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Transfusion requirements after head trauma: a randomized feasibility controlled trial
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. All eligible consecutive adult patients admitted...
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| Published in: | Critical care (London, England) England), 2019-03, Vol.23 (1), p.89-89, Article 89 |
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| creator | Gobatto, André L N Link, Milena A Solla, Davi J Bassi, Estevão Tierno, Paulo F Paiva, Wellingson Taccone, Fabio S Malbouisson, Luiz M |
| description | 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.
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.
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 |
| doi_str_mv | 10.1186/s13054-018-2273-9 |
| format | article |
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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.
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).
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.
ClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.</description><identifier>ISSN: 1364-8535</identifier><identifier>EISSN: 1466-609X</identifier><identifier>EISSN: 1364-8535</identifier><identifier>DOI: 10.1186/s13054-018-2273-9</identifier><identifier>PMID: 30871608</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Anemia ; Anemia - complications ; Anemia - therapy ; Blood transfusion ; Blood Transfusion - methods ; Blood Transfusion - standards ; Brain injuries ; Brazil ; Complications and side effects ; Craniocerebral Trauma - physiopathology ; Craniocerebral Trauma - therapy ; Feasibility Studies ; Female ; Glasgow Coma Scale ; Glycosylated hemoglobin ; Head injuries ; Hemoglobins ; Hospital patients ; Humans ; Intensive Care Units - organization & administration ; Intensive Care Units - statistics & numerical data ; Intracranial pressure ; Male ; Middle Aged ; Mortality ; Patient outcomes ; Risk factors ; Transfusion ; Traumatic brain injury</subject><ispartof>Critical care (London, England), 2019-03, Vol.23 (1), p.89-89, Article 89</ispartof><rights>COPYRIGHT 2019 BioMed Central Ltd.</rights><rights>The Author(s). 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c532t-bf553ada79a8d301b6723c11e6add4034422cb1ba44e6dc4dde5b084c0e73c953</citedby><cites>FETCH-LOGICAL-c532t-bf553ada79a8d301b6723c11e6add4034422cb1ba44e6dc4dde5b084c0e73c953</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419414/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419414/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,37013,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30871608$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Gobatto, André L N</creatorcontrib><creatorcontrib>Link, Milena A</creatorcontrib><creatorcontrib>Solla, Davi J</creatorcontrib><creatorcontrib>Bassi, Estevão</creatorcontrib><creatorcontrib>Tierno, Paulo F</creatorcontrib><creatorcontrib>Paiva, Wellingson</creatorcontrib><creatorcontrib>Taccone, Fabio S</creatorcontrib><creatorcontrib>Malbouisson, Luiz M</creatorcontrib><title>Transfusion requirements after head trauma: a randomized feasibility controlled trial</title><title>Critical care (London, England)</title><addtitle>Crit Care</addtitle><description>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.
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.
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).
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.
ClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.</description><subject>Adult</subject><subject>Anemia</subject><subject>Anemia - complications</subject><subject>Anemia - therapy</subject><subject>Blood transfusion</subject><subject>Blood Transfusion - methods</subject><subject>Blood Transfusion - standards</subject><subject>Brain injuries</subject><subject>Brazil</subject><subject>Complications and side effects</subject><subject>Craniocerebral Trauma - physiopathology</subject><subject>Craniocerebral Trauma - therapy</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Glasgow Coma Scale</subject><subject>Glycosylated hemoglobin</subject><subject>Head injuries</subject><subject>Hemoglobins</subject><subject>Hospital patients</subject><subject>Humans</subject><subject>Intensive Care Units - organization & administration</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Intracranial pressure</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Patient outcomes</subject><subject>Risk factors</subject><subject>Transfusion</subject><subject>Traumatic brain injury</subject><issn>1364-8535</issn><issn>1466-609X</issn><issn>1364-8535</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>DOA</sourceid><recordid>eNptkl9rFTEQxRdRbK1-AF9kwRdftmY2fzbrg1CK2kLBlxZ8C5Nk9jZld9Mmu0L99Ob2tsULkoeEyTk_ZoZTVe-BHQNo9TkDZ1I0DHTTth1v-hfVIQilGsX6Xy_LmyvRaMnlQfUm5xvGoNOKv64OONMdKKYPq6vLhHMe1hziXCe6W0OiieYl1zgslOprQl8vCdcJv9RYF7GPU_hDvh4Ic7BhDMt97eK8pDiOtNUGHN9WrwYcM717vI-qq-_fLk_PmoufP85PTy4aJ3m7NHaQkqPHrkftOQOrupY7AFLovWBciLZ1FiwKQco74T1Jy7RwjDruesmPqvMd10e8MbcpTJjuTcRgHgoxbQymJbiRjBrACq9Fx4mLQbRWCm2t5zBIdKSgsL7uWLernci7soSE4x50_2cO12YTfxsloBcgCuDTIyDFu5XyYqaQHY0jzhTXbFroOXSMt7pIP-6kGyythXmIhei2cnMiNQjJ4WG64_-oyvE0hbJyGkKp7xlgZ3Ap5pxoeO4emNkmxuwSY0pizDYxpi-eD_-O_ex4igj_CwowvR0</recordid><startdate>20190312</startdate><enddate>20190312</enddate><creator>Gobatto, André L N</creator><creator>Link, Milena A</creator><creator>Solla, Davi J</creator><creator>Bassi, Estevão</creator><creator>Tierno, Paulo F</creator><creator>Paiva, Wellingson</creator><creator>Taccone, Fabio S</creator><creator>Malbouisson, Luiz M</creator><general>BioMed Central Ltd</general><general>BioMed Central</general><general>BMC</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope></search><sort><creationdate>20190312</creationdate><title>Transfusion requirements after head trauma: a randomized feasibility controlled trial</title><author>Gobatto, André L N ; Link, Milena A ; Solla, Davi J ; Bassi, Estevão ; Tierno, Paulo F ; Paiva, Wellingson ; Taccone, Fabio S ; Malbouisson, Luiz M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c532t-bf553ada79a8d301b6723c11e6add4034422cb1ba44e6dc4dde5b084c0e73c953</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Anemia</topic><topic>Anemia - complications</topic><topic>Anemia - therapy</topic><topic>Blood transfusion</topic><topic>Blood Transfusion - methods</topic><topic>Blood Transfusion - standards</topic><topic>Brain injuries</topic><topic>Brazil</topic><topic>Complications and side effects</topic><topic>Craniocerebral Trauma - physiopathology</topic><topic>Craniocerebral Trauma - therapy</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Glasgow Coma Scale</topic><topic>Glycosylated hemoglobin</topic><topic>Head injuries</topic><topic>Hemoglobins</topic><topic>Hospital patients</topic><topic>Humans</topic><topic>Intensive Care Units - organization & administration</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Intracranial pressure</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Patient outcomes</topic><topic>Risk factors</topic><topic>Transfusion</topic><topic>Traumatic brain injury</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Gobatto, André L N</creatorcontrib><creatorcontrib>Link, Milena A</creatorcontrib><creatorcontrib>Solla, Davi J</creatorcontrib><creatorcontrib>Bassi, Estevão</creatorcontrib><creatorcontrib>Tierno, Paulo F</creatorcontrib><creatorcontrib>Paiva, Wellingson</creatorcontrib><creatorcontrib>Taccone, Fabio S</creatorcontrib><creatorcontrib>Malbouisson, Luiz M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Critical care (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Gobatto, André L N</au><au>Link, Milena A</au><au>Solla, Davi J</au><au>Bassi, Estevão</au><au>Tierno, Paulo F</au><au>Paiva, Wellingson</au><au>Taccone, Fabio S</au><au>Malbouisson, Luiz M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transfusion requirements after head trauma: a randomized feasibility controlled trial</atitle><jtitle>Critical care (London, England)</jtitle><addtitle>Crit Care</addtitle><date>2019-03-12</date><risdate>2019</risdate><volume>23</volume><issue>1</issue><spage>89</spage><epage>89</epage><pages>89-89</pages><artnum>89</artnum><issn>1364-8535</issn><eissn>1466-609X</eissn><eissn>1364-8535</eissn><abstract>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.
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.
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).
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.
ClinicalTrials.gov, NCT02203292 . Registered on 29 July 2014.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>30871608</pmid><doi>10.1186/s13054-018-2273-9</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Anemia Anemia - complications Anemia - therapy Blood transfusion Blood Transfusion - methods Blood Transfusion - standards Brain injuries Brazil Complications and side effects Craniocerebral Trauma - physiopathology Craniocerebral Trauma - therapy Feasibility Studies Female Glasgow Coma Scale Glycosylated hemoglobin Head injuries Hemoglobins Hospital patients Humans Intensive Care Units - organization & administration Intensive Care Units - statistics & numerical data Intracranial pressure Male Middle Aged Mortality Patient outcomes Risk factors Transfusion Traumatic brain injury |
| title | Transfusion requirements after head trauma: a randomized feasibility controlled trial |
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