title: Transfusion of red blood cells is associated with improved central venous oxygen saturation but not mortality in septic shock patients.
abstract: BACKGROUND
  Although the optimum hemoglobin (H) concentration for patients with septic shock (SS) has not been specifically investigated, current guidelines suggest that H of 7 - 9 g/dL, compared with 10 - 12 g/dL, was not associated with increased mortality in critically ill adults. This contrasts with early goal-directed resuscitation protocols that use a target hematocrit of 30% in patients with low central venous oxygen saturation (ScvO2) during the first 6 hours of resuscitation of SS.
  
  
  METHODS
  Data elements were prospectively collected on all patients with SS patients (lactic acid (LA) > 4 mmol/L, or hypotension). Out of a total of 396 SS patients, 46 patients received red blood cell (RBC) transfusion for ScvO2 < 70% (RBC group). We then matched 71 SS patients that did not receive RBC transfusion (NRBC group) on the following goals (G): LA obtained within 6 hours (G1), antibiotics given within 3 hours (G2), 20 mL/kg fluid bolus followed by vasopressors (VP) if needed to keep mean arterial pressure > 65 mm Hg (G3), central venous pressure > 8 mm Hg within 6 hours (G4) and ScvO2 > 70% within 6 hours (G5).
  
  
  RESULTS
  In the RBC group, after one unit of RBC transfusion, ScvO2 improved from average of 63% (± 12%) to 68% (± 10%) (P = 0.02). Sixteen patients required another unit of RBC, and this resulted in increase of ScvO2 to 78% (± 11%) (P < 0.01). The RBC and NRBC groups were matched on sequential organ failure assessment (SOFA) scores and all five goals. There was no difference in mortality between the two groups: 41% vs. 39.4% (OR: 0.8, 95% CI: 0.4 - 1.7, P = 0.6).
  
  
  CONCLUSIONS
  In our study, transfusion of RBC was not associated with decreased mortality in SS patients.
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Farid
authors.initials: F
authors.lastname: Sadaka
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Trottier
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: David
authors.initials: D
authors.lastname: Tannehill
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Paige L
authors.initials: PL
authors.lastname: Donnelly
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Mia T
authors.initials: MT
authors.lastname: Griffin
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Zerihun
authors.initials: Z
authors.lastname: Bunaye
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Jacklyn
authors.initials: J
authors.lastname: O'Brien
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Korobey
authors.affiliation: Mercy Hospital St Louis; St Louis University, St. Louis, MO, USA.
authors.forename: Rekha
authors.initials: R
authors.lastname: Lakshmanan
keywords: Central venous oxygen saturation; EGDT; Early goal-directed therapy; Mortality; RBC; ScvO2; Septic shock; Transfusion