Intraoperative transfusion threshold and tissue oxygenation: a randomised trial

TY - JOUR

T1 - Intraoperative transfusion threshold and tissue oxygenation

T2 - a randomised trial

AU - Nielsen, K

AU - Dahl, B

AU - Johansson, P I

AU - Henneberg, S W

AU - Rasmussen, L S

N1 - © 2012 The Authors. Transfusion Medicine © 2012 British Blood Transfusion Society.

PY - 2012/12

Y1 - 2012/12

N2 - Background and Objectives: Transfusion with allogeneic red blood cells (RBCs) may be needed to maintain oxygen delivery during major surgery, but the appropriate haemoglobin (Hb) concentration threshold has not been well established. We hypothesised that a higher level of Hb would be associated with improved subcutaneous oxygen tension during major spinal surgery. Materials and Methods: Fifty patients aged 18years or older scheduled for spinal fusion with instrumentation were included and randomised to receive RBCs at either a Hb concentration of 7·3gdL-1 (restrictive group) or a Hb concentration of 8·9gdL-1 (liberal group) (Registration no.: H-C-2009-072). Oxygen tension was measured with a polarographic electrode placed subcutaneously over the left deltoid muscle. The primary endpoint was subcutaneous oxygen tension at the time most patients were still undergoing surgery. Results: Forty-eight patients were included in the intention-to-treat analysis; 25 patients in the restrictive group and 23 patients in the liberal group. The median change in subcutaneous oxygen tension 60min after surgical incision was -0·79 and -0·75kPa in the restrictive and the liberal groups, respectively (P=0·78). No significant difference was found in the lowest subcutaneous oxygen tension; -2·07 vs. -1·95kPa in the restrictive and the liberal groups, respectively (P=0·85). Conclusion: A Hb concentration transfusion threshold of 8·9gdL-1 was not associated with a higher subcutaneous oxygen tension during major spinal surgery than a threshold of 7·3gdL-1, but the trial was compromised by methodological difficulties.

AB - Background and Objectives: Transfusion with allogeneic red blood cells (RBCs) may be needed to maintain oxygen delivery during major surgery, but the appropriate haemoglobin (Hb) concentration threshold has not been well established. We hypothesised that a higher level of Hb would be associated with improved subcutaneous oxygen tension during major spinal surgery. Materials and Methods: Fifty patients aged 18years or older scheduled for spinal fusion with instrumentation were included and randomised to receive RBCs at either a Hb concentration of 7·3gdL-1 (restrictive group) or a Hb concentration of 8·9gdL-1 (liberal group) (Registration no.: H-C-2009-072). Oxygen tension was measured with a polarographic electrode placed subcutaneously over the left deltoid muscle. The primary endpoint was subcutaneous oxygen tension at the time most patients were still undergoing surgery. Results: Forty-eight patients were included in the intention-to-treat analysis; 25 patients in the restrictive group and 23 patients in the liberal group. The median change in subcutaneous oxygen tension 60min after surgical incision was -0·79 and -0·75kPa in the restrictive and the liberal groups, respectively (P=0·78). No significant difference was found in the lowest subcutaneous oxygen tension; -2·07 vs. -1·95kPa in the restrictive and the liberal groups, respectively (P=0·85). Conclusion: A Hb concentration transfusion threshold of 8·9gdL-1 was not associated with a higher subcutaneous oxygen tension during major spinal surgery than a threshold of 7·3gdL-1, but the trial was compromised by methodological difficulties.

U2 - 10.1111/j.1365-3148.2012.01196.x

DO - 10.1111/j.1365-3148.2012.01196.x

M3 - Journal article

C2 - 23121563

SN - 0958-7578

VL - 22

SP - 418

EP - 425

JO - Transfusion Medicine

JF - Transfusion Medicine

IS - 6

ER -