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Neurocritical Care

Erschienen in:

01.06.2008 | ORIGINAL ARTICLE

Aggressive Red Blood Cell Transfusion: No Association with Improved Outcomes for Victims of Isolated Traumatic Brain Injury

verfasst von: Mark E. George, David E. Skarda, Charles R. Watts, Hoai D. Pham, Greg J. Beilman

Erschienen in: Neurocritical Care | Ausgabe 3/2008

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Abstract

Background

Clinical studies have caused blood transfusion practices in critically ill patients to become more conservative in the last decade. However, few studies have focused on trauma patients, particularly those with severe isolated traumatic brain injury.

Methods

We conducted a retrospective study to test the hypothesis that patients with severe brain injury would not benefit from aggressive red blood cell transfusion (RBCT). End points of the study were in-hospital mortality and morbidity (pneumonia, urinary tract infection, deep venous thrombosis, pulmonary embolus, decubitus ulcer, bacteremia, septic shock, myocardial infarction, and seizure). Included in our retrospective study were patients at two urban, level I trauma centers who were admitted with a diagnosis of isolated head injury and with a Glasgow Coma Scale (GCS) score of 8 or less. We recorded demographic, interventional, and outcome variables.

Results

In 289 patients, 24 of 25 (96%) were transfused if their lowest recorded intensive care unit (ICU) hemoglobin level was 8.0 g/dl or less. In contrast, only 9/182 (5%) of these 289 patients were transfused if the hemoglobin levels were 10.0 g/dl or greater. In the remaining 82 patients with lowest ICU hemoglobin levels of 8.0–10.0 g/dl, 52% were transfused. These 82 patients (43 underwent RBCT and 39 did not) were included in our analysis.

Discussion

The overall in-hospital mortality rate was 32%; rates were similar between the two groups (29%, non-RBCT; 35%, RBCT) (P = 0.64). Likewise, in-hospital morbidity was similar between groups. Logistic and proportional hazard regression analyses identified RBCT as one predictor of mortality.

Conclusions

Our results suggest that a restrictive transfusion practice is safe for severely head-injured patients.

American College of Physicians. Practice strategies for elective red blood cell transfusion. Ann Intern Med 1992;116:403–6.

Carlson AP, Schermer CR, Lu SW. Retrospective evaluation of anemia and transfusion in traumatic brain injury. J Trauma 2006;61:567–71.PubMedCrossRef

Brain Trauma Foundation. Guidelines for the prehospital management of traumatic brain injury. Guidelines for the management and prognosis of severe traumatic brain injury. Guidelines for the surgical management of traumatic brain injury. Available at: www.braintrauma.org.

Winn HR. Youmans neurological surgery: fifth edition. Philadelphia: WB Saunders Company; 2004.

Guidelines for the management of severe head injury. Brain Trauma Foundation, American Association of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. J Neurotrauma 1996;13:641–734.

Brain Trauma Foundation, Inc., American Association of Neurological Surgeons. Part 1: guidelines for the management of severe traumatic brain injury. New York, NY: Brain Trauma Foundation, Inc.; 2000. p. 165.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2:81–4.PubMedCrossRef

Fischer J, Mathieson C. The history of the Glasgow Coma Scale: implications for practice. Crit Care Nurs 2001;23:52–8.

Baker SP, O’Neill B, Haddon W, Long W. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974;14:187.PubMed

10.

Baker SP, O’Neill B. The injury severity score: an update. J Trauma 1976;6:882–5.

11.

Eisenberg HM, Gary HE Jr, Aldrich EF, et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 1990;73:688–98.PubMed

12.

Marshall LF, Marshall SB, Klauber MR, et al. The diagnosis of head injury requires a classification based on computed axial tomography. J Neurotrauma 1992;1:S287–92.

13.

Hebert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999;340:409–17.PubMedCrossRef

14.

Hebert PC, Wells G, Tweeddale M, et al. Does transfusion practice affect mortality in critically ill patients? Transfusion Requirements in Critical Care (TRICC) Investigators and the Canadian Critical Care Trials Group. Am J Respir Crit Care Med 1997;155:1618–23.PubMed

15.

Corwin HL, Gettinger A, Pearl RG, et al. The CRIT Study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 2004;32:39–52.PubMedCrossRef

16.

Vincent JL, Baron JF, Reinhart K, et al. ABC (Anemia and Blood Transfusion in Critical Care) Investigators. Anemia and blood transfusion in critically ill patients. JAMA 2002;288:1499–507.PubMedCrossRef

17.

McIntyre L, Hebert PC, Wells G, et al. Is a restrictive transfusion strategy safe for resuscitated and critically ill trauma patients? J Trauma 2004;57:563–8.PubMed

18.

Shapiro MJ, Gettinger A, Corwin HL, et al. Anemia and blood transfusion in trauma patients admitted to the intensive care unit. J Trauma 2003;55:269–73.PubMedCrossRef

19.

Bordin JO, Heddle NM, Blajchman MA. Biological effects of leukocytes present in transfused cellular blood products. Blood 1994;84:1703–21.PubMed

20.

Moore FA, Moore EE, Sauaia A. Blood transfusion. An independent risk factor for postinjury multiple organ failure. Arch Surg 1997;132:620–4.PubMed

21.

Norenberg MD. Astrocyte responses to CNS injury. J Neuropathol Exp Neurol 1994;53:213–20.PubMedCrossRef

22.

Robertson CS, Valadka AB, Hannay HJ, et al. Prevention of secondary ischemic insults after severe head injury. Crit Care Med 1999;27:2086–95.PubMedCrossRef

23.

Rosner MJ, Rosner SD, Johnsonn AH. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 1995;83:949–62.PubMed

24.

Ling GS, Neal CJ. Maintaining cerebral perfusion pressure is a worthy clinical goal. Neurocrit Care 2005;2:75–815.PubMedCrossRef

25.

Feinstein AJ, Patel MB, Sanui M, Cohn SM, Majetschak M, Proctor KG. Resuscitation with pressors after traumatic brain injury. J Am Coll Surg 2005;201:536–45.PubMedCrossRef

26.

Smith MJ, Stiefel MF, Magge S, et al. Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med 2005;33:1104–8.PubMedCrossRef

27.

Leal-Noval SR, Rincon-Ferrari MD, Marin-Niebla A, et al. Transfusion of erythrocyte concentrates produces a variable increment on cerebral oxygenation in patients with severe traumatic brain injury: a preliminary study. Intensive Care Med 2006;32:1733–40.PubMedCrossRef

28.

Dietrich KA, Conrad SA, Hebert CA, Levy GL, Romero MD. Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients. Crit Care Med 1990;18:940–4.PubMedCrossRef

29.

Lorente JA, Landin L, De Pablo R, Renes E, Rodriguez-Diaz R, Liste D. Effects of blood transfusion on oxygen transport variables in severe sepsis. Crit Care Med 1993;21:1312–8.PubMedCrossRef

30.

Smith MJ, Le Roux PD, Elliott JP, Winn HR. Blood transfusion and increased risk for vasospasm and poor outcome after subarachnoid hemorrhage. J Neurosurg 2004;101:1–7.PubMed

31.

Naidech AM, Drescher J, Ault ML, Shaibani A, Batjer HH, Alberts MJ. Higher hemoglobin is associated with less cerebral infarction, poor outcome, and death after subarachnoid hemorrhage. Neurosurgery 2006;59:775–9.PubMedCrossRef

32.

Hukkelhoven CW, Steyerberg EW, Habbema JD, et al. Predicting outcome after traumatic brain injury: development and validation of a prognostic score based on admission characteristics. J Neurotrauma 2005;22:1025–39.PubMedCrossRef

33.

Nilsson KR, Berenholtz SM, Garrett-Mayer E, Dorman T, Klag MJ, Pronovost PJ. Association between venous thromboembolism and perioperative allogenic transfusion. Arch Surg 2007;142:126–32.PubMedCrossRef

Titel: Aggressive Red Blood Cell Transfusion: No Association with Improved Outcomes for Victims of Isolated Traumatic Brain Injury
verfasst von: Mark E. George
David E. Skarda
Charles R. Watts
Hoai D. Pham
Greg J. Beilman
Publikationsdatum: 01.06.2008
Verlag: Humana Press Inc
Erschienen in: Neurocritical Care / Ausgabe 3/2008
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI: https://doi.org/10.1007/s12028-008-9066-y

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Abstract

Background

Methods

Results

Discussion

Conclusions

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