The choice of blood transfusion strategy in severe traumatic brain injury
DOI:
https://doi.org/10.14739/2310-1210.2024.4.299531Keywords:
traumatic brain injury, blood transfusion, anemia, intensive careAbstract
Traumatic brain injury (TBI) remains one of the leading causes of long-term disability, especially among young and middle-aged people. One of the main directions of treatment for patients with TBI is to prevent the development of secondary brain damage due to systemic dysfunction. Anemia occupies an important place among them. Anemia is considered a marker of illness severity in critically ill patients and is included in the list of parameters for risk prediction in intensive care units. However, the relationship between anemia and adverse outcomes in patients with TBI is controversial.
Aim. The purpose of the work is to analyze the effect of anemia on the course of severe TBI, to determine the position of anemia in the pathophysiological mechanisms of brain damage, the development of blood transfusion-associated complications, to evaluate different blood transfusion strategies (liberal and restrictive) and their impact on treatment results, taking into account individual tolerance to anemia.
Studies suggest that the restrictive transfusion strategy could be useful in reducing complications and length of hospital stay. However, the lack of clear evidence for optimal hemoglobin levels as a trigger to initiate blood transfusions reinforces the need for further clinical studies. The use of multimodal neuromonitoring allows to evaluate the latest approaches to assessing individual hemoglobin thresholds. These methods could help in identifying patients at increased risk of complications and determining optimal strategies to manage anemia.
Conclusions. The problem of tolerance to anemia in patients with severe TBI remains a controversial topic, and determining hemoglobin thresholds for blood transfusion in this group of patients requires further studies, special attention should therefore be paid to an individual approach to resolving the issue of red blood cell transfusion, in particular, integrating clinical status of a patient and concomitant pathology. The risk of possible brain damage worsening associated with anemia due to deterioration of cerebral oxygenation should always be weighed against the risk of developing transfusion-associated complications.
References
Capizzi A, Woo J, Verduzco-Gutierrez M. Traumatic Brain Injury: An Overview of Epidemiology, Pathophysiology, and Medical Management. Med Clin North Am. 2020;104(2):213-38. doi: https://doi.org/10.1016/j.mcna.2019.11.001
GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(1):56-87. doi: https://doi.org/10.1016/S1474-4422(18)30415-0
Soendergaard PL, Siert L, Poulsen I, Wood RL, Norup A. Measuring Neurobehavioral Disabilities Among Severe Brain Injury Survivors: Reports of Survivors and Proxies in the Chronic Phase. Front Neurol. 2019;10:51. doi: https://doi.org/10.3389/fneur.2019.00051
Tsarev AV. [Maintaining normothermia in intensive care of severe traumatic brain injury]. Emergency Medicine. 2018;0(4):99-103. Ukrainian. doi: https://doi.org/10.22141/2224-0586.4.91.2018.137865
Crupi R, Cordaro M, Cuzzocrea S, Impellizzeri D. Management of Traumatic Brain Injury: From Present to Future. Antioxidants. 2020;9(4):297. doi: https://doi.org/10.3390/antiox9040297
Dalby T, Wohl E, Dinsmore M, Unger Z, Chowdhury T, Venkatraghavan L. Pathophysiology of cerebral edema - A comprehensive review. J Neuroanaesth Crit Care. 2021;8:163-72. doi: https://doi.org/10.1055/s-0040-1721165
Postolache TT, Wadhawan A, Can A, Lowry CA, Woodbury M, Makkar H, et al. Inflammation in traumatic brain injury. J Alheimers Dis. 2020;74(1):1-28. doi: https://doi.org/10.3233/JAD-191150
Siwicka-Gieroba D, Robba C, Gołacki J, Badenes R, Dabrowski W. Cerebral Oxygen Delivery and Consumption in Brain-Injured Patients. J Pers Med. 2022;12(11):1763. doi: https://doi.org/10.3390/jpm12111763
Freire MA, Rocha GS, Bittencourt LO, Falcao D, Lima RR, Cavalcanti JR. Cellular and Molecular Pathophysiology of Traumatic Brain Injury: What Have We Learned So Far? Biology (Basel). 2023;12(8):1139. doi: https://doi.org/10.3390/biology12081139
Mira RG, Lira M, Cerpa W. Traumatic Brain Injury: Mechanisms of Glial Response. Front Physiol. 2021;12:740939. doi: https://doi.org/10.3389/fphys.2021.740939
East JM, Viau-Lapointe J, McCredie VA. Transfusion practices in traumatic brain injury. Curr Opin Anaesthesiol. 2018;31(2):219-26. doi: https://doi.org/10.1097/ACO.0000000000000566
Stolla M, Zhang F, Meyer MR, Zhang J, Dong JF. Current state of transfusion in traumatic brain injury and associated coagulopathy. Transfusion. 2019;59(S2):1522-8. doi: https://doi.org/10.1111/trf.15169
Montoya-Gacharna JV, Kendale S. Blood transfusion and traumatic brain injury. In: Scher CS, Kaye AD, Liu H, Perelman S, Leavitt S, editors. Essentials of blood product management in anesthesia practice. Berlin: Springer; 2021. p. 313-20. doi: https://doi.org/10.1007/978-3-030-59295-0_30
Egea-Guerreroa JJ, García-Sáezb I, Quintana-Díazc M. Trigger transfusion in severe traumatic brain injury. Medicina Intensiva. 2022;46(3):157-60. doi: https://doi.org/10.1016/j.medine.2021.12.003
Li S, Hafeez A, Noorulla F, Geng X, Shao G, Ren C, et al. Preconditioning in neuroprotection: From hypoxia to ischemia. Prog Neurobiol. 2017;157:79-91. doi: https://doi.org/10.1016/j.pneurobio.2017.01.001
Vanhala H, Junttila E, Kataja A, Huhtala H, Luostarinen T, Luoto T. Incidence and associated factors of anemia in patients with acute moderate and severe traumatic brain injury. Neurocrit Care. 2022;37(3):629-37. doi: https://doi.org/10.1007/s12028-022-01561-9
Naumenko Y, Yuryshinetz I, Zabenko Y, Pivneva T. Mild traumatic brain injury as a pathological process. Heliyon. 2023;9(7):e18342. doi: https://doi.org/10.1016/j.heliyon.2023.e18342
Benghanem S, Mazeraud A, Azabou E, Chhor V, Shinotsuka CR, Claassen J, et al. Brainstem dysfunction in critically ill patients. Crit Care. 2020;24(1):5. doi: https://doi.org/10.1186/s13054-019-2718-9
Ladak AA, Enam SA, Ibrahim MT. A Review of the Molecular Mechanisms of Traumatic Brain Injury. World Neurosurg. 2019;131:126-32. doi: https://doi.org/10.1016/j.wneu.2019.07.039
Anwar S, Bakhsh A, Manieanan S, Khan M. 1339 Haemoglobin threshold for red blood cell transfusion in traumatic brain injury. A systematic review and meta-analysis. British Journal of Surgery. 2021;108(Suppl 6):vi175. doi: https://doi.org/10.1093/bjs/znab259.658
Laflamme M, Haghbayan H, Lalu MM, Zarychanski R, Lauzier F, Boutin A, et al. Red blood cell transfusion in animal models of acute brain injuries: a systematic review protocol. Syst Rev. 2021;10(1):177. doi: https://doi.org/10.1186/s13643-021-01703-8
Zhang W, Du K, Chen X. Benefits of red blood cell transfusion in patients with traumatic brain injury. Crit Care. 2019;23(1):218. doi: https://doi.org/10.1186/s13054-019-2498-2
Ferrando-Vivas P, Jones A, Rowan KM, Harrison DA. Development and validation of the new ICNARC model for prediction of acute hospital mortality in adult critical care. J Crit Care. 2017;38:335-9. doi: https://doi.org/10.1016/j.jcrc.2016.11.031
Boutin A, Moore L, Lauzier F, Chassé M, English S, Zarychanski R, et al. Transfusion of red blood cells in patients with traumatic brain injuries admitted to Canadian trauma health centres: A multicentre cohort study. BMJ Open. 2017;7(3):e014472. doi: https://doi.org/10.1136/bmjopen-2016-014472
Hatton GE, Brill JB, Tang B, Mueck KM, McCoy CC, Kao LS, et al. Patients with both traumatic brain injury and hemorrhagic shock benefit from resuscitation with whole blood. Journal of Trauma and Acute Care Surgery. 2023;95(6):918-24. doi: https://doi.org/10.1097/TA.0000000000004110
Park YH, Ryu DH, Lee BK, Lee DH. The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury. Acute Crit Care. 2019;34(4):255-62. doi: https://doi.org/10.4266/acc.2019.00640
Montgomery EY, Barrie U, Kenfack YJ, Edukugho D, Caruso JP, Rail B, et al. Transfusion Guidelines in Traumatic Brain Injury: A Systematic Review and Meta-Analysis of the Currently Available Evidence. Neurotrauma Rep. 2022;3(1):554-68. doi: https://doi.org/10.1089/neur.2022.0056
Chegondi M, Hernandez Rivera JF, Alkhoury F, Totapally BR. The need for blood transfusion therapy is associated with increased mortality in children with traumatic brain injury. PLoS One. 2023;18(1):e0279709. doi: https://doi.org/10.1371/journal.pone.0279709
Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery. 2017;80(1):6-15. doi: https://doi.org/10.1227/NEU.0000000000001432
Badenes R, Oddo M, Suarez JI, Antonelli M, Lipman J, Citerio G, et al. Hemoglobin concentrations and RBC transfusion thresholds in patients with acute brain injury: An international survey. Crit Care. 2017;21(1):159. doi: https://doi.org/10.1186/s13054-017-1748-4
Huijben JA, van der Jagt M, Cnossen MC, Kruip MJ, Haitsma IK, Stocchetti N, et al. Variation in blood transfusion and coagulation management in traumatic brain injury at the intensive care unit: A survey in 66 neurotrauma centers participating in the collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study. J Neurotrauma. 2018;35(2):323-32. doi: https://doi.org/10.1089/neu.2017.5194
Bonaventure PL, Lauzier F, Zarychanski R, Boutin A, Shemilt M, Saxena M, et al. Red blood cell transfusion in critically ill patients with traumatic brain injury: An international survey of physicians’ attitudes. Can J Anesth. 2019;66:1038-48. doi: https://doi.org/10.1007/s12630-019-01369-w
Turgeon AF, Fergusson DA, Clayton L, Patton MP, Zarychanski R, English S, et al. Haemoglobin transfusion threshold in traumatic brain injury optimisation (HEMOTION): A multicentre, randomised, clinical trial protocol. BMJ Open. 2022;12(10):e067117. doi: https://doi.org/10.1136/bmjopen-2022-067117
Taccone FS, Badenes R, Rynkowski CB, Bouzat P, Caricato A, Kurtz P, et al. TRansfusion strategies in Acute brain INjured patients (TRAIN): a prospective multicenter randomized interventional trial protocol. Trials. 2023;24(1):20. doi: https://doi.org/10.1186/s13063-022-07061-7
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