Untitled [Supplement, CMAJ

Table 4: Summary of 13 studies of the effects of red blood cell transfusion on O₂ delivery, O₂ consumption and lactate levels

Changes after transfusion

Study Condition in study population No. of patients Average volume of transfusion Increased [Hb] Increased DO₂ Increased VO₂ Decreased Lactate Comments

Ronco et al¹⁷² (1990) PCP 5 1.5 U Yes Yes Yes NA All patients had Increased lactate at baseline. Thermodilution used for DO₂ and VO₂ measurements.

Fenwick et al¹⁷³ (1990) ARDS 24 1.5 U Yes
Yes
Yes
Yes
No
No
No
Yes
Normal lactate group (n = 1) was compared with high lactate group (n = 13). Thermodilution catheter used for all measurements. Significant increases in VO₂ in response to transfusion in high lactate group.

Ronco et al¹⁷⁴ (1991) ARDS 17 1.5 U Yes Yes No NA Normal lactate group (n = 7) was compared with high lactate group (n = 10). No relationship between VO₂ and DO₂ when VO₂ directly measured with expired gases.

Shah et al¹⁷⁵ (1982) Post-trauma 8 1 or 2 U Yes Yes Yes NA Thermodilution used for DO₂ and VO₂ measurements.

Steffes et al¹⁷⁶ (1991) Postoperative + post-trauma 21 1-2 U Yes Yes Yes No 27 measurement sets in 21 patients. Thermodilution used for DO₂ and VO₂ measurements. Increased lactate levels did not predict VO₂ response.

Babineau et al¹⁶⁷ (1992) Postoperative 31 328 +- 9 mL Yes Yes No NA 32 of 33 transfusions were single units. Thermodilution used for DO₂ and VO₂ measurements. 58% of transfusions did not increase VO₂.

Gilbert et al¹⁷⁷ (1988) Septic 17 delta 20 g/L Yes Yes No No 33 measurement sets in 31 patients. 10 of 17 patients had increased lactate levels. VO₂ significantly increased in high group only.

Dietrich et al¹⁷⁸ (1990) Medical shock (septic/cardiac) 32 577 mL Yes Yes No No 36 measurement sets in 32 patients. No change in VO₂ after transfusion. Thermodilution used for DO₂ and VO₂ measurements.

Conrad et al¹⁷⁹ (1990) Septic shock 19 delta 30 g/L Yes Yes No No Normal lactate group (n = 8) compared with high lactate group (n = 11). No increase in VO₂ with transfusion in either group. Thermodilution used for DO₂ and VO₂ measurements.

Marik et al¹¹⁵ (1993) Septic 23 3 U Yes Yes No No DO₂ measured independently of VO₂. Using gastric tonometry, patients receiving old RBCs developed evidence of gastric ischemia.

Lorento et al¹⁸⁰ (1993) Septic 16 2 U Yes Yes No NA Dobutamine significantly increased VO₂; RBCs did not. Thermodilution used for DO₂ and VO₂ measurements.

Mink et al¹⁸¹ (1990) Septic shock (2 months-6 years) 8 8-10 mL/kg × 1-2 h Yes Yes No NA In pediatric patients, VO₂ did not increase with RBCs. Thermodilution used for DO₂ and VO₂ measurements.

Lucking et al¹⁸² (1990) Septic shock (4 months-15 years) 7 10-15 mL/kg × 1-3 h Yes Yes Yes NA 8 measurement sets in 7 patients. Thermodilution used for DO₂ and VO₂ measurements.

Note: PCP = Pneumocystis carinii pneumonia; Increased [Hb] = increased hemoglobin concentration; Increased DO₂ = increased O₂ delivery; Increased VO₂ = increased O₂ consumption; NA = not available; ARDS = adult respiratory distress syndrome.

Table 4: Summary of 13 studies of the effects of red blood cell transfusion on O₂ delivery, O₂ consumption and lactate levels
				Changes after transfusion
Study	Condition in study population	No. of patients	Average volume of transfusion	Increased [Hb]	Increased DO₂	Increased VO₂	Decreased Lactate	Comments
Ronco et al¹⁷² (1990)	PCP	5	1.5 U	Yes	Yes	Yes	NA	All patients had Increased lactate at baseline. Thermodilution used for DO₂ and VO₂ measurements.
Fenwick et al¹⁷³ (1990)	ARDS	24	1.5 U	Yes Yes	Yes Yes	No No	No Yes	Normal lactate group (n = 1) was compared with high lactate group (n = 13). Thermodilution catheter used for all measurements. Significant increases in VO₂ in response to transfusion in high lactate group.
Ronco et al¹⁷⁴ (1991)	ARDS	17	1.5 U	Yes	Yes	No	NA	Normal lactate group (n = 7) was compared with high lactate group (n = 10). No relationship between VO₂ and DO₂ when VO₂ directly measured with expired gases.
Shah et al¹⁷⁵ (1982)	Post-trauma	8	1 or 2 U	Yes	Yes	Yes	NA	Thermodilution used for DO₂ and VO₂ measurements.
Steffes et al¹⁷⁶ (1991)	Postoperative + post-trauma	21	1-2 U	Yes	Yes	Yes	No	27 measurement sets in 21 patients. Thermodilution used for DO₂ and VO₂ measurements. Increased lactate levels did not predict VO₂ response.
Babineau et al¹⁶⁷ (1992)	Postoperative	31	328 +- 9 mL	Yes	Yes	No	NA	32 of 33 transfusions were single units. Thermodilution used for DO₂ and VO₂ measurements. 58% of transfusions did not increase VO₂.
Gilbert et al¹⁷⁷ (1988)	Septic	17	delta 20 g/L	Yes	Yes	No	No	33 measurement sets in 31 patients. 10 of 17 patients had increased lactate levels. VO₂ significantly increased in high group only.
Dietrich et al¹⁷⁸ (1990)	Medical shock (septic/cardiac)	32	577 mL	Yes	Yes	No	No	36 measurement sets in 32 patients. No change in VO₂ after transfusion. Thermodilution used for DO₂ and VO₂ measurements.
Conrad et al¹⁷⁹ (1990)	Septic shock	19	delta 30 g/L	Yes	Yes	No	No	Normal lactate group (n = 8) compared with high lactate group (n = 11). No increase in VO₂ with transfusion in either group. Thermodilution used for DO₂ and VO₂ measurements.
Marik et al¹¹⁵ (1993)	Septic	23	3 U	Yes	Yes	No	No	DO₂ measured independently of VO₂. Using gastric tonometry, patients receiving old RBCs developed evidence of gastric ischemia.
Lorento et al¹⁸⁰ (1993)	Septic	16	2 U	Yes	Yes	No	NA	Dobutamine significantly increased VO₂; RBCs did not. Thermodilution used for DO₂ and VO₂ measurements.
Mink et al¹⁸¹ (1990)	Septic shock (2 months-6 years)	8	8-10 mL/kg × 1-2 h	Yes	Yes	No	NA	In pediatric patients, VO₂ did not increase with RBCs. Thermodilution used for DO₂ and VO₂ measurements.
Lucking et al¹⁸² (1990)	Septic shock (4 months-15 years)	7	10-15 mL/kg × 1-3 h	Yes	Yes	Yes	NA	8 measurement sets in 7 patients. Thermodilution used for DO₂ and VO₂ measurements.
Note: PCP = Pneumocystis carinii pneumonia; Increased [Hb] = increased hemoglobin concentration; Increased DO₂ = increased O₂ delivery; Increased VO₂ = increased O₂ consumption; NA = not available; ARDS = adult respiratory distress syndrome.