| The effect of blood transfusion on brain oxygenation in children with severe traumatic brain injury. | |
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MedLine Citation:
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PMID: 19794323 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The indications for blood transfusion in traumatic brain injury are controversial. In particular, little is known about the effect of blood transfusion in childhood traumatic brain injury. This study aimed to examine the influence of blood transfusion on brain tissue oxygen tension in children with severe traumatic brain injury. DESIGN: A retrospective analysis of a prospective observational database of children with severe traumatic brain injury who received brain tissue oxygen tension monitoring and a blood transfusion. SETTING: University-affiliated pediatric hospital. PATIENTS: Children with severe traumatic brain injury and blood transfusion. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Brain tissue oxygen tension was measured in normal-appearing white matter with a commercially available polarographic Clarke-type electrode. Brain tissue oxygen tension values after blood transfusion were compared with pre-transfusion values in hemodynamically stable patients. Limited interventions were allowed during the studied period. Brain tissue oxygen tension values were examined for early (1-4 hrs) and late (24 hrs) changes after blood transfusion, controlling for multiple clinical and physiologic variables with regression techniques. Further comparison was made with matched non-transfused controls to examine the influence of time after injury. Nineteen blood transfusions in 17 patients were evaluated. Brain tissue oxygen tension increased significantly in the early period after blood transfusion (p = .0018; 79% increased, 21% decreased) in comparison with baseline values and matched controls, but the overall changes were small and, in part, influenced by accompanying cerebral perfusion pressure changes. Also, this effect was limited to the early period after blood transfusion and was not significant after 24 hrs. In general, the brain tissue oxygen tension increase was larger in patients with higher baseline brain tissue oxygen tension and lower initial hemoglobin; however, no factors associated with the magnitude of the brain tissue oxygen tension change were significant in multivariate analysis. Increased age of blood did not appear to impair brain tissue oxygen tension changes, but most blood transfusion were <14 days old. CONCLUSIONS: Brain tissue oxygen tension increased transiently in 79% of blood transfusion in pediatric traumatic brain injury patients, and decreased transiently in 21%. Brain tissue oxygen tension returned to baseline within 24 hrs. Reliable predictors of this brain tissue oxygen tension response to blood transfusion, however, remain elusive. |
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Authors:
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Anthony A Figaji; Eugene Zwane; M Kogels; A Graham Fieggen; Andrew C Argent; Peter D Le Roux; Jonathan C Peter |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies Volume: 11 ISSN: 1529-7535 ISO Abbreviation: Pediatr Crit Care Med Publication Date: 2010 May |
Date Detail:
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Created Date: 2010-05-10 Completed Date: 2010-09-08 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100954653 Medline TA: Pediatr Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 325-31 Citation Subset: IM |
Affiliation:
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Division of Neurosurgery, School of Child and Adolescent Health, University of Cape Town, Red Cross Childrens Hospital, Cape Town, South Africa. Anthony.Figaji@uct.ac.za |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Transfusion* Brain / blood supply* Brain Injuries / physiopathology, therapy* Child Child, Preschool Databases, Factual Erythrocyte Transfusion Hospitals, Pediatric Humans Oxygen / metabolism* Retrospective Studies Trauma Severity Indices |
| Chemical | |
Reg. No./Substance:
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7782-44-7/Oxygen |
| Comments/Corrections | |
Comment In:
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Pediatr Crit Care Med. 2010 May;11(3):420-1
[PMID:
20453612
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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