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Red blood cell transfusion affects microdialysis-assessed interstitial lactate/pyruvate ratio in critically ill patients with late sepsis

Petros Kopterides| Maria Theodorakopoulou| Nikitas Nikitas| Ioannis Ilias| Dimitra Argiro Vassiliadi| Stylianos E. Orfanos| Iraklis Tsangaris| Nikolaos A. Maniatis| Argirios E. Tsantes| Anthi Travlou| George Dimitriadis| Apostolos Armaganidis| Urban Ungerstedt| Ioanna Dimopoulou
Original
Volume 38, Issue 11 / November , 2012

Pages 1843 - 1850

Abstract

Purpose

The aim of this study was to explore the effect of red blood cell (RBC) transfusion on microdialysis-assessed interstitial fluid metabolic parameters in septic patients.

Methods

We conducted a retrospective study of 37 patients with severe sepsis/septic shock requiring transfusion of one to two RBC units. Interstitial fluid metabolic alterations were monitored by a microdialysis catheter inserted in the subcutaneous adipose tissue. Samples were collected before (T0) and after transfusion at two time-points: T1a and T1b; median post-transfusion times of 120 [interquartile range (IQR); 45–180] and 360 (IQR; 285–320) min. Lactate, pyruvate, glycerol and glucose concentrations were measured with a bedside analyzer, and the lactate/pyruvate (LP) ratio was calculated automatically.

Results

RBC transfusions decreased the LP ratio from (T0) 18.80 [interquartile range (IQR); 14.85–27.45] to (T1a) 17.80 (IQR; 14.35–25.20; P < 0.05) and (T1b) 17.90 (IQR; 14.45–22.75; P < 0.001), while there was also significant interindividual variation. Post-transfusion LP ratio changes at T1a [r = −0.42; 95 % confidence interval (CI), −0.66 to −0.098; P = 0.01] and T1b (r = −0.68; 95 % [CI], −0.82 to −0.44; P < 0.001) were significantly correlated with the pre-transfusion LP ratio, but not with baseline demographic characteristics, vital signs, severity scores, hemoglobin level and blood lactate. RBC storage time and leukocyte reduction had no influence on the tissue metabolic response to transfusion.

Conclusions

Tissue oxygenation is affected by RBC transfusion in critically ill septic patients. Monitoring of tissue LP ratio by microdialysis may represent a useful method for individual clinical management.

Keywords

References

  1. Corwin HL, Krantz SB (2000) Anemia of the critically ill: acute anemia of chronic disease. Crit Care Med 28:3098–3099
    • View reference on PubMed
    • View reference on publisher's website
  2. Nguyen BV, Bota DP, Melot C, Vincent JL (2003) Time course of hemoglobin concentrations in nonbleeding intensive care unit patients. Crit Care Med 31:406–410
    • View reference on PubMed
    • View reference on publisher's website
  3. Hebert PC, Wells G, Blajchman MA, Marshall J, Martin C, Pagliarello G, Tweeddale M, Schweitzer I, Yetisir E (1999) A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care: Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 340:409–417
    • View reference on PubMed
    • View reference on publisher's website
  4. Blood Observational Study Investigators of ANZICS-Clinical Trials Group, Westbrook A, Pettilä V, Nichol A, Bailey MJ, Syres G, Murray L, Bellomo R, Wood E, Phillips LE, Street A, French C, Orford N, Santamaria J, Cooper DJ (2010) Transfusion practice and guidelines in Australian and New Zealand intensive care units. Intensive Care Med 36:1138–1146
  5. Wang JK, Klein HG (2010) Red blood cell transfusion in the treatment and management of anaemia: the search for the elusive transfusion trigger. Vox Sang 98:2–11
    • View reference on PubMed
    • View reference on publisher's website
  6. Vincent J-L, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D, ABC (Anemia and Blood Transfusion in Critical Care) Investigators (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507
    • View reference on PubMed
    • View reference on publisher's website
  7. Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ (2004) The CRIT Study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 32:39–52
    • View reference on PubMed
    • View reference on publisher's website
  8. Oliver E, Carrio ML, Rodriguez-Castro D, Javierre C, Farrero E, Torrado H, Castells E, Ventura JL (2009) Relationships among haemoglobin level, packed red cell transfusion and clinical outcomes in patients after cardiac surgery. Intensive Care Med 35:1548–1555
  9. Möhnle P, Snyder-Ramos SA, Miao Y, Kulier A, Böttiger BW, Levin J, Mangano DT, Multicenter Study of Perioperative Ischemia (McSPI) Research Group (2011) Postoperative red blood cell transfusion and morbid outcome in uncomplicated cardiac surgery patients. Intensive Care Med 37:97–109
  10. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M, Early Goal-Directed Therapy Collaborative Group (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377
    • View reference on PubMed
    • View reference on publisher's website
  11. Dellinger RP, Levy MM, Carlet JM, Bion J, Parker MM, Jaeschke R, Reinhart K, Angus DC, Brun-Buisson C, Beale R, Calandra T, Dhainaut JF, Gerlach H, Harvey M, Marini JJ, Marshall J, Ranieri M, Ramsay G, Sevransky J, Thompson BT, Townsend S, Vender JS, Zimmerman JL, Vincent JL, International Surviving Sepsis Campaign Guidelines Committee, American Association of Critical-Care Nurses, American College of Chest Physicians, American College of Emergency Physicians, Canadian Critical Care Society, European Society of Clinical Microbiology and Infectious Diseases, European Society of Intensive Care Medicine, European Respiratory Society, International Sepsis Forum, Japanese Association for Acute Medicine, Japanese Society of Intensive Care Medicine, Society of Critical Care Medicine, Society of Hospital Medicine, Surgical Infection Society, World Federation of Societies of Intensive and Critical Care Medicine (2008) Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 36:296–327
    • View reference on PubMed
    • View reference on publisher's website
  12. Orlov D, O’Farrell R, McCluskey SA, Carroll J, Poonawala H, Hozhabri S, Karkouti K (2009) The clinical utility of an index of global oxygenation for guiding red blood cell transfusion in cardiac surgery. Transfusion 49:682–688
    • View reference on PubMed
    • View reference on publisher's website
  13. Vallet B, Adamczyk S, Barreau O, Lebuffe G (2007) Physiologic transfusion triggers. Best Pract Res Clin Anaesthesiol 21:173–181
    • View reference on PubMed
    • View reference on publisher's website
  14. Vallet B, Robin E, Lebuffe G (2010) Venous oxygen saturation as a physiologic transfusion trigger. Crit Care 14:213
    • View reference on PubMed
    • View reference on publisher's website
  15. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 166:98–104
    • View reference on PubMed
    • View reference on publisher's website
  16. Sakr Y, Chierego M, Piagnerelli M, Verdant C, Dubois MJ, Koch M, Creteur J, Gullo A, Vincent JL, De Backer D (2007) Microvascular response to red blood cell transfusion in patients with severe sepsis. Crit Care Med 35:1639–1644
    • View reference on PubMed
    • View reference on publisher's website
  17. Creteur J, Neves AP, Vincent JL (2009) Near-infrared spectroscopy technique to evaluate the effects of red blood cell transfusion on tissue oxygenation. Crit Care 13:S11
    • View reference on PubMed
    • View reference on publisher's website
  18. Ruggieri AJ, Levy RJ, Deutschman CS (2010) Mitochondrial dysfunction and resuscitation in sepsis. Crit Care Clin 26:567–575
    • View reference on PubMed
    • View reference on publisher's website
  19. Ungerstedt U, Rostami E (2004) Microdialysis in neurointensive care. Curr Pharm Des 10:2145–2152
    • View reference on PubMed
    • View reference on publisher's website
  20. Kopterides P, Nikitas N, Vassiliadi D, Orfanos SE, Theodorakopoulou M, Ilias I, Boutati E, Dimitriadis G, Maratou E, Diamantakis A, Armaganidis A, Ungerstedt U, Dimopoulou I (2011) Microdialysis-assessed interstitium alterations during sepsis: relationship to stage, infection, and pathogen. Intensive Care Med 37:1756–1764
  21. Dimopoulou I, Nikitas N, Orfanos SE, Theodorakopoulou M, Vassiliadi D, Ilias I, Ikonomidis I, Boutati E, Maratou I, Tsangaris I, Karkouli G, Tsafou E, Diamantakis A, Kopterides P, Maniatis N, Kotanidou A, Armaganidis A, Ungerstedt U (2011) Kinetics of adipose tissue microdialysis-derived metabolites in critically ill septic patients: associations with sepsis severity and clinical outcome. Shock 35:343–348
    • View reference on PubMed
    • View reference on publisher's website
  22. Zygun DA, Nortje J, Hutchinson PJ, Timofeev I, Menon DK, Gupta AK (2009) The effect of red blood cell transfusion on cerebral oxygenation and metabolism after severe traumatic brain injury. Crit Care Med 37:1074–1078
    • View reference on PubMed
    • View reference on publisher's website
  23. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G, SCCM/ESICM/ACCP/ATS/SIS (2003) 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 31:1250–1256
    • View reference on PubMed
    • View reference on publisher's website
  24. Gogos C, Kotsaki A, Pelekanou A, Giannikopoulos G, Vaki I, Maravitsa P, Adamis S, Alexiou Z, Andrianopoulos G, Antonopoulou A, Athanassia S, Baziaka F, Charalambous A, Christodoulou S, Dimopoulou I, Floros I, Giannitsioti E, Gkanas P, Ioakeimidou A, Kanellakopoulou K, Karabela N, Karagianni V, Katsarolis I, Kontopithari G, Kopterides P, Koutelidakis I, Koutoukas P, Kranidioti H, Lignos M, Louis K, Lymberopoulou K, Mainas E, Marioli A, Massouras C, Mavrou I, Mpalla M, Michalia M, Mylona H, Mytas V, Papanikolaou I, Papanikolaou K, Patrani M, Perdios I, Plachouras D, Pistiki A, Protopapas K, Rigaki K, Sakka V, Sartzi M, Skouras V, Souli M, Spyridaki A, Strouvalis I, Tsaganos T, Zografos G, Mandragos K, Klouva-Molyvdas P, Maggina N, Giamarellou H, Armaganidis A, Giamarellos-Bourboulis EJ (2010) Early alterations of the innate and adaptive immune statuses in sepsis according to the type of underlying infection. Crit Care 14:R96
    • View reference on PubMed
    • View reference on publisher's website
  25. Faul F, Erdfelder E, Lang AG, Buchner A (2007) G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 39:175–191
    • View reference on PubMed
    • View reference on publisher's website
  26. Marik PE, Sibbald WJ (1993) Effect of stored-blood transfusion on oxygen delivery in patients with sepsis. JAMA 269:3024–3029
    • View reference on PubMed
    • View reference on publisher's website
  27. Zallen G, Offner PJ, Moore EE, Blackwell J, Ciesla DJ, Gabriel J, Denny C, Silliman CC (1999) Age of transfused blood is an independent risk factor for post injury multiple organ failure. Am J Surg 178:570–572
    • View reference on PubMed
    • View reference on publisher's website
  28. Ospina-Tascon G, Neves AP, Occhipinti G, Donadello K, Büchele G, Simion D, Chierego ML, Silva TO, Fonseca A, Vincent JL, De Backer D (2010) Effects of fluids on microvascular perfusion in patients with severe sepsis. Intensive Care Med 36:949–955
  29. De Backer D, Ortiz JA, Salgado D (2010) Coupling microcirculation to systemic hemodynamics. Curr Opin Crit Care 16:250–254
    • View reference on PubMed
    • View reference on publisher's website
  30. Jhanji S, Lee C, Watson D, Hinds C, Pearse RM (2009) Microvascular flow and tissue oxygenation after major abdominal surgery: association with post-operative complications. Intensive Care Med 35:671–677
  31. Pottecher J, Deruddre S, Teboul JL, Georger JF, Laplace C, Benhamou D, Vicaut E, Duranteau J (2010) Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med 36:1867–1874
  32. Lelubre C, Vincent JL (2011) Red blood cell transfusion in the critically ill patient. Ann Intensive Care 1:43
    • View reference on PubMed
    • View reference on publisher's website
  33. Doerschug KC, Delsing AS, Schmidt GA, Haynes WG (2007) Impairments in microvascular reactivity are related to organ failure in human sepsis. Am J Physiol Heart Circ Physiol 293:H1065–H1071
    • View reference on PubMed
    • View reference on publisher's website
  34. Nichol AD, Egi M, Pettila V, Bellomo R, French C, Hart G, Davies A, Stachowski E, Reade MC, Bailey M, Cooper DJ (2010) Relative hyperlactatemia and hospital mortality in critically ill patients: a retrospective multi-centre study. Crit Care 14:R25
    • View reference on PubMed
    • View reference on publisher's website
  35. Pojar M, Mand’ák J, Cibícek N, Lonský V, Dominik J, Palicka V, Kubícek J (2008) Peripheral tissue metabolism during off-pump versus on-pump coronary artery bypass graft surgery: the microdialysis study. Eur J Cardiothorac Surg 33:899–905
    • View reference on PubMed
    • View reference on publisher's website
  36. Timofeev I, Carpenter KL, Nortje J, Al-Rawi PG, O’Connell MT, Czosnyka M, Smielewski P, Pickard JD, Menon DK, Kirkpatrick PJ, Gupta AK, Hutchinson PJ (2011) Cerebral extracellular chemistry and outcome following traumatic brain injury: a microdialysis study of 223 patients. Brain 134:484–494
    • View reference on PubMed
    • View reference on publisher's website
  37. Hollenberg SM (2010) Think locally: evaluation of the microcirculation in sepsis. Intensive Care Med 36:1807–1809

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