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Influence of tissue perfusion on the outcome of surgical patients who need blood transfusion.
Silva, Joao Manoel Jr MD, MsC a,b,*; Toledo, Diogo Oliveira MD b; Magalhaes, Danielle Dourado MD a; Cicero Pinto, Marco Aurelio MD a; Gulinelli, Andre MD c; Sousa, Jose Marconi Almeida MD, PhD b; da Silva, Israel Ferreira MD a; Rezende, Ederlon MD b; Pontes-Arruda, Alessandro MD, MsC, PhD d
[Miscellaneous Article] Journal of Critical Care. 24(3):426-434, September 2009.

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Purpose: The aim this study was to evaluate the clinical outcome of patients needing intra-operative blood transfusion by tissue perfusion markers.

Methods: A prospective single center cohort study. Adult patients needing blood transfusion during the intra-operative period were recruited.

Results: This study included 61 patients. At the time of blood transfusion the hemoglobin level was 8.4 /-1.8 g/dL. Scv02 has been the best tissue perfusion marker to determine mortality, compared with hematemetric values and other tissue perfusion markers, with a cut-off point at ROC curve equal to 80% (AUC=0.75; sensitivity=80%; specificity=65.2%). Patients who received blood transfusion and had Scv02 <=80% (N=29), in comparison to those with Scv02>80% (N=32), had lower mortality rates (12.5% vs. 47.1%; p=0.008) and lower incidence of postoperative complications (58.9% vs. 72.9%; p=0.06). Blood transfusion with a Scv02 <=80% was also associated with reduced use of vasopressors (5.9% vs. 36.8%; p=0.009). Lower incidence of hypoperfusion (17.6% vs. 52.6%; p=0.009), and lower incidence of infection (23.5% vs. 52.6%; p=0.038) in the postoperative period.

Conclusions: In major surgeries, Scv02 appears to be an important variable to be taken into consideration to decide for or against blood transfusion, since blood transfusion with adequte perfusion, reflected by Scv02>80%, are associated with worse clinical outcomes.