Ahmet Salih Tüzen, Murat Aksun, Atilla Şencan, Senem Girgin, Birzat Emre Gölboyu, Gizem Kırbaş, Ozan Şanlı
{"title":"重症监护病房红细胞输注后氧提取率变化的评估：一项前瞻性观察性非介入性研究。","authors":"Ahmet Salih Tüzen, Murat Aksun, Atilla Şencan, Senem Girgin, Birzat Emre Gölboyu, Gizem Kırbaş, Ozan Şanlı","doi":"10.1111/trf.18164","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The decision-making process for red blood cell transfusion (RBCT) in critically ill patients in the intensive care unit (ICU) remains primarily guided by hemoglobin-based thresholds. However, as a component of personalized medicine, innovative and individualized criteria should be developed to optimize RBCT decisions. This study aims to assess the impact of RBCTs on oxygenation parameters and patient outcomes, with a specific focus on the oxygen extraction ratio (O<sub>2</sub>ER).</p><p><strong>Study design and methods: </strong>This prospective observational study included 77 critically ill patients receiving RBCTs according to ICU transfusion protocols. The primary hypothesis is that patients with an O<sub>2</sub>ER > 0.30 will benefit most from RBCTs. To investigate this, patients receiving RBCTs were divided into two groups: those with O<sub>2</sub>ER > 0.30 (RBCTs appropriate) and those with O<sub>2</sub>ER ≤ 0.30 (RBCTs appropriateness questionable). The two groups were compared in terms of primarily O<sub>2</sub>ER, other oxygenation parameters, and clinical outcomes. The primary outcome was the change in O<sub>2</sub>ER following RBCTs, while secondary outcomes encompassed other oxygenation parameter changes.</p><p><strong>Results: </strong>The O<sub>2</sub>ER > 0.30 group showed significant improvement in O<sub>2</sub>ER (0.38 ± 0.04 vs. 0.32 ± 0.05; p < .001), whereas no such improvement was observed in the O<sub>2</sub>ER ≤ 0.30 group (0.26 ± 0.03 vs. 0.28 ± 0.05; p: .017). Additionally, the O<sub>2</sub>ER > 0.30 group exhibited improvements in central venous oxygen saturation (ScvO<sub>2</sub>) following RBCTs, which were not seen in the O<sub>2</sub>ER ≤ 0.30 group.</p><p><strong>Discussion: </strong>Our study reveals promising insights into the impact of RBCTs on O<sub>2</sub>ER; however, these physiological changes did not result in significant clinical improvements. Hence, this study provides a rational basis for the feasibility of implementing a personalized strategy focused on physiological triggers for RBCTs.</p><p><strong>Trial registration number: </strong>NCT05798130 (https://clinicaltrials.gov/study/NCT05798130).</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":" ","pages":""},"PeriodicalIF":2.5000,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Assessment of oxygen extraction rate changes following red blood cell transfusion in the intensive care unit: A prospective observational noninterventional study.\",\"authors\":\"Ahmet Salih Tüzen, Murat Aksun, Atilla Şencan, Senem Girgin, Birzat Emre Gölboyu, Gizem Kırbaş, Ozan Şanlı\",\"doi\":\"10.1111/trf.18164\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The decision-making process for red blood cell transfusion (RBCT) in critically ill patients in the intensive care unit (ICU) remains primarily guided by hemoglobin-based thresholds. However, as a component of personalized medicine, innovative and individualized criteria should be developed to optimize RBCT decisions. This study aims to assess the impact of RBCTs on oxygenation parameters and patient outcomes, with a specific focus on the oxygen extraction ratio (O<sub>2</sub>ER).</p><p><strong>Study design and methods: </strong>This prospective observational study included 77 critically ill patients receiving RBCTs according to ICU transfusion protocols. The primary hypothesis is that patients with an O<sub>2</sub>ER > 0.30 will benefit most from RBCTs. To investigate this, patients receiving RBCTs were divided into two groups: those with O<sub>2</sub>ER > 0.30 (RBCTs appropriate) and those with O<sub>2</sub>ER ≤ 0.30 (RBCTs appropriateness questionable). The two groups were compared in terms of primarily O<sub>2</sub>ER, other oxygenation parameters, and clinical outcomes. The primary outcome was the change in O<sub>2</sub>ER following RBCTs, while secondary outcomes encompassed other oxygenation parameter changes.</p><p><strong>Results: </strong>The O<sub>2</sub>ER > 0.30 group showed significant improvement in O<sub>2</sub>ER (0.38 ± 0.04 vs. 0.32 ± 0.05; p < .001), whereas no such improvement was observed in the O<sub>2</sub>ER ≤ 0.30 group (0.26 ± 0.03 vs. 0.28 ± 0.05; p: .017). Additionally, the O<sub>2</sub>ER > 0.30 group exhibited improvements in central venous oxygen saturation (ScvO<sub>2</sub>) following RBCTs, which were not seen in the O<sub>2</sub>ER ≤ 0.30 group.</p><p><strong>Discussion: </strong>Our study reveals promising insights into the impact of RBCTs on O<sub>2</sub>ER; however, these physiological changes did not result in significant clinical improvements. Hence, this study provides a rational basis for the feasibility of implementing a personalized strategy focused on physiological triggers for RBCTs.</p><p><strong>Trial registration number: </strong>NCT05798130 (https://clinicaltrials.gov/study/NCT05798130).</p>\",\"PeriodicalId\":23266,\"journal\":{\"name\":\"Transfusion\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2025-03-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Transfusion\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/trf.18164\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"HEMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transfusion","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/trf.18164","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"HEMATOLOGY","Score":null,"Total":0}
Assessment of oxygen extraction rate changes following red blood cell transfusion in the intensive care unit: A prospective observational noninterventional study.
Background: The decision-making process for red blood cell transfusion (RBCT) in critically ill patients in the intensive care unit (ICU) remains primarily guided by hemoglobin-based thresholds. However, as a component of personalized medicine, innovative and individualized criteria should be developed to optimize RBCT decisions. This study aims to assess the impact of RBCTs on oxygenation parameters and patient outcomes, with a specific focus on the oxygen extraction ratio (O2ER).
Study design and methods: This prospective observational study included 77 critically ill patients receiving RBCTs according to ICU transfusion protocols. The primary hypothesis is that patients with an O2ER > 0.30 will benefit most from RBCTs. To investigate this, patients receiving RBCTs were divided into two groups: those with O2ER > 0.30 (RBCTs appropriate) and those with O2ER ≤ 0.30 (RBCTs appropriateness questionable). The two groups were compared in terms of primarily O2ER, other oxygenation parameters, and clinical outcomes. The primary outcome was the change in O2ER following RBCTs, while secondary outcomes encompassed other oxygenation parameter changes.
Results: The O2ER > 0.30 group showed significant improvement in O2ER (0.38 ± 0.04 vs. 0.32 ± 0.05; p < .001), whereas no such improvement was observed in the O2ER ≤ 0.30 group (0.26 ± 0.03 vs. 0.28 ± 0.05; p: .017). Additionally, the O2ER > 0.30 group exhibited improvements in central venous oxygen saturation (ScvO2) following RBCTs, which were not seen in the O2ER ≤ 0.30 group.
Discussion: Our study reveals promising insights into the impact of RBCTs on O2ER; however, these physiological changes did not result in significant clinical improvements. Hence, this study provides a rational basis for the feasibility of implementing a personalized strategy focused on physiological triggers for RBCTs.
期刊介绍：
TRANSFUSION is the foremost publication in the world for new information regarding transfusion medicine. Written by and for members of AABB and other health-care workers, TRANSFUSION reports on the latest technical advances, discusses opposing viewpoints regarding controversial issues, and presents key conference proceedings. In addition to blood banking and transfusion medicine topics, TRANSFUSION presents submissions concerning patient blood management, tissue transplantation and hematopoietic, cellular, and gene therapies.
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