Health
Study Recommends Aggressive Blood Transfusion in TBI Intensive Care
Increasing the use of blood transfusions after severe traumatic brain injury may help people admitted to intensive care units regain greater functional independence and a better quality of life.
Six months after a significant traumatic brain injury (TBI), patients who benefited from this approach regained more functional independence and had a better quality of life than those who received a more restrictive approach, although the rates of death and major disability were not significantly different between the two treatment groups.
That's the conclusion of an international team of researchers led by Alexis Turgeon, professor and chair of neurocritical care and trauma research at Laval University in Canada and an intensive care physician and researcher at the Université du Québec à Laval, whose study was published today in the New England Journal of Medicine.
“This randomized clinical trial, which began in 2017, was carried out in 34 hospital centres in Canada, the UK, France and Brazil. Its aim was to compare two transfusion strategies used to treat patients admitted to intensive care after TBI – so-called restrictive and liberal transfusions. These approaches differ in the degree of anaemia, i.e. the minimum haemoglobin concentration that must be present in the patient's blood before a transfusion can be administered,” explains Professor Turgeon.
“Haemoglobin enables red blood cells to carry oxygen to tissues and organs. Most patients hospitalized after TBI have anemia, defined as low haemoglobin levels, which can reduce the brain's ability to transport oxygen at a time when it is most vulnerable,” said François Lauzier, a professor at Laval University who led the study with Professor Dean Ferguson of the Ottawa Hospital Research Institute.
A restrictive approach consists of allowing low hemoglobin levels before transfusion is given, whereas a liberal approach aims to maintain high hemoglobin levels and give more transfusions.
Improving oxygen delivery to the brain during acute treatment may help preserve more neurons and prevent further brain damage in the days following TBI.”
Alexis Turgeon, Professor at Laval University
To conduct the study, the researchers recruited 742 critically ill patients with moderate or severe TBI and anemia, defined as a hemoglobin level of 10 g/dL or less during hospitalization. These patients were randomly divided into two groups to receive one of two transfusion strategies during their stay in the intensive care unit. To maintain these thresholds, the care team administered transfusions as needed.
Six months after the TBI, the team assessed each group's overall level of recovery, including neurotrophic status, dependency on daily activities, and barriers to resuming activities previously performed before the TBI. “The overall incidence of death and severe disability was not statistically different between the two groups, but all analyses seemed to favour the permissive strategy,” says Professor Turgeon. Furthermore, they found that patients treated with a permissive approach had higher functional independence indexes and quality of life indexes than those treated with a restrictive approach.
“Given the overall results of our study and the current safety of transfusions, the free-choice strategy should probably be the preferred option in acute care to improve long-term outcomes after TBI,” Professor Turgeon concluded.
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Journal References:
Turgeon, A.F. other. (2024) Liberal or restrictive transfusion strategies in patients with traumatic brain injury. New England Journal of Medicine. translation:.
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