Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery—A randomized, double-blinded, clinical trial
| Autor: | Gerda Leitner, Michael Hiesmayr, Nina K. I. Küntzel, Roman Ullrich, David M. Baron, Joanna Baron-Stefaniak, Elias L. Meyer |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Time Factors Cardiovascular Procedures Hemodynamics Blood Pressure 030204 cardiovascular system & hematology Vascular Medicine law.invention 0302 clinical medicine Randomized controlled trial Animal Cells law Red Blood Cells Hypoxic pulmonary vasoconstriction Medicine and Health Sciences Medicine 030212 general & internal medicine Pulmonary Arteries Multidisciplinary Hematology Arteries Middle Aged Clinical Laboratory Sciences Cardiac surgery medicine.anatomical_structure Anesthesia Female Anatomy Cellular Types Erythrocyte Transfusion Research Article medicine.medical_specialty Cardiac Surgery Science Critical Illness Drug Storage Surgical and Invasive Medical Procedures Postoperative Hemorrhage Pulmonary Artery Glycocalyx 03 medical and health sciences Double-Blind Method Diagnostic Medicine medicine.artery Humans Blood Transfusion Cardiac Surgical Procedures Aged Blood Cells Transfusion Medicine business.industry Biology and Life Sciences Endothelial Cells Cell Biology Clinical trial Vasoconstriction Pulmonary artery Cardiovascular Anatomy Vascular resistance Blood Vessels Vascular Resistance business Packed red blood cells |
| Zdroj: | PLoS ONE PLoS ONE, Vol 14, Iss 3, p e0213000 (2019) |
| ISSN: | 1932-6203 |
| Popis: | BackgroundExperimental and volunteer studies have reported pulmonary vasoconstriction during transfusion of packed red blood cells (PRBCs) stored for prolonged periods. The primary aim of this study was to evaluate whether transfusion of PRBCs stored over 21 days (standard-issue, siPRBCs) increases pulmonary artery pressure (PAP) to a greater extent than transfusion of PRBCs stored for less then 14 days (fresh, fPRBCs) in critically ill patients following cardiac surgery. The key secondary aim was to assess whether the pulmonary vascular resistance index (PVRI) increases after transfusion of siPRBCs to a greater extent than after transfusion of fPRBCs.MethodsThe study was performed as a single-center, double-blinded, parallel-group, randomized clinical trial. Leukoreduced PRBCs were transfused while continuously measuring hemodynamic parameters. Systemic concentrations of syndecan-1 were measured to assess glycocalyx injury. After randomizing 19 patients between January 2014 and June 2016, the study was stopped due to protracted patient recruitment.ResultsOf 19 randomized patients, 11 patients were transfused and included in statistical analyses. Eight patients were excluded prior to transfusion, 6 patients received fPRBCs (10±3 storage days), whereas 5 patients received siPRBCs (33±4 storage days). The increase in PAP (7±3 vs. 2±2 mmHg, P = 0.012) was greater during transfusion of siPRBCs than during transfusion of fPRBCs. In addition, the change in PVRI (150±89 vs. -4±37 dyn·s·cm-5·m2, P = 0.018) was greater after transfusion of siPRBCs than after transfusion of fPRBCs. The increase in PAP correlated with the change of systemic syndecan-1 concentrations at the end of transfusion (R = 0.64,P = 0.034).ConclusionAlthough this study is underpowered and results require verification in larger clinical trials, our findings suggest that transfusion of siPRBCs increases PAP and PVRI to a greater extent than transfusion of fPRBCs in critically ill patients following cardiac surgery. Glycocalyx injury might contribute to pulmonary vasoconstriction associated with transfusion of stored blood. |
| Databáze: | OpenAIRE |
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