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CARDIOVASCULAR ANESTHESIA

The Influence of Allogeneic Red Blood Cell Transfusion Compared with 100% Oxygen Ventilation on Systemic Oxygen Transport and Skeletal Muscle Oxygen Tension After Cardiac Surgery

Stefan Suttner, MD^*, Swen N. Piper, MD^*, Bernhard Kumle, MD^*, Katrin Lang, MD^*, Kerstin D. Röhm, MD^*, Frank Isgro, MD, and Joachim Boldt, MD^*

Departments of *Anesthesiology and Intensive Care Medicine and Cardiac Surgery, Klinikum Ludwigshafen, Ludwigshafen, Germany

Address correspondence and reprint requests to Stefan Suttner, MD, Department of Anesthesiology and Intensive Care Medicine, Klinikum Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen, Germany. Address e-mail to suttner{at}gmx.de

In this study we investigated the effects of allogeneic red blood cell (RBC) transfusion on tissue oxygenation compared with those of 100% oxygen ventilation by using systemic oxygen transport variables and skeletal muscle oxygen tension (P_tiO₂). Fifty-one volume-resuscitated, mechanically ventilated patients with a nadir hemoglobin concentration in the range from 7.5 to 8.5 g/dL after elective coronary artery bypass grafting were allocated randomly to receive 1 unit (transfusion 1; n = 17) or 2 units (transfusion 2; n = 17) of allogeneic RBCs and ventilation with 40% oxygen or pure oxygen ventilation (100% oxygen; n = 17) and no allogeneic blood for 3 hours. Invasive arterial and pulmonary artery pressures and calculations of oxygen delivery (oxygen delivery index) and consumption indices (oxygen consumption index) were documented at 30-min intervals. P_tiO₂ was measured continuously by using implantable polarographic microprobes. Systemic oxygen transport variables and P_tiO₂ were similar between groups at baseline. The oxygen delivery index increased significantly with transfusion of allogeneic RBCs and 100% oxygen ventilation, whereas the oxygen consumption index remained unchanged. Oxygen 100% ventilation increased P_tiO₂ significantly (from 24.0 ± 5.1 mm Hg to 34.2 ± 6.2 mm Hg), whereas no change was found after transfusion of allogeneic RBCs. Peak P_tiO₂ values were 25.2 ± 5.2 mm Hg and 26.3 ± 6.5 mm Hg in the transfusion 1 and 2 groups, respectively. Transfusion of stored allogeneic RBCs was effective only in improving systemic oxygen delivery index, whereas 100% oxygen ventilation improved systemic oxygen transport and P_tiO₂. This improved oxygenation status was most likely due to an increase in convective oxygen transport with a large driving gradient for diffusion of plasma-dissolved oxygen into the tissue.

IMPLICATIONS: We used systemic oxygen transport variables and skeletal muscle oxygen tension to assess the oxygenation status of moderately anemic, mechanically ventilated cardiac surgery patients in response to either allogeneic red blood cell transfusion or 100% oxygen ventilation. Transfusion of stored allogeneic blood was effective only in improving systemic oxygen delivery, whereas 100% oxygen ventilation improved systemic oxygenation and skeletal muscle oxygen tension.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999