Cardiovascular and metabolic response to red blood cell transfusion in critically ill volume-resuscitated nonsurgical patients.
We examined the cardiovascular and metabolic response to RBC transfusion in patients with circulatory shock after volume resuscitation. Data were analyzed from 36 transfusions in 32 patients who were undergoing continuous hemodynamic monitoring. Transfusions were administered for moderate to severe anemia, mean Hgb 8.3 g/dl. The diagnosis were sepsis (19/36), cardiogenic shock (14/36), connective tissue disease (2/36), and severe hypocalcemia (1/36). Benefit from transfusion was defined as an improvement in tissue oxygen utilization (increased oxygen consumption [VO2] or decreased lactate), a decrease in myocardial VO2 (MAP x HR), or a decrease in myocardial work (left ventricular work index). Mean transfusion volume was 577 ml over 4.5 h. Hgb and oxygen delivery (DO2) increased by 27% and 28%, respectively, while pulmonary artery wedge pressure and cardiac index were unchanged. No significant change was noted in VO2, or lactate, after augmentation of red cell mass. An increase occurred in myocardial work indices and MAP x HR. No changes were identified when subgroups were analyzed based on diagnosis, pretransfusion Hgb, lactate, or VO2 levels. We conclude that selective increase in DO2 by augmentation of RBC mass and oxygen-carrying capacity did not improve the shock state in these volume-resuscitated patients, regardless of the etiology of the shock.
Department of Pediatrics, Lousiana State University Medical Center, Shreveport.
K A
KA
Dietrich
S A
SA
Conrad
C A
CA
Hebert
G L
GL
Levy
M D
MD
Romero
D000293:Adolescent; D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D005440:Fluid Therapy; D006321:Heart / Q000503:physiopathology; D006439:Hemodynamics; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D007223:Infant; D007773:Lactates / Q000378:metabolism; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism; D010101:Oxygen Consumption; D012151:Resuscitation; D012770:Shock, Cardiogenic / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology / Q000628:therapy
D006454:Hemoglobins; D007773:Lactates