The effect of red blood cell transfusion on tissue oxygenation and microcirculation in severe septic patients

Abstract

BackgroundMicrocirculation plays a vital role in the development of multiple organ failure in severe sepsis. The effects of red blood cell (RBC) transfusions on these tissue oxygenation and microcirculation variables in early severe sepsis are not well defined.MethodsThis is a prospective, observational study of patients with severe sepsis requiring RBC transfusions of one to two units of non-leukoreduced RBCs for a hemoglobin < 7.0, or for a hemoglobin between 7.0 and 9.0 with lactic acidosis or central venous oxygen saturation < 70%. This study took place in a 54-bed, medical-surgical intensive care unit of a university-affiliated hospital. Thenar tissue oxygen saturation was measured by using a tissue spectrometer on 21 patients, and a vaso-occlusive test was performed before and 1 hour after transfusion. The sublingual microcirculation was assessed with a Sidestream Dark Field device concomitantly on 11 of them.ResultsRBC transfusion resulted in increase in hemoglobin (7.23 (± 0.87) to 8.75 (± 1.06) g/dl; p < 0.001). RBC transfusion did not globally affect near-infrared spectrometry (NIRS)-derived variables. However, percent change in muscle oxygen consumption was negatively correlated with baseline (r = - 0.679, p = 0.001). There was no statistically significant correlation between percent change in vascular reactivity and baseline (p = 0.275). There was a positive correlation between percent change in oxygen consumption and percent change in vascular reactivity (r = 0.442, p = 0.045). In the 11 patients, RBC transfusion did not globally affect NIRS-derived variables or SDF-derived variables. There was no statistically significant correlation between percent change in small vessel perfusion and baseline perfusion (r = -0.474, p = 0.141), between percent change in small vessel flow and baseline flow (r = -0.418, p = 0.201), or between percent change in small vessel perfusion and percent change in small vessel flow (r = 0.435, p = 0.182).ConclusionsIn a small sample population, muscle tissue oxygen consumption, microvascular reactivity and sublingual microcirculation were globally unaltered by RBC transfusion in severe septic patients. However, muscle oxygen consumption improved in patients with low baseline and deteriorated in patients with preserved baseline. Future research with larger samples is needed to further examine the association between RBC transfusion and outcomes of patients resuscitated early in severe sepsis, with an emphasis on elucidating the potential contribution of microvascular factors.

S-nitrosylation therapy to improve oxygen delivery of banked blood

“…3); elevated lactate and lactate/pyruvate ratio (Table 1)]. This interpretation is consistent with clinical studies in which administration of blood to septic patients fails to improve oxygen utilization (56,57) and may even increase morbidity and mortality (58). Sepsis is characterized in part by increased NO generation and dysregulation of SNO homeostasis (59).…”

Actualización del bundle de reanimación inicial y monitorización integral de la perfusión tisular en la sepsis severa

“…Se ha observado que los pacientes que mejoran precozmente su patrón microcirculatorio tienen una mayor posibilidad de supervivencia 75,76 . No obstante, la respuesta de la microcirculación a manipulaciones hemodiná-micas es compleja y depende mucho de su estado basal o del tipo de intervención 32,[77][78][79][80] . Un estudio prospectivo aleatorio que comparó una infusión de nitroglicerina intravenosa contra placebo durante la reanimación inicial de pacientes con sepsis severa o shock séptico, no demostró mejoría de la microcirculación sublingual evaluada por SDF.…”

Red Blood Cell Transfusion in Sepsis: A Review

“…In severe septic patient requiring leukoreduced RBC transfusion, using SDF, Sakr et al showed that the sublingual microcirculation was globally unaltered, however, it improved in patients with altered capillary perfusion at baseline [105]. Using SDF and NIRS, Sadaka et al [106] looked at patients that got non-leukoreduced RBCs for a hemoglobin <7.0, or for a hemoglobin between 7.0 and 9.0 with either lactic acidosis or central venous oxygen saturation < 70%. Sadaka et al [106] showed that muscle tissue oxygen consumption, microvascular reactivity, and sublingual microcirculation were globally unaltered by RBC transfusion in severe septic patients.…”

“…Using SDF and NIRS, Sadaka et al [106] looked at patients that got non-leukoreduced RBCs for a hemoglobin <7.0, or for a hemoglobin between 7.0 and 9.0 with either lactic acidosis or central venous oxygen saturation < 70%. Sadaka et al [106] showed that muscle tissue oxygen consumption, microvascular reactivity, and sublingual microcirculation were globally unaltered by RBC transfusion in severe septic patients. However, muscle oxygen consumption improved in patients with low baseline and deteriorated in patients with preserved baseline.…”