Evaluation of blood transfusion effects on mixed venous oxygen saturation and lactate levels in patients with SIRS/sepsis.
OBJECTIVE
To evaluate the effects of red blood cell transfusion in patients with SIRS/sepsis who presented hemoglobin levels under 9.0 g/dL at intensive care unit admission, using two parameters of organ perfusion: mixed venous oxygen saturation and serum lactate levels.


METHODS
All patients admitted to the intensive care unit with SIRS/sepsis, as defined by Consensus Conference in 1992, and hemoglobin levels under 9.0 g/dL were included. Hemoglobin levels, mixed venous oxygen saturation, and lactate levels were collected before red blood cell transfusion (pre-T) and up to 1 hour after transfusion (post-T). These variables were analyzed through a paired t test, and results were considered significant if P < .05.


RESULTS
Twenty-nine patients (17 male, 12 female) with ages of 61.9 +/- 15.1 (mean +/- SD) years (range, 21-85 years) and a mean APACHE II score of 12.5 +/- 3.75 (7-21) were transfused with a mean of 1.41 packed red cell units. A significant increase in hemoglobin levels was reached by blood transfusion, from 8.14 +/- 0.64 g/dL (pre-T) to 9.4 +/- 0.33 g/dL (post-T), with P <.001. However, this was not accompanied by a significant change in lactate levels, from 1.87 +/- 1.22 mmol/l (pre-T) to 1.56 +/- 0.28 mmol/l (post-T), with P =.28, or in mixed venous oxygen saturation, from 64.3 +/- 8.52% (pre-T) to 67.4 +/- 6.74% (post-T), with P = .13. The results were similar even in patients with hemoglobin levels under 8.0 g/dL (n = 9). These results suggest that red blood cell transfusions, in spite of leading to a significant increase in hemoglobin levels, are not associated with an improvement in tissue oxygenation in patients with SIRS/sepsis and hemoglobin levels < 9 g/dL.
Mazza
Bruno Franco
BF
Intensive Care Unit, Discipline of Anesthesiology, Pain and Intensive Care, Federal University of São Paulo, SP, Brazil.
Machado
Flávia Ribeiro
FR
Mazza
Débora Dutra
DD
Hassmann
Valeria
V
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001803:Blood Transfusion; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000097:blood*; D012128:Respiratory Distress Syndrome / Q000628:therapy; D018746:Systemic Inflammatory Response Syndrome / Q000628:therapy*
D006454:Hemoglobins; D019344:Lactic Acid; D010100:Oxygen