Regional cerebral tissue oxygen saturation changes following blood transfusion in neuro‐intensive care unit patients – a pilot observational study

Radhakrishnan, M.; Shaikh, N. A.; Surve, Rohini M.; Ganne, Umamaheswara Rao S.; Philip, Mariamma

doi:10.1111/tme.12504

Cited by 10 publications

(5 citation statements)

References 27 publications

(27 reference statements)

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“…While we identified a number of studies evaluating alternative transfusion triggers such as ScVO2 [75][76][77][78], arteriovenous oxygen difference [79][80][81][82], cerebral oxygenation [82][83][84][85], tissue oxygenation, lactate [86][87][88][89][90], veno-arterial oxygen gradient [91,92], and mitochondrial oxygen [93], only one RCT [85] prospectively compared the use of physiologic transfusion triggers to traditional haemoglobin/haematocrit-based approaches. This RCT randomized patients to a "generic" algorithm or "patient-specific" algorithm involving measurement of cerebral oxygenation during cardiac surgery, of which transfusion was one component.…”

Section: Evidence Summarymentioning

confidence: 99%

Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

et al. 2020

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Objective: To develop evidence-based clinical practice recommendations regarding transfusion practices in nonbleeding, critically ill adults. Design: A task force involving 13 international experts and three methodologists used the GRADE approach for guideline development. Methods: The task force identified four main topics: red blood cell transfusion thresholds, red blood cell transfusion avoidance strategies, platelet transfusion, and plasma transfusion. The panel developed structured guideline questions using population, intervention, comparison, and outcomes (PICO) format. Results: The task force generated 16 clinical practice recommendations (3 strong recommendations, 13 conditional recommendations), and identified five PICOs with insufficient evidence to make any recommendation. Conclusions: This clinical practice guideline provides evidence-based recommendations and identifies areas where further research is needed regarding transfusion practices and transfusion avoidance in non-bleeding, critically ill adults.

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Section: Evidence Summarymentioning

confidence: 99%

Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

et al. 2020

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“…Several physiological factors have been shown to influence rScO 2 and V MCA including cardiac output, hemoglobin, and body temperature 25 . In this study, all the measurements were performed before surgery to eliminate the impact of surgical stimulation leading to cerebral hemodynamics changes.…”

Section: Discussionmentioning

confidence: 99%

Age‐related cerebrovascular carbon dioxide reactivity in children with ventricular septal defect younger than 3 years

Cui

Ouyang

Xie

et al. 2020

Pediatric Anesthesia

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Advances in medical care have improved the survival of many neonates and infants with congenital heart disease (CHD). However, adverse neurodevelopmental outcomes in children with CHD still exist. In children undergoing cardiac surgery, impaired cerebrovascular reactivity to carbon dioxide reactivity (CO 2 R) and lower levels of regional cerebral oxygen saturation (rScO 2) contribute to neurologic morbidity. 1 Carbon dioxide reactivity is a vasomotor response to changes in endtidal carbon dioxide pressure(P ET CO 2) 1 and leads to changes in cerebral blood flow(CBF) and cerebral blood volume. 2 Pulmonary hypertension in infants with CHD is commonly associated with left-to-right shunt defects. Hyperventilation, which is used to reduce pulmonary vascular resistance, has been reported to negatively impact CO 2 R. Impaired CO 2 R is often associated with poor patient outcome, 3 and it can also be affected by age even in healthy individuals 4 Previous studies have reported that CO 2 R is higher in children 5 and lower in adults. 6 Age-related differences in

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“…Studies have reported a decrease in c-rSO 2 with vasopressor infusion both in aSAH ( 48 ) and healthy patients ( 49 ), whereas it improved c-rSO2 values in the first few hours post-cardiac arrest ( 50 ). Studies reporting the effect of red blood cell transfusions in neurocritical care patients, a minority of which were aSAH, have also yielded conflicting results ( 51 – 53 ). Controlled hypercapnia, in the range of 50–60 mmHg, had some success to improve c-rSO 2 in two studies involving aSAH patients ( 22 , 54 ).…”

Section: Physiological Data—oxygenation Blood Flow Cerebrovascular Re...mentioning

confidence: 99%

Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage—A Concise Review

et al. 2022

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Delayed cerebral ischemia (DCI) disproportionately affects poor grade aneurysmal subarachnoid hemorrhage (aSAH) patients. An unreliable neurological exam and the lack of appropriate monitoring leads to unrecognized DCI, which in turn is associated with severe long-term deficits and higher mortality. Near Infrared Spectroscopy (NIRS) offers simple, continuous, real time, non-invasive cerebral monitoring. It provides regional cerebral oxygen saturation (c-rSO2), which reflects the balance between cerebral oxygen consumption and supply. Reports have demonstrated a good correlation with other cerebral oxygen and blood flow monitoring, and credible cerebrovascular reactivity indices were also derived from NIRS signals. Multiple critical c-rSO2 values have been reported in aSAH patients, based on various thresholds, duration, variation from baseline or cerebrovascular reactivity indices. Some were associated with vasospasm, some with DCI and others with clinical outcomes. However, the poor grade aSAH population has not been specifically studied and no randomized clinical trial has been published. The available literature does not support a specific NIRS-based intervention threshold to guide diagnostic or treatment in aSAH patients. We review herein the fundamental basic concepts behind NIRS technology, relationship of c-rSO2 to other brain monitoring values and their potential clinical interpretation. We follow with a critical evaluation of the use of NIRS in the aSAH population, more specifically its ability to diagnose vasospasm, to predict DCI and its association to outcome. In summary, NIRS might offer significant potential for poor grade aSAH in the future. However, current evidence does not support its use in clinical decision-making, and proper technology evaluation is required.

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Regional cerebral tissue oxygen saturation changes following blood transfusion in neuro‐intensive care unit patients – a pilot observational study

Abstract: RBC transfusion increased rSO significantly on both sides of the brain. As patients' outcomes were not studied, whether this increase in regional cerebral oxygen saturation is beneficial or if it is because of excess DO is still unclear. Further studies are required to clarify this issue.

Cited by 10 publications

References 27 publications

Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Transfusion strategies in non-bleeding critically ill adults: a clinical practice guideline from the European Society of Intensive Care Medicine

Age‐related cerebrovascular carbon dioxide reactivity in children with ventricular septal defect younger than 3 years

Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage—A Concise Review

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