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Effects of massive transfusion on oxygen availability
J O Auler Júnior1, E Bonetti, A C Hueb
1Heart Institute, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Insights
Massive blood transfusions after cardiac surgery can impair oxygen transport, leading to high lactate and low P50 levels in non-survivors. These findings suggest cell oxygenation disturbances in patients receiving massive transfusions.
Area of Science:
- Cardiovascular Surgery
- Transfusion Medicine
- Critical Care Medicine
Background:
- Massive blood replacement is a critical intervention in complex cardiovascular surgeries.
- Understanding the physiological impact of massive transfusions is crucial for patient outcomes.
- Oxygen-derived parameters, hemodynamics, and biochemical markers provide insights into cellular function post-transfusion.
Purpose of the Study:
- To investigate oxygen-derived parameters, hemodynamic, and biochemical data in patients undergoing massive blood replacement after cardiac surgery.
- To identify potential markers associated with adverse outcomes in this patient cohort.
Main Methods:
- Prospective study conducted at the Heart Institute, University of São Paulo, Brazil.
- Involved twelve patients after cardiac surgery requiring massive transfusion.
- Monitored oxygen parameters, 2,3 Diphosphoglycerate (2,3 DPG), lactate, and blood gases.
Main Results:
- Non-survivors (n=6) exhibited significantly higher lactate and lower P50 levels compared to survivors (p < 0.05).
- Both groups showed increased oxygen consumption and O2 extraction, with no significant intergroup differences.
- Slightly reduced 2,3 Diphosphoglycerate levels were observed in both survivor and non-survivor groups.
Conclusions:
- Massive transfusions in cardiovascular surgery patients are associated with disturbances in cellular oxygenation.
- Inadequate oxygen transport appears to be a contributing factor to these observed disturbances.
- Lactate and P50 levels may serve as indicators of oxygen transport adequacy post-massive transfusion.
Objectives:
To determine oxygen derived parameters, hemodynamic and biochemical laboratory data (2,3 Diphosphoglycerate, lactate and blood gases analysis) in patients after cardiac surgery who received massive blood replacement.
Design:
Prospective study.
Setting:
Heart Institute (Instituto do Caração), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Brazil.
Participants:
Twelve patients after cardiac surgery who received massive transfusion replacement; six of them evolved to a fatal outcome within the three-day postoperative follow-up.
Measurements And Main Results:
The non-survivors group (n = 6) presented high lactate levels and low P50 levels, when compared to the survivors group (p < 0.05). Both groups presented an increase in oxygen consumption and O2 extraction, and there were no significant differences between them regarding these parameters. The 2,3 DPG levels were slightly reduced in both groups.
Conclusions:
This study shows that patients who are massively transfused following cardiovascular surgery present cell oxygenation disturbances probably as a result of O2 transport inadequacy.