From the Division of Trauma, Critical Care & Acute Care Surgery Department of Surgery (B.H.M., S.J.U., L.K., N.T.G., D.T.M., E.A.R., R.K.D., C.W., N.A., M.A.S.), Oregon Health & Science University, Portland, Oregon; Center for Translational Injury Research, Division of Acute Care Surgery, Department of Surgery (J.B.H., B.A.C.), University of Texas Health Science Center, Houston, Texas; Division of Trauma and Critical Care, Department of Surgery (B.R.H.R.), University of Washington, Seattle, Washington; Division of Burn/Trauma/Critical Care, Department of Surgery (J.P.M.), University of Texas Southwestern, Dallas, Texas; Division of Trauma and Emergency Surgery, Department of Surgery (R.M.S.), University of Texas San Antonio, San Antonio, Texas.
J Trauma Acute Care Surg. 2018 Jan;84(1):104-111. doi: 10.1097/TA.0000000000001717.
Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors red blood cell (RBC) function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients.
Two hundred forty-three trauma patients at five Level I trauma centers who required RBC transfusion were randomized to receive one to two units of liquid packed RBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in nonobese (body mass index [BMI] < 30) and obese (BMI ≥ 30) patients. StO2 was also compared between obese patients with BMI of 30 to 34.9 and BMI ≥ 35. StO2 was normalized and expressed as % change after RBC transfusion. A p value less than 0.05 indicated significance.
Patients with BMI less than 30 (n = 141) and BMI of 30 or greater (n = 102) had similar Injury Severity Score, Glasgow Coma Scale, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients after CPRBC (125 [72-259] μg/mL) versus LPRBC transfusion (230 [178-388] μg/mL; p < 0.05). StO2 was similar in nonobese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104 ± 1%) versus LPRPCs (99 ± 1%, p < 0.05; 8 hours after transfusion). Subanalysis showed improved StO2 after CPRBC transfusion was specific to BMI of 35 or greater, starting 5 hours after transfusion (p < 0.05 vs. LPRBCs). CPRBCs did not improve clinical outcomes in either group.
CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2.
Therapeutic, level IV.
低组织氧合（StO2）与肥胖创伤患者的不良预后相关。一种新的治疗方法可能是输注冷冻保存的浓缩红细胞（CPRBC），其体外生化特征有利于红细胞（RBC）功能。我们假设 CPRBC 输血可改善肥胖创伤患者的 StO2。
在五个一级创伤中心，需要输血的 243 名创伤患者被随机分为接受 1 至 2 单位的液态浓缩红细胞（LPRBC）或 CPRBC。在非肥胖（体重指数[BMI] < 30）和肥胖（BMI ≥ 30）患者中比较了人口统计学、损伤严重程度、StO2、结局和 RBC 功能的生物标志物。还比较了 BMI 为 30 至 34.9 和 BMI ≥ 35 的肥胖患者之间的 StO2。StO2 在 RBC 输血后归一化为并表示为%变化。p 值小于 0.05 表示具有统计学意义。
BMI 小于 30（n = 141）和 BMI 为 30 或更大（n = 102）的患者具有相似的损伤严重程度评分、格拉斯哥昏迷量表和基线 StO2。CPRBC 输注后肥胖患者的游离血红蛋白（RBC 溶血的指标）水平较低（125 [72-259] μg/mL），而 LPRBC 输注后（230 [178-388] μg/mL；p < 0.05）。无论输注类型如何，非肥胖患者的 StO2 相似，但接受 CPRBC 的肥胖患者的 StO2 改善（104 ± 1%）与 LPRPC（99 ± 1%，p < 0.05；输血后 8 小时）。亚分析表明，CPRBC 输血后 StO2 的改善是 BMI 为 35 或更高的特异性，从输血后 5 小时开始（与 LPRBC 相比，p < 0.05）。CPRBC 输血在两组患者中均未改善临床结局。
CPRBC 输血与肥胖创伤患者的 StO2 升高和游离血红蛋白水平降低相关，但并未改善临床结局。需要进一步研究以确定肥胖患者中 CPRBC 输血是否通过减轻溶血来改善 StO2。
治疗性，IV 级。
