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IRIS
Background: Red blood cell (RBC) transfusion is associated with inconsistent changes in brain tissue oxygenation (PbO<inf>2</inf>). Previous studies have failed to consider alterations in cerebral autoregulation. Our objective was to investigate the effect of RBC transfusion on cerebral autoregulation, as measured by pressure reactivity index (PRx). Methods: Retrospective analysis of 28 severe traumatic brain injury (TBI) patients from a prospective registry between 2007 and 2014. We recorded hemoglobin (Hb) concentration, intracranial pressure, PbO<inf>2</inf>, cerebral perfusion pressure, PRx, and cerebral lactate/pyruvate ratio for 6 h before and after RBC transfusion. We also recorded body temperature, PaO<inf>2</inf>, PCO<inf>2</inf>, pH, and fraction of inspired oxygen. Subgroups of normoxia (PbO<inf>2</inf> >20 mmHg) and hypoxia (PbO<inf>2</inf> <20 mmHg) prior to transfusion were defined a priori. Results: The median age was 36 years [interquartile range (IQR) 27–49], 32 % were female. The median admission Glasgow Coma score was 5 (IQR 4–9) and injury severity score was 16 (IQR 9–21). Overall, mean Hb concentration [80 g/L (SD 7) to 89 g/L (SD 8), p < 0.001] and PbO<inf>2</inf> increased [23.5 mmHg (SD 8) to 25.0 mmHg (SD 9), p = 0.033] following transfusion. PRx increased post-transfusion [0.028 (SD 0.29) to 0.11 (SD 0.24), p = 0.034], indicating worsening cerebrovascular pressure reactivity. In patients with mean PbO<inf>2</inf> >20 mmHg pre-transfusion (n = 20), the PRx increased significantly [−0.052 (SD 0.24) to 0.079 (SD 0.22), p = 0.007] but did not change in patients with PbO<inf>2</inf> <20 mmHg: PRx [0.22 (SD 0.34) to 0.18 (SD 0.30), p = 0.36]. Conclusion: RBC transfusion in severe TBI patients results in worsening PRx, indicating impaired cerebral autoregulation.
The Effect of Red Blood Cell Transfusion on Cerebral Autoregulation in Patients with Severe Traumatic Brain Injury
Sekhon, Mypinder S.;Griesdale, Donald E.;Czosnyka, Marek;Donnelly, Joseph;Liu, Xia;Aries, Marcel J.;ROBBA, CHIARA;Lavinio, Andrea;Menon, David K.;Smielewski, Peter;Gupta, Arun K.
2015-01-01
Abstract
Background: Red blood cell (RBC) transfusion is associated with inconsistent changes in brain tissue oxygenation (PbO2). Previous studies have failed to consider alterations in cerebral autoregulation. Our objective was to investigate the effect of RBC transfusion on cerebral autoregulation, as measured by pressure reactivity index (PRx). Methods: Retrospective analysis of 28 severe traumatic brain injury (TBI) patients from a prospective registry between 2007 and 2014. We recorded hemoglobin (Hb) concentration, intracranial pressure, PbO2, cerebral perfusion pressure, PRx, and cerebral lactate/pyruvate ratio for 6 h before and after RBC transfusion. We also recorded body temperature, PaO2, PCO2, pH, and fraction of inspired oxygen. Subgroups of normoxia (PbO2 >20 mmHg) and hypoxia (PbO2 <20 mmHg) prior to transfusion were defined a priori. Results: The median age was 36 years [interquartile range (IQR) 27–49], 32 % were female. The median admission Glasgow Coma score was 5 (IQR 4–9) and injury severity score was 16 (IQR 9–21). Overall, mean Hb concentration [80 g/L (SD 7) to 89 g/L (SD 8), p < 0.001] and PbO2 increased [23.5 mmHg (SD 8) to 25.0 mmHg (SD 9), p = 0.033] following transfusion. PRx increased post-transfusion [0.028 (SD 0.29) to 0.11 (SD 0.24), p = 0.034], indicating worsening cerebrovascular pressure reactivity. In patients with mean PbO2 >20 mmHg pre-transfusion (n = 20), the PRx increased significantly [−0.052 (SD 0.24) to 0.079 (SD 0.22), p = 0.007] but did not change in patients with PbO2 <20 mmHg: PRx [0.22 (SD 0.34) to 0.18 (SD 0.30), p = 0.36]. Conclusion: RBC transfusion in severe TBI patients results in worsening PRx, indicating impaired cerebral autoregulation.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11567/860847
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.
