in ICU setting/some case to guide you

1. Physiological triggers for blood Transfusion in the ICU Dr. T.R. Chandrashekar Intensivist K.R.Hospital Bangalore

3. Transfusion Trigger Acceptable hemoglobin concentration Risk of blood transfusion Risk of low hemoglobin

4. Oxygen transport physiology

6. Oxygendelivery CaO2 = (1.34 x Hb x SaO2) +dissolved O2 DO2 = CO X CaO2 Cardiac output= HR x SV Mitochondria in end organs

9. DO2/VO2 Patients have to be kept them well above the Critical Point so that oxygenation of any tissue is not compromised Supply dependent area In critically ill supply dependent area

12. Does old blood improve oxygen content?

13. Storage Defects and Microvascular Perfusion Decreased 2,3- DPG, ADP,NO Build-up of cytokines, Free Hb, K+, debris Poor deformability Will they improve oxygen content and delivery ? Immune suppression Infections Clinical and animal studies report contradictory findings about the oxygenation capacity of stored RBCs

14. Transfusion “Trigger” Controversy Transfusion trigger: “ a particular hemoglobin level of discomfort in the Prescribing physician, Not defined by clear Physiologic parameters” 8/24? 7/21? 10/30? Transfusion paradigms

16. Transfusion trigger (Crit Care Med 2009; 37:3124 –3157)

29. Septic shock-EGDT

31. CaO2 = (1.34 x Hb x SaO2) +dissolved O2 DO2 = CO X CaO2 Cardiac output Mitochondria in end organs 7 g % ALI/ARDS PE Sepsis induced myocardial depression Drugs Inotropes Pericardial effusion v MMDS-cannot extract O2 O 2 lactate CO 2 v a

38. Thank You