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. 2022 Jun 1;50(6):e539-e547.
doi: 10.1097/CCM.0000000000005460. Epub 2022 Feb 8.

Factors Associated With Brain Tissue Oxygenation Changes After RBC Transfusion in Acute Brain Injury Patients

Elisa Gouvêa Bogossian  1 , Verena Rass  2 , Anna Lindner  2 , Carolina Iaquaniello  3 , John Paul Miroz  3 , Elaine Cavalcante Dos Santos  1 , Hassane Njimi  1 , Jacques Creteur  1 , Mauro Oddo  3 , Raimund Helbok  2 , Fabio Silvio Taccone  1
Affiliations

Factors Associated With Brain Tissue Oxygenation Changes After RBC Transfusion in Acute Brain Injury Patients

Elisa Gouvêa Bogossian et al. Crit Care Med. .

Abstract

Objectives: Anemia is common after acute brain injury and can be associated with brain tissue hypoxia. RBC transfusion (RBCT) can improve brain oxygenation; however, predictors of such improvement remain unknown. We aimed to identify the factors associated with PbtO2 increase (greater than 20% from baseline value) after RBCT, using a generalized mixed model.

Design: This is a multicentric retrospective cohort study (2012-2020).

Setting: This study was conducted in three European ICUs of University Hospitals located in Belgium, Switzerland, and Austria.

Patients: All patients with acute brain injury who were monitored with brain tissue oxygenation (PbtO2) catheters and received at least one RBCT.

Intervention: Patients received at least one RBCT. PbtO2 was recorded before, 1 hour, and 2 hours after RBCT.

Measurements and main results: We included 69 patients receiving a total of 109 RBCTs after a median of 9 days (5-13 d) after injury. Baseline hemoglobin (Hb) and PbtO2 were 7.9 g/dL [7.3-8.7 g/dL] and 21 mm Hg (16-26 mm Hg), respectively; 2 hours after RBCT, the median absolute Hb and PbtO2 increases from baseline were 1.2 g/dL [0.8-1.8 g/dL] (p = 0.001) and 3 mm Hg (0-6 mm Hg) (p = 0.001). A 20% increase in PbtO2 after RBCT was observed in 45 transfusions (41%). High heart rate (HR) and low PbtO2 at baseline were independently associated with a 20% increase in PbtO2 after RBCT. Baseline PbtO2 had an area under receiver operator characteristic of 0.73 (95% CI, 0.64-0.83) to predict PbtO2 increase; a PbtO2 of 20 mm Hg had a sensitivity of 58% and a specificity of 73% to predict PbtO2 increase after RBCT.

Conclusions: Lower PbtO2 values and high HR at baseline could predict a significant increase in brain oxygenation after RBCT.

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Conflict of interest statement

The authors have disclosed that they do not have any potential conflicts of interest.

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