Gouvêa Bogossian Elisa, Rass Verena, Lindner Anna, Iaquaniello Carolina, Miroz John Paul, Cavalcante Dos Santos Elaine, Njimi Hassane, Creteur Jacques, Oddo Mauro, Helbok Raimund, Taccone Fabio Silvio
Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Crit Care Med. 2022 Jun 1;50(6):e539-e547. doi: 10.1097/CCM.0000000000005460. Epub 2022 Feb 8.
Anemia is common after acute brain injury and can be associated with brain tissue hypoxia. RBC transfusion (RBCT) can improve brain oxygenation; however, predictors of such improvement remain unknown. We aimed to identify the factors associated with PbtO2 increase (greater than 20% from baseline value) after RBCT, using a generalized mixed model.
This is a multicentric retrospective cohort study (2012-2020).
This study was conducted in three European ICUs of University Hospitals located in Belgium, Switzerland, and Austria.
All patients with acute brain injury who were monitored with brain tissue oxygenation (PbtO2) catheters and received at least one RBCT.
Patients received at least one RBCT. PbtO2 was recorded before, 1 hour, and 2 hours after RBCT.
We included 69 patients receiving a total of 109 RBCTs after a median of 9 days (5-13 d) after injury. Baseline hemoglobin (Hb) and PbtO2 were 7.9 g/dL [7.3-8.7 g/dL] and 21 mm Hg (16-26 mm Hg), respectively; 2 hours after RBCT, the median absolute Hb and PbtO2 increases from baseline were 1.2 g/dL [0.8-1.8 g/dL] (p = 0.001) and 3 mm Hg (0-6 mm Hg) (p = 0.001). A 20% increase in PbtO2 after RBCT was observed in 45 transfusions (41%). High heart rate (HR) and low PbtO2 at baseline were independently associated with a 20% increase in PbtO2 after RBCT. Baseline PbtO2 had an area under receiver operator characteristic of 0.73 (95% CI, 0.64-0.83) to predict PbtO2 increase; a PbtO2 of 20 mm Hg had a sensitivity of 58% and a specificity of 73% to predict PbtO2 increase after RBCT.
Lower PbtO2 values and high HR at baseline could predict a significant increase in brain oxygenation after RBCT.
贫血在急性脑损伤后很常见，且可能与脑组织缺氧有关。红细胞输血（RBCT）可改善脑氧合；然而，这种改善的预测因素仍不明确。我们旨在使用广义混合模型确定RBCT后脑组织氧分压（PbtO2）升高（较基线值升高超过20%）相关的因素。
这是一项多中心回顾性队列研究（2012 - 2020年）。
本研究在比利时、瑞士和奥地利的三所大学医院的欧洲重症监护病房进行。
所有使用脑组织氧合（PbtO2）导管进行监测且接受至少一次RBCT的急性脑损伤患者。
患者接受至少一次RBCT。在RBCT前、后1小时和2小时记录PbtO2。
我们纳入了69例患者，他们在受伤后中位9天（5 - 13天）共接受了109次RBCT。基线血红蛋白（Hb）和PbtO2分别为7.9 g/dL [7.3 - 8.7 g/dL]和21 mmHg（16 - 26 mmHg）；RBCT后2小时，Hb和PbtO2较基线的中位绝对增加值分别为1.2 g/dL [0.8 - 1.8 g/dL]（p = 0.001）和3 mmHg（0 - 6 mmHg）（p = 0.001）。45次输血（41%）中观察到RBCT后PbtO2升高20%。基线时高心率（HR）和低PbtO2与RBCT后PbtO2升高20%独立相关。基线PbtO2预测PbtO2升高的受试者工作特征曲线下面积为0.73（95% CI，0.64 - 0.83）；PbtO2为20 mmHg时预测RBCT后PbtO2升高的灵敏度为58%，特异度为73%。
较低的基线PbtO2值和高HR可预测RBCT后脑氧合的显著增加。
