Transfusion of standard-issue packed red blood cells induces pulmonary vasoconstriction in critically ill patients after cardiac surgery—A randomized, double-blinded, clinical trial

Abstract

BackgroundExperimental and volunteer studies have reported pulmonary vasoconstriction during transfusion of packed red blood cells (PRBCs) stored for prolonged periods. The primary aim of this study was to evaluate whether transfusion of PRBCs stored over 21 days (standard-issue, siPRBCs) increases pulmonary artery pressure (PAP) to a greater extent than transfusion of PRBCs stored for less then 14 days (fresh, fPRBCs) in critically ill patients following cardiac surgery. The key secondary aim was to assess whether the pulmonary vascular resistance index (PVRI) increases after transfusion of siPRBCs to a greater extent than after transfusion of fPRBCs.MethodsThe study was performed as a single-center, double-blinded, parallel-group, randomized clinical trial. Leukoreduced PRBCs were transfused while continuously measuring hemodynamic parameters. Systemic concentrations of syndecan-1 were measured to assess glycocalyx injury. After randomizing 19 patients between January 2014 and June 2016, the study was stopped due to protracted patient recruitment.ResultsOf 19 randomized patients, 11 patients were transfused and included in statistical analyses. Eight patients were excluded prior to transfusion, 6 patients received fPRBCs (10±3 storage days), whereas 5 patients received siPRBCs (33±4 storage days). The increase in PAP (7±3 vs. 2±2 mmHg, P = 0.012) was greater during transfusion of siPRBCs than during transfusion of fPRBCs. In addition, the change in PVRI (150±89 vs. -4±37 dyn·s·cm-5·m2, P = 0.018) was greater after transfusion of siPRBCs than after transfusion of fPRBCs. The increase in PAP correlated with the change of systemic syndecan-1 concentrations at the end of transfusion (R = 0.64,P = 0.034).ConclusionAlthough this study is underpowered and results require verification in larger clinical trials, our findings suggest that transfusion of siPRBCs increases PAP and PVRI to a greater extent than transfusion of fPRBCs in critically ill patients following cardiac surgery. Glycocalyx injury might contribute to pulmonary vasoconstriction associated with transfusion of stored blood.

Volume incompliance and transfusion are essential for transfusion‐associated circulatory overload: a novel animal model

“…They showed a significant rise in wedge pressure after transfusion; however, they lacked a fluid control group. Additionally, a recent large observational study in intensive care unit patients showed an increase in PCWP after transfusion, as well as a cardiac surgery study showing similar results . We see a similar effect of transfusion on capillary pressures; however, with our RL‐infused control group, we show that this increase is specifically transfusion product related.…”

Autologous red blood cell transfusion does not result in a more profound increase in pulmonary capillary wedge pressure compared to saline in critically ill patients: A randomized crossover trial

“…Storage lesion may be an alternative pathway leading to hydrostatic pulmonary oedema after transfusion. Baron-Stefaniak et al compared fresh versus standard-issued RBCs and suggested PAP increase in the latter [14]. We transfused fresh RBCs and confirmed their finding that RBCs stored for 3 days did not alter PVRI.…”

“…Previous studies assessing the effect of allogeneic RBC transfusion on hydrostatic pressure have found a pulmonary capillary wedge pressure (PCWP) rise of 3 mmHg in chronic anaemic patients following transfusion [12,13], and suggested pulmonary artery pressure (PAP) increases after standard-issue versus fresh RBCs in critically ill patients [14]. A volunteer study showed an increase in the mean PAP following autologous transfusion of 1 unit of stored RBCs [15].…”

Optimal blood management as priority route in cardiac surgery

“…Повышение концентрации гемоглобина вслед за переливанием ЭСК хотя и может способствовать улучшению глобальной доставки кислорода, но ожидаемое повышение оксигенации тканей при этом наблюдаются лишь у малой части больных [64,65]. Объясняться это может либо причинами дисбаланса между доставкой и потреблением кислорода, не связанными с анемией, т. е. переливание ЭСК не было обусловлено клинической ситуацией, не являлось показанным и, следовательно, не было эффективно, либо изменениями донорских ЭСК, происходящих в процессе заготовки, переработки и хранения [66][67][68][69][70][71][72][73]. Большое количество клинических сравнений безопасности и эффективности, предпринятых у разных категорий больных, в том числе объединенные в метаанализы, не выявило преимуществ высоких или низких триггеров трансфузий ЭСК на основании концентрации гемоглобина.…”