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Paul E. Marik, MMed; William J. Sibbald, MD, FRCPC

JAMA. 1993;269(23):3024-3029.

Abstract
Background.
—Red blood cell transfusion is commonly used to augment systemic oxygen delivery to supranormal levels in patients with sepsis. However, clinical studies have not consistently demonstrated that this therapeutic maneuver is accompanied by an increase in oxygen utilization at either the whole-body level or within individual organs.

Study Objectives.
—To determine the effect of red blood cell transfusion on gastrointestinal and whole-body oxygen uptake.

Design.
—Prospective, controlled, interventional study.

Setting.
—Multidisciplinary intensive care unit of a tertiary care teaching hospital.

Patients.
—Twenty-three critically ill patients with sepsis undergoing mechanical ventilation.

Measurements and Main Results.
—Systemic oxygen uptake was measured by indirect calorimetry and calculated by the Fick method. Gastric intramucosal pH as measured by tonometry was used to assess changes in splanchnic oxygen availability. Measurements were made prior to transfusion of 3 U of packed red blood cells. These were then repeated immediately following transfusion, as well as 3 and 6 hours later. There was no increase in systemic oxygen uptake measured by indirect calorimetry in any of the patients studied for up to 6 hours posttransfusion (including those patients with an elevated arterial lactate concentration). However, the calculated systemic oxygen uptake increased in parallel with the oxygen delivery in all the patients. More importantly, we found an inverse association between the change in gastric intramucosal pH and the age of the transfused blood (r=-.71; P<.001). In those patients receiving blood that had been stored for more than 15 days, the gastric intramucosal pH consistently decreased following the red blood cell transfusion.

Conclusion.
—We failed to demonstrate a beneficial effect of red blood cell transfusion on measured systemic oxygen uptake in patients with sepsis. Patients receiving old transfused red blood cells developed evidence of splanchnic ischemia. We postulate that the poorly deformable transfused red blood cells cause microcirculatory occlusion in some organs, which may lead to tissue ischemia in some organs.

(JAMA. 1993;269:3024-3029)

Author Affiliations
From the AC Burton Vascular Biology Laboratory, Victoria Hospital Research Institute, and the Program in Critical Care, Departments of Medicine and Surgery, University of Western Ontario, London. Dr Marik is currently with the Department of Internal Medicine, Division of Critical Care, Detroit (Mich) Receiving Hospital.

Footnotes
Reprint requests to Critical Care Medicine, Victoria Hospital, Room 482 4 NW, 375 South St, London, Ontario, Canada N6A 4G5 (Dr Sibbald).

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