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Blood transfusions in septic shock: is 7.0g/dL really the appropriate threshold?
OBJECTIVE: To evaluate the immediate effects of red blood cell transfusion on central venous oxygen saturation and lactate levels in septic shock patients with different transfusion triggers. METHODS: We included patients with a diagnosis of septic shock within the last 48 hours and hemoglobin level...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Associação Brasileira de Medicina
intensiva
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396895/ https://www.ncbi.nlm.nih.gov/pubmed/25909311 http://dx.doi.org/10.5935/0103-507X.20150007 |
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author | Mazza, Bruno Franco Freitas, Flavio Geraldo Rezende Barros, Melca Maria Oliveira Azevedo, Luciano Cesar Pontes Machado, Flavia Ribeiro |
author_facet | Mazza, Bruno Franco Freitas, Flavio Geraldo Rezende Barros, Melca Maria Oliveira Azevedo, Luciano Cesar Pontes Machado, Flavia Ribeiro |
author_sort | Mazza, Bruno Franco |
collection | PubMed |
description | OBJECTIVE: To evaluate the immediate effects of red blood cell transfusion on central venous oxygen saturation and lactate levels in septic shock patients with different transfusion triggers. METHODS: We included patients with a diagnosis of septic shock within the last 48 hours and hemoglobin levels below 9.0g/dL Patients were randomized for immediate transfusion with hemoglobin concentrations maintained above 9.0g/dL (Group Hb9) or to withhold transfusion unless hemoglobin felt bellow 7.0g/dL (Group Hb7). Hemoglobin, lactate, central venous oxygen saturation levels were determined before and one hour after each transfusion. RESULTS: We included 46 patients and 74 transfusions. Patients in Group Hb7 had a significant reduction in median lactate from 2.44 (2.00 - 3.22) mMol/L to 2.21 (1.80 - 2.79) mMol/L, p = 0.005, which was not observed in Group Hb9 [1.90 (1.80 - 2.65) mMol/L to 2.00 (1.70 - 2.41) mMol/L, p = 0.23]. Central venous oxygen saturation levels increased in Group Hb7 [68.0 (64.0 - 72.0)% to 72.0 (69.0 - 75.0)%, p < 0.0001] but not in Group Hb9 [72.0 (69.0 - 74.0)% to 72.0 (71.0 - 73.0)%, p = 0.98]. Patients with elevated lactate or central venous oxygen saturation < 70% at baseline had a significant increase in these variables, regardless of baseline hemoglobin levels. Patients with normal values did not show a decrease in either group. CONCLUSION: Red blood cell transfusion increased central venous oxygen saturation and decreased lactate levels in patients with hypoperfusion regardless of their baseline hemoglobin levels. Transfusion did not appear to impair these variables in patients without hypoperfusion. ClinicalTrials.gov NCT01611753 |
format | Online Article Text |
id | pubmed-4396895 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Associação Brasileira de Medicina
intensiva |
record_format | MEDLINE/PubMed |
spelling | pubmed-43968952015-04-15 Blood transfusions in septic shock: is 7.0g/dL really the appropriate threshold? Mazza, Bruno Franco Freitas, Flavio Geraldo Rezende Barros, Melca Maria Oliveira Azevedo, Luciano Cesar Pontes Machado, Flavia Ribeiro Rev Bras Ter Intensiva Original Articles OBJECTIVE: To evaluate the immediate effects of red blood cell transfusion on central venous oxygen saturation and lactate levels in septic shock patients with different transfusion triggers. METHODS: We included patients with a diagnosis of septic shock within the last 48 hours and hemoglobin levels below 9.0g/dL Patients were randomized for immediate transfusion with hemoglobin concentrations maintained above 9.0g/dL (Group Hb9) or to withhold transfusion unless hemoglobin felt bellow 7.0g/dL (Group Hb7). Hemoglobin, lactate, central venous oxygen saturation levels were determined before and one hour after each transfusion. RESULTS: We included 46 patients and 74 transfusions. Patients in Group Hb7 had a significant reduction in median lactate from 2.44 (2.00 - 3.22) mMol/L to 2.21 (1.80 - 2.79) mMol/L, p = 0.005, which was not observed in Group Hb9 [1.90 (1.80 - 2.65) mMol/L to 2.00 (1.70 - 2.41) mMol/L, p = 0.23]. Central venous oxygen saturation levels increased in Group Hb7 [68.0 (64.0 - 72.0)% to 72.0 (69.0 - 75.0)%, p < 0.0001] but not in Group Hb9 [72.0 (69.0 - 74.0)% to 72.0 (71.0 - 73.0)%, p = 0.98]. Patients with elevated lactate or central venous oxygen saturation < 70% at baseline had a significant increase in these variables, regardless of baseline hemoglobin levels. Patients with normal values did not show a decrease in either group. CONCLUSION: Red blood cell transfusion increased central venous oxygen saturation and decreased lactate levels in patients with hypoperfusion regardless of their baseline hemoglobin levels. Transfusion did not appear to impair these variables in patients without hypoperfusion. ClinicalTrials.gov NCT01611753 Associação Brasileira de Medicina intensiva 2015 /pmc/articles/PMC4396895/ /pubmed/25909311 http://dx.doi.org/10.5935/0103-507X.20150007 Text en http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Articles Mazza, Bruno Franco Freitas, Flavio Geraldo Rezende Barros, Melca Maria Oliveira Azevedo, Luciano Cesar Pontes Machado, Flavia Ribeiro Blood transfusions in septic shock: is 7.0g/dL really the appropriate threshold? |
title | Blood transfusions in septic shock: is 7.0g/dL really the appropriate
threshold? |
title_full | Blood transfusions in septic shock: is 7.0g/dL really the appropriate
threshold? |
title_fullStr | Blood transfusions in septic shock: is 7.0g/dL really the appropriate
threshold? |
title_full_unstemmed | Blood transfusions in septic shock: is 7.0g/dL really the appropriate
threshold? |
title_short | Blood transfusions in septic shock: is 7.0g/dL really the appropriate
threshold? |
title_sort | blood transfusions in septic shock: is 7.0g/dl really the appropriate
threshold? |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4396895/ https://www.ncbi.nlm.nih.gov/pubmed/25909311 http://dx.doi.org/10.5935/0103-507X.20150007 |
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