Effects of Red Blood Cell Transfusion on Long-Term Disability of Patients with Traumatic Brain Injury

Leal-Noval, Santiago R.; Muñoz-Serrano, Ángela; Arellano-Orden, Victoria; Cayuela, Aurelio; Múñoz-Gómez, Manuel; Recio, Antonio; A, Alcantara; Amaya-Villar, Rosario; Casado-Méndez, Manuel; Murillo-Cabezas, Francisco

doi:10.1007/s12028-015-0220-z

Cited by 26 publications

(18 citation statements)

References 23 publications

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“…[1][2][3] Although anemia is associated with secondary brain injury, 4 its independent association with unfavourable outcomes is uncertain. [5][6][7] While RBC transfusion and the adoption of a more liberal transfusion strategy have been suggested to improve tissue oxygenation in the injured brain, [8][9][10][11] several observational studies report deleterious effects of transfusion in this population. 5,[12][13][14] Large clinical trials have shown that restrictive transfusion strategies (higher threshold to transfuse) are as safe as liberal strategies (lower threshold) in critically ill pediatric and adult patients.…”

Section: Résumémentioning

confidence: 99%

“…17 Of note, patients with TBI were underrepresented in these studies. 18 While uncontrolled observational studies have reported an association between transfusion or transfusion volume and adverse neurological outcome in patients with TBI, 5,9,12,13,19,20 few comparative studies have been conducted to clarify the effect of transfusion or anemia in this patient population, 21 and very few have assessed the impact of transfusion on clinical outcome. In a trial of 200 TBI patients randomized to a restrictive or liberal RBC transfusion strategy, no difference in neurologic outcome was observed.…”

Section: Résumémentioning

confidence: 99%

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Red blood cell transfusion in critically ill patients with traumatic brain injury: an international survey of physicians’ attitudes

Bonaventure

Lauzier

Zarychanski

et al. 2019

Can J Anesth/J Can Anesth

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Introduction Restrictive transfusion strategies have been advocated in critically ill patients. Nevertheless, considerable uncertainty exists regarding optimal transfusion thresholds in traumatic brain injury (TBI) patients because the injured brain is susceptible to hypoxemic damage. We aimed to identify the determinants of red blood cell (RBC) transfusion and the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12630-019-01369-w) contains supplementary material, which is available to authorized users.

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Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

Red blood cell transfusion in critically ill patients with traumatic brain injury: an international survey of physicians’ attitudes

Bonaventure

Lauzier

Zarychanski

et al. 2019

Can J Anesth/J Can Anesth

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“…14,40,43,45,46 Literature on long-term functional outcomes with RBCT in TBI patients is limited and fails to show any improvement following RBCT. [45][46][47] Both Hb and cerebral oxygenation-based targets have been used and studied to decide RBCT in these patients. In studies targeting physiologic parameters, RBCT has shown differential improvement in TBI patients.…”

Section: Traumatic Brain Injurymentioning

confidence: 99%

Red Blood Cell Transfusion Practices in the Neurointensive Care Unit: A Narrative Review

Surve

Bansal

Radhakrishnan

2019

Journal of Neuroanaesthesiology and Critical Care

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Anemia is common in neurointensive care unit (NICU) patients and is one of the common causes of systemic insults to the brain. Though the recent literature favors restrictive blood transfusion practices over liberal transfusion to correct anemia in the general ICU, whether a similar practice can be adopted in NICU patients is doubtful due to lack of strong evidence. Impairment of cerebral autoregulation and cardiac function following acute brain injury affects the body's compensatory mechanism to anemia and renders the brain susceptible to anemic hypoxia at different hemoglobin (Hb) thresholds. Hence, red blood cell transfusion (RBCT) practice based on a single Hb threshold value might be inappropriate. On the other hand, allogenic RBCT has its own risks, both in short and in long run, leading to adverse outcomes. Thus, instead of relying only on arbitrary Hb values, a better way to decide the need for RBCT in NICU patients is to target parameters based on systemic and regional cerebral oxygenation. This approach will help us to individualize RBCT practices. In this narrative review, based on the available literature, authors have discussed the impact of anemia and blood transfusion on the immediate and late neurological outcomes and the current role of regional brain monitoring in guiding blood transfusion practices. In the end, authors have tried to update on the current RBCT practices in neurosurgical and neuromedical patients admitted to the NICU.

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“…However, the potential benefits of RBCT to avoid anemia and reduce cerebral tissue hypoxia may be opposed by the potentially adverse effects related to this therapy [ 25 ▪ ]. Several studies have shown that RBCT administration in TBI is associated with increased mortality [ 11 , 14 , 34 , 41 , 42 , 43 ▪▪ , 44 ], decreased functional outcomes [ 39 , 42 , 45 ▪ , 46 ], increased ICU length of stay [ 47 ], and impaired cerebral autoregulation [ 48 ]. Furthermore, compared to a restrictive strategy, a liberal transfusion strategy applying a threshold trigger of 10 g/dl was associated with an increased risk of progressive cerebral hemorrhagic injury [ 49 ▪ ] and thromboembolic events [ 10 ].…”

Section: Effects Of Anemia and Red Blood Cell Transfusions On Traumatmentioning

confidence: 99%

Transfusion practices in traumatic brain injury

East

Viau-Lapointe

McCredie

2018

Current Opinion in Anaesthesiology

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Purpose of reviewThe aim of this review is to summarize the recent studies looking at the effects of anemia and red blood cell transfusion in critically-ill patients with traumatic brain injury (TBI), describe the transfusion practice variations observed worldwide, and outline the ongoing trials evaluating restrictive versus liberal transfusion strategies for TBI.Recent findingsAnemia is common among critically-ill patients with TBI, it is also thought to exacerbate secondary brain injury, and is associated with an increased risk of poor outcome. Conversely, allogenic red blood cell transfusion carries its own risks and complications, and has been associated with worse outcomes. Globally, there are large reported differences in the hemoglobin threshold used for transfusion after TBI. Observational studies have shown differential results for improvements in cerebral oxygenation and metabolism after red blood cell transfusion in TBI.SummaryCurrently, there is insufficient evidence to make strong recommendations regarding which hemoglobin threshold to use as a transfusion trigger in critically-ill patients with TBI. There is also uncertainty whether the restrictive transfusion strategy used in general critical care can be extrapolated to acutely brain injured patients. Ultimately, the consequences of anemia-induced cerebral injury need to be weighed up against the risks and complications associated with red blood cell transfusion.

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Effects of Red Blood Cell Transfusion on Long-Term Disability of Patients with Traumatic Brain Injury

Abstract: Our results strongly suggest an independent association between RBCT and unfavorable long-term functional outcomes of patients with TBI.

Cited by 26 publications

References 23 publications

Red blood cell transfusion in critically ill patients with traumatic brain injury: an international survey of physicians’ attitudes

Red blood cell transfusion in critically ill patients with traumatic brain injury: an international survey of physicians’ attitudes

Red Blood Cell Transfusion Practices in the Neurointensive Care Unit: A Narrative Review

Transfusion practices in traumatic brain injury

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