Background
Methods
Study design and patients
Arterial oxygen content and oxygen delivery
Measurement of hemodynamic parameters
Statistical analysis
Results
Patients’ characteristics
Patients’ characteristics | |
---|---|
Sex, male, n (%) | 22 (65%) |
Age, years | 59 ± 13 |
Height, cm | 172 ± 8 |
Body weight, kg | 78 (74-90) |
Reason for intensive care unit treatment
| |
Liver cirrhosis/acute liver failure, n (%) | 13 (38%) |
Acute respiratory insufficiency/pneumonia, n (%) | 11 (32%) |
Severe sepsis/septic multiple organ dysfunction syndrome, n (%) | 6 (18%) |
Cardiopulmonary resuscitation, n (%) | 2 (6%) |
Other, n (%) | 2 (6%) |
Clinical characteristics on day of red blood cell transfusion
| |
Therapeutic Intervention Scoring System, points | 22 ± 9 |
Mechanical ventilation, n (%) | 23 (68%) |
Norepinephrine therapy, n (%) | 13 (38%) |
Effect of red blood cell transfusion on hematocrit, hemoglobin, arterial oxygen content, oxygen delivery, arterial blood gas analysis, and central venous oxygen saturation
Parameter | Before RBC transfusion | After RBC transfusion | p-value compared with baseline | 2 h after RBC transfusion | p-value compared with baseline |
---|---|---|---|---|---|
Hematocrit, % | 22 ± 2 | 28 ± 3 |
<0.001
| 27 ± 2 |
<0.001
|
Hemoglobin, g/dL | 7.6 ± 0.8 | 9.4 ± 0.9 |
<0.001
| 9.2 ± 0.8 |
<0.001
|
CaO2, mL/dL | 9.9 ± 1.0 | 12.2 ± 1.2 |
<0.001
| 12.0 ± 1.1 |
<0.001
|
DO2, mL/min | 934 ± 288 | 1073 ± 369 |
<0.001
| 1042 ± 334 |
0.002
|
PaO2, mmHg | 84.0 ± 13.1 | 82.7 ± 16.8 | 0.700 | 89.1 ± 18.4 | 0.227 |
PaCO2, mmHg | 48.3 ± 11.7 | 48.6 ± 13.1 | 0.785 | 48.4 ± 14.3 | 0.972 |
SaO2, % | 95.4 (93.1-96.8) | 95.5 (92.4-96.7) | 0.650 | 95.5 (94.2-97.1) | 0.543 |
ScvO2, % | 71.6 ± 6.2 | 71.1 ± 7.1 | 0.581 | 73.9 ± 7.3 | 0.113 |
Effects of red blood cell transfusion on hemodynamics
Parameter | Before RBC transfusion | After RBC transfusion | p-value compared with baseline | 2 h after RBC transfusion | p-value compared with baseline |
---|---|---|---|---|---|
Basic hemodynamic parameters
| |||||
Heart rate, bpm | 95 ± 14 | 91 ± 16 |
0.007
| 90 ± 16 |
0.012
|
Systolic blood pressure, mmHg | 130 (114-150) | 136 (126-150) |
0.001
| 131 (117-144) | 0.852 |
Diastolic blood pressure, mmHg | 57 (52-65) | 63 (60-69) |
<0.001
| 60 (55-67) | 0.102 |
MAP, mmHg | 78 (74-93) | 87 (84-97) |
<0.001
| 84 (77-93) | 0.176 |
Cardiac preload
| |||||
CVP, mmHg | 16 ± 7 | 17 ± 7 |
0.048
| 16 ± 7 | 0.514 |
GEDVI, mL/m2 | 882 ± 238 | 869 ± 228 | 0.304 | 874 ± 223 | 0.626 |
Cardiac function
| |||||
CO, L/min | 9.42 ± 2.75 | 8.89 ± 3.06 |
0.020
| 8.70 ± 2.75 |
0.005
|
CI, L/min/m2 | 4.82 ± 1.21 | 4.53 ± 1.36 |
0.016
| 4.45 ± 1.28 |
0.004
|
SV, mL | 100 ± 28 | 99 ± 30 | 0.512 | 98 ± 30 | 0.487 |
CPI, W/m2 | 0.89 ± 0.28 | 0.91 ± 0.27 | 0.403 | 0.85 ± 0.28 | 0.268 |
dPmax, mmHg/s | 1394 (1136-1726) | 1414 (1200-1677) | 0.851 | 1287 (1056-1662) | 0.245 |
Vascular resistance
| |||||
SVRI, dyn*s*cm-5*m2 | 1103 (902-1422) | 1212 (1028-1856) |
0.001
| 1193 (951-1612) |
0.010
|
Pulmonary hydration and permeability
| |||||
EVLWI, mL/kg | 11 (9-14) | 10 (9-14) | 0.283 | 10 (8-13) | 0.286 |
PVPI | 1.7 (1.4-2.5) | 1.8 (1.5-2.4) | 0.243 | 1.7 (1.4-2.4) | 0.992 |
Discussion
Limitations of the study
Conclusions
Key messages
-
Anemia is a common finding in intensive care unit patients and is usually treated with red blood cell transfusion. There are limited data on the impact of red blood cell transfusion on advanced hemodynamic parameters reflecting cardiopulmonary function.
-
According to our results, in ICU patients, the transfusion of 2 red blood cell units induces a significant decrease in cardiac output and cardiac index because of a significant decrease in heart rate (while stroke volume remains unchanged). In addition, red blood cell transfusion results in a significant increase in mean arterial pressure and systemic vascular resistance index.
-
Despite the decrease in cardiac output, oxygen delivery significantly increases because of a significant increase in arterial oxygen content.
-
No significant changes in transpulmonary thermodilution-derived parameters reflecting cardiac preload, pulmonary edema, and pulmonary vascular permeability are observed following red blood cell transfusion.