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Intraoperative transfusion threshold and tissue oxygenation: a randomised trial.

K Nielsen¹, B Dahl, P I Johansson

¹Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Kamilla.nielsen.kn@gmail.com

Transfusion Medicine (Oxford, England)

|November 6, 2012

Summary

A higher red blood cell (RBC) transfusion threshold of 8.9 g/dL did not improve subcutaneous oxygen tension during major spinal surgery compared to a 7.3 g/dL threshold. Methodological issues compromised the study findings.

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Area of Science:

Anesthesiology
Transfusion Medicine
Surgical Critical Care

Background:

Maintaining adequate oxygen delivery is crucial during major surgery.
The optimal hemoglobin (Hb) concentration threshold for red blood cell (RBC) transfusion remains debated.
Subcutaneous oxygen tension is a potential indicator of tissue oxygenation.

Purpose of the Study:

To investigate if a higher Hb concentration threshold (8.9 g/dL) improves subcutaneous oxygen tension during major spinal surgery compared to a restrictive threshold (7.3 g/dL).
To assess the association between Hb levels and tissue oxygenation in patients undergoing spinal fusion.

Main Methods:

A randomized controlled trial involving 50 patients undergoing spinal fusion with instrumentation.
Patients were assigned to either a restrictive (Hb 7.3 g/dL) or liberal (Hb 8.9 g/dL) RBC transfusion group.

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Subcutaneous oxygen tension was measured using a polarographic electrode.

Main Results:

No significant difference in the median change or lowest subcutaneous oxygen tension was observed between the restrictive and liberal transfusion groups.
The P-values for the primary endpoint and lowest oxygen tension were 0.78 and 0.85, respectively.
Forty-eight patients completed the intention-to-treat analysis.

Conclusions:

A liberal Hb transfusion threshold of 8.9 g/dL was not associated with improved subcutaneous oxygen tension compared to a restrictive threshold of 7.3 g/dL in major spinal surgery.
The study was limited by methodological difficulties, impacting the certainty of the findings.
Further research is needed to establish optimal transfusion strategies for tissue oxygenation during complex surgeries.