Transfusion of Red Blood Cells Is Associated With Improved Central Venous Oxygen Saturation But Not Mortality in Septic Shock Patients

Abstract

BackgroundAlthough the optimum hemoglobin (H) concentration for patients with septic shock (SS) has not been specifically investigated, current guidelines suggest that H of 7 - 9 g/dL, compared with 10 - 12 g/dL, was not associated with increased mortality in critically ill adults. This contrasts with early goal-directed resuscitation protocols that use a target hematocrit of 30% in patients with low central venous oxygen saturation (ScvO2) during the first 6 hours of resuscitation of SS.MethodsData elements were prospectively collected on all patients with SS patients (lactic acid (LA) > 4 mmol/L, or hypotension). Out of a total of 396 SS patients, 46 patients received red blood cell (RBC) transfusion for ScvO2 < 70% (RBC group). We then matched 71 SS patients that did not receive RBC transfusion (NRBC group) on the following goals (G): LA obtained within 6 hours (G1), antibiotics given within 3 hours (G2), 20 mL/kg fluid bolus followed by vasopressors (VP) if needed to keep mean arterial pressure > 65 mm Hg (G3), central venous pressure > 8 mm Hg within 6 hours (G4) and ScvO2 > 70% within 6 hours (G5).ResultsIn the RBC group, after one unit of RBC transfusion, ScvO2 improved from average of 63% (± 12%) to 68% (± 10%) (P = 0.02). Sixteen patients required another unit of RBC, and this resulted in increase of ScvO2 to 78% (± 11%) (P < 0.01). The RBC and NRBC groups were matched on sequential organ failure assessment (SOFA) scores and all five goals. There was no difference in mortality between the two groups: 41% vs. 39.4% (OR: 0.8, 95% CI: 0.4 - 1.7, P = 0.6).ConclusionsIn our study, transfusion of RBC was not associated with decreased mortality in SS patients.

Transfusion Decision Making in Pediatric Critical Illness

“…Much of the uncertainty in RBC transfusion stems from the fact that it is not currently possible to quantify anemia risk and balance that against risk of donor RBCs. There are many technologies attempting to infer risk of anemia, but to date we lack biomarkers that fulfill Prentice criteria (9, 65–67). As such, there is a plurality of perspectives and clinical practice regarding RBC transfusion (64), (54).…”

Optimal hematocrit in an artificial microvascular network

“…A normalization of anemia in chronic kidney disease did not reduce the risk of cardiovascular events and did not improve quality of life but did increase the risk of stroke and death . In septic shock, critical care, and acute upper gastrointestinal bleeding, a restrictive transfusion regimen was as effective as or even superior to a liberal transfusion regimen. Treatment of anemia in chronic heart failure had no clinical benefit .…”

Impact of red blood cell transfusion on oxygen transport and metabolism in patients with sepsis and septic shock: a systematic review and meta-analysis

“…Data from the subgroup analysis performed by Gilbert et al, ( 24 ) Silverman et al, ( 25 ) Sadaka et al, ( 26 ) and Mazza et al ( 14 ) were abstracted and analyzed separately because we considered that each subgroup represented a different population.…”

“…The Level of Evidence analyzed through the ELIS system revealed that 5 studies met the criteria for level II evidence, ( 11 , 14 , 26 - 28 ) 8 studies were classified as level III, ( 12 , 24 , 25 , 29 - 33 ) and the remaining were level IV ( ).…”