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Transfusion requirements after head trauma: a randomized feasibility controlled trial

Internal Medicine, Hospital Sao Rafael, Salvador, Brazil. Intensive Care Unit, Hospital da Cidade, Salvador, Brazil. Surgical Intensive Care Unit, Anesthesiology Division, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. Division of Neurosurgery, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. Trauma Intensive Care Unit, Surgery Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. Intensive Care Unit, Hospital Alemao Oswaldo Cruz, Sao Paulo, Brazil. Department of Intensive Care, Erasme Hospital, Brussels, Belgium. Surgical Intensive Care Unit, Anesthesiology Division, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. luiz.malbouisson@hc.fm.usp.br. Trauma Intensive Care Unit, Surgery Emergency Department, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil. luiz.malbouisson@hc.fm.usp.br.

Critical care (London, England). 2019;23(1):89
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Abstract
BACKGROUND Anemia is frequent among patients with traumatic brain injury (TBI) and is associated with an increased risk of poor outcome. The optimal hemoglobin concentration to trigger red blood cell (RBC) transfusion in patients with TBI is not clearly defined. METHODS All eligible consecutive adult patients admitted to the intensive care unit (ICU) with moderate or severe TBI were randomized to a "restrictive" (hemoglobin transfusion threshold of 7 g/dL), or a "liberal" (threshold 9 g/dL) transfusion strategy. The transfusion strategy was continued for up to 14 days or until ICU discharge. The primary outcome was the mean difference in hemoglobin between groups. Secondary outcomes included transfusion requirements, intracranial pressure management, cerebral hemodynamics, length of stay, mortality and 6-month neurological outcome. RESULTS A total of 44 patients were randomized, 21 patients to the liberal group and 23 to the restrictive group. There were no baseline differences between the groups. The mean hemoglobin concentrations during the 14-day period were 8.4 +/- 1.0 and 9.3 +/- 1.3 (p < 0.01) in the restrictive and liberal groups, respectively. Fewer RBC units were administered in the restrictive than in the liberal group (35 vs. 66, p = 0.02). There was negative correlation (r = - 0.265, p < 0.01) between hemoglobin concentration and middle cerebral artery flow velocity as evaluated by transcranial Doppler ultrasound and the incidence of post-traumatic vasospasm was significantly lower in the liberal strategy group (4/21, 3% vs. 15/23, 65%; p < 0.01). Hospital mortality was higher in the restrictive than in the liberal group (7/23 vs. 1/21; p = 0.048) and the liberal group tended to have a better neurological status at 6 months (p = 0.06). CONCLUSIONS The trial reached feasibility criteria. The restrictive group had lower hemoglobin concentrations and received fewer RBC transfusions. Hospital mortality was lower and neurological status at 6 months favored the liberal group. TRIAL REGISTRATION ClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.
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Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine