holst LB., et al. “Restrictive versus liberal transfusion strategy for red blood cell transfusion: systematic review of randomised trials with meta-analysis and trial sequential analysis”. British Medical Journal (2015): 350.
  14. Saugel B., et al. “Effects of red blood cell transfusion on hemodynamic parameters: a prospective study in intensive care unit patients”. Scandinavian Journal of Trauma, Resuscitation (2013): 21.
  15. Zeroual N., et al. “ScvO2 changes after red‐blood‐cell transfusion for anemia in cardiothoracic and vascular ICU patients: an observational study”. Vox Sanguinis (2018): 136-142.
  16. Surve RM., et al. “The effect of blood transfusion on central venous oxygen saturation in critically ill patients admitted to a neurointensive care unit”. Transfusion Medicine (2016): 343-448.
  17. Mungayi V., et al. “Blood transfusion and oxygen extraction ratio in patients admitted to the general intensive care unit: a quasi experimental study”. African Journal of Emergency Medicine (2014): 66-70.
  18. Cornet AD., et al. “Pulmonary effects of red blood cell transfusion in critically ill, non‐bleeding patients”. Transfusion Medicine (2010): 221-226.
  19. Sadaka F., et al. “The effect of red blood cell transfusion on tissue oxygenation and microcirculation in severe septic patients”. Annals of Intensive Care (2011): 46.
  20. Cavalcante Dos Santos E., et al. “Systematic Review and Meta-Analysis of Effects of Transfusion on Hemodynamic and Oxygenation Variables”. Critical Care Medicine (2020): 241-248.
  21. Roberts J., et al. “Oxygen delivery in septic shock”. Annals of the American Thoracic Society (2015): 952-955.
  22. Vincent JL., et al. “Restrictive versus more liberal blood transfusions? The answer is in your heart”. Minerva Anestesiologica (2016): 511-513.
  23. Mazza BF., et al. “Evaluation of blood transfusion effects on mixed venous oxygen saturation and lactate levels in patients with SIRS/sepsis”. Clinics (2005): 311-316.
  24. Fogagnolo A., et al. “Using arterial-venous oxygen difference to guide red blood cell transfusion strategy”. Crit Care (2020): 160.
  25. Gramm J., et al. “Effect of transfusion on oxygen transport in critically ill patients”. Shock (1996): 190-193.
  26. Casutt M., et al. “Factors influencing the individual effects of blood transfusions on oxygen delivery and oxygen consumption”. Critical Care Medicine (2001): 173-179.
  27. Gilbert EM., et al. “The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis”. The American Review of Respiratory Disease (1986): 873-878.
Citation: Ahlem Trifi., et al.“Effect of Erythrocyte Transfusion on Hemodynamic and Oxygenation Parameters in ICU Patients”. EC Emergency Medicine and Critical Care 5.7 (2021): 106-117.

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