Research output: Contribution to journal › Article › Academic › peer-review
Autologous red blood cell transfusion does not result in a more profound increase in pulmonary capillary wedge pressure compared to saline in critically ill patients : A randomized crossover trial. / Bosboom, Joachim J; Klanderman, Robert B; Terwindt, Lotte E et al.
In: Vox sanguinis, Vol. 117, No. 8, 08.2022, p. 1035-1042.Research output: Contribution to journal › Article › Academic › peer-review
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TY - JOUR
T1 - Autologous red blood cell transfusion does not result in a more profound increase in pulmonary capillary wedge pressure compared to saline in critically ill patients
T2 - A randomized crossover trial
AU - Bosboom, Joachim J
AU - Klanderman, Robert B
AU - Terwindt, Lotte E
AU - Bulle, Esther B
AU - Wijnberge, Marije
AU - Eberl, Susanne
AU - Driessen, Antoine H
AU - Winkelman, Toon A
AU - Geerts, Bart F
AU - Veelo, Denise P
AU - Hollmann, Markus W
AU - Vlaar, Alexander P J
N1 - Funding Information: Dr. Denise P. Veelo reported receipt of grants and consultancy fees from Edwards Lifesciences, and research grants from Philips and Hemologic. Dr. Markus W. Hollmann reported serving as executive section editor of pharmacology for and as section editor of anaesthesiology for the and receipt of speakers fees from CSL Behring and Eurocept BV and consultancy fees from Eurocept BV. The other authors declare no conflict of interest. Anaesthesia & Analgesia Journal of Clinical Medicine Funding Information: This research was supported by a Landsteiner Foundation for Blood Research (LSBR) fellowship grant to Alexander P. J. Vlaar (no. 1931F). FUNDING INFORMATION Publisher Copyright: © 2022 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.
PY - 2022/8
Y1 - 2022/8
N2 - BACKGROUND AND OBJECTIVES: Transfusion-associated circulatory overload (TACO) is a major cause of severe transfusion-related morbidity. Transfusion of red blood cells (RBCs) has been shown to induce hydrostatic pressure overload. It is unclear which product-specific factors contribute. We set out to determine the effect of autologous RBC transfusion versus saline on pulmonary capillary wedge pressure (PCWP) change.MATERIALS AND METHODS: In a randomized crossover trial, patients who had undergone coronary bypass surgery were allocated to treatment post-operatively in the intensive care unit with either an initial 300 ml autologous RBC transfusion (salvaged during surgery) or 300 ml saline infusion first, followed by the other. Primary outcome was the difference in PCWP change. Secondary outcome measures were the difference in extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).RESULTS: Change in PCWP was not higher after autologous RBC transfusion compared to saline (ΔPCWP 0.3 ± 0.4 vs. 0.1 ± 0.4 mmHg). ΔEVLWI and ΔPVPI were significantly decreased after autologous RBC transfusion compared to saline (ΔEVLWI -1.6 ± 0.6 vs. 0.2 ± 0.4, p = 0.02; ΔPVPI -0.3 ± 0.1 vs. 0.0 ± 0.1, p = 0.01). Haemodynamic variables and colloid osmotic pressure were not different for autologous RBC transfusion versus saline.CONCLUSION: Transfusion of autologous RBCs did not result in a more profound increase in PCWP compared to saline. RBC transfusion resulted in a decrease of EVLWI and PVPI compared to saline. Our data suggest that transfusing autologous RBCs may lead to less pulmonary oedema compared to saline. Future studies with allogeneic RBCs are needed to investigate other factors that may mediate the increase of PCWP, resulting in TACO.
AB - BACKGROUND AND OBJECTIVES: Transfusion-associated circulatory overload (TACO) is a major cause of severe transfusion-related morbidity. Transfusion of red blood cells (RBCs) has been shown to induce hydrostatic pressure overload. It is unclear which product-specific factors contribute. We set out to determine the effect of autologous RBC transfusion versus saline on pulmonary capillary wedge pressure (PCWP) change.MATERIALS AND METHODS: In a randomized crossover trial, patients who had undergone coronary bypass surgery were allocated to treatment post-operatively in the intensive care unit with either an initial 300 ml autologous RBC transfusion (salvaged during surgery) or 300 ml saline infusion first, followed by the other. Primary outcome was the difference in PCWP change. Secondary outcome measures were the difference in extra-vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).RESULTS: Change in PCWP was not higher after autologous RBC transfusion compared to saline (ΔPCWP 0.3 ± 0.4 vs. 0.1 ± 0.4 mmHg). ΔEVLWI and ΔPVPI were significantly decreased after autologous RBC transfusion compared to saline (ΔEVLWI -1.6 ± 0.6 vs. 0.2 ± 0.4, p = 0.02; ΔPVPI -0.3 ± 0.1 vs. 0.0 ± 0.1, p = 0.01). Haemodynamic variables and colloid osmotic pressure were not different for autologous RBC transfusion versus saline.CONCLUSION: Transfusion of autologous RBCs did not result in a more profound increase in PCWP compared to saline. RBC transfusion resulted in a decrease of EVLWI and PVPI compared to saline. Our data suggest that transfusing autologous RBCs may lead to less pulmonary oedema compared to saline. Future studies with allogeneic RBCs are needed to investigate other factors that may mediate the increase of PCWP, resulting in TACO.
KW - autologous blood transfusion
KW - volume overload
UR - http://www.scopus.com/inward/record.url?scp=85130006909&partnerID=8YFLogxK
U2 - 10.1111/vox.13292
DO - 10.1111/vox.13292
M3 - Article
C2 - 35560234
VL - 117
SP - 1035
EP - 1042
JO - Vox sanguinis
JF - Vox sanguinis
SN - 0042-9007
IS - 8
ER -
ID: 23945987