Sublingual microcirculation does not reflect red blood cell transfusion thresholds in the intensive care unit—a prospective observational study in the intensive care unit
| Autor: | Desirée Yeginsoy, Vera Meier, Jonas Scheuzger, Julian Flükiger, Anna Zehnder, Martin Siegemund |
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| Rok vydání: | 2020 |
| Předmět: |
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Letter Blood transfusion medicine.medical_treatment Sublingual microcirculation Vessel perfusion Hemodynamics Intensivist 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Capillary density law.invention Microcirculation 03 medical and health sciences 0302 clinical medicine law Intensive care medicine Humans Intensive care unit Prospective Studies Mouth Floor Aged Spectroscopy Near-Infrared Transfusion Medicine business.industry Transfusion Cardiogenic shock lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 Blood flow Middle Aged medicine.disease Intensive Care Units Anesthesia Female Erythrocyte Transfusion Critical illness business |
| Zdroj: | Critical Care, Vol 24, Iss 1, Pp 1-10 (2020) Critical Care |
| ISSN: | 1364-8535 |
| DOI: | 10.1186/s13054-020-2728-7 |
| Popis: | Purpose Hemoglobin (Hb) transfusion thresholds are established in intensive care units. A restrictive transfusion threshold (Hb 70–75 g/l) is recommended in septic patients, and a liberal transfusion threshold (Hb 90 g/l) for cardiogenic shock. It is unclear whether these historically adopted transfusion thresholds meet the challenges of individual patients. Methods We evaluated microvascular flow index (MFI) and proportion of perfused vessels (PPV) in the sublingual microcirculation with CytoCam-IDF microscopy and near-infrared spectroscopy (NIRS). A study team-independent, treating intensivist assigned a total of 64 patients to 1 of 2 two transfusion thresholds, 43 patients to the Hb 75 g/l threshold and 21 patients to the Hb 90 g/l threshold, at a surgical intensive care unit. We performed microcirculatory measurements 1 h before and 1 h after transfusion of 1 unit of red blood cells. Results Microcirculatory flow variables correlated negatively with pre-transfusion flow variables (ΔMFI: ρ = − 0.821, p ρ = − 0.778, p 2.84, PPV > 88%) showed a deteriorated microcirculation after red blood cell transfusion. An impaired microcirculation improved after transfusion. At both transfusion thresholds, approximately one third of the patients showed an initially impaired microcirculation. In contrast, one third in every group had good microcirculation above the cutoff variables and did not profit from the transfusion. Conclusion The data suggest that the established transfusion thresholds and other hemodynamic variables do not reflect microcirculatory perfusion of patients. Blood transfusion at both thresholds 75 g/l and 90 g/l hemoglobin can either improve or harm the microcirculatory blood flow, questioning the concept of arbitrary transfusion thresholds. |
| Databáze: | OpenAIRE |
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