title: Transfusion of packed red blood cells is not associated with improved central venous oxygen saturation or organ function in patients with septic shock.
abstract: BACKGROUND
  The exact role of packed red blood cell (PRBC) transfusion in the setting of early resuscitation in septic shock is unknown.
  
  
  OBJECTIVE
  To evaluate whether PRBC transfusion is associated with improved central venous oxygen saturation (ScvO(2)) or organ function in patients with severe sepsis and septic shock receiving early goal-directed therapy (EGDT).
  
  
  METHODS
  Retrospective cohort study (n=93) of patients presenting with severe sepsis or septic shock treated with EGDT.
  
  
  RESULTS
  Thirty-four of 93 patients received at least one PRBC transfusion. The ScvO(2) goal>70% was achieved in 71.9% of the PRBC group and 66.1% of the no-PRBC group (p=0.30). There was no difference in the change in Sequential Organ Failure Assessment (SOFA) score within the first 24 h in the PRBC group vs. the no-PRBC group (8.6-8.3 vs. 5.8-5.6, p=0.85), time to achievement of central venous pressure>8 mm Hg (732 min vs. 465 min, p=0.14), or the use of norepinephrine to maintain mean arterial pressure>65 mm Hg (81.3% vs. 83.8%, p=0.77).
  
  
  CONCLUSIONS
  In this study, the transfusion of PRBC was not associated with improved cellular oxygenation, as demonstrated by a lack of improved achievement of ScvO(2)>70%. Also, the transfusion of PRBC was not associated with improved organ function or improved achievement of the other goals of EGDT. Further studies are needed to determine the impact of transfusion of PRBC within the context of early resuscitation of patients with septic shock.
authors.affiliation: Department of Anesthesiology, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Fuller
authors.forename: Mithil
authors.initials: M
authors.lastname: Gajera
authors.forename: Christa
authors.initials: C
authors.lastname: Schorr
authors.forename: David
authors.initials: D
authors.lastname: Gerber
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
authors.forename: Joseph
authors.initials: J
authors.lastname: Parrillo
authors.forename: Sergio
authors.initials: S
authors.lastname: Zanotti
mesh_terms: D062186:Arterial Pressure; D002496:Central Venous Pressure; D017707:Erythrocyte Transfusion; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000627:therapeutic use; D063305:Organ Dysfunction Scores; D010100:Oxygen / Q000097:blood*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy*; D013997:Time Factors; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D010100:Oxygen; D009638:Norepinephrine