Blood Transfusions May Have Limited Effect on Muscle Oxygenation After Total Knee Arthroplasty

Abstract

BACKGROUND: Traditionally, blood transfusions in the perioperative setting are used to maintain adequate delivery of nutrients and oxygen to organs. However, the effect of blood administration on tissue oxygenation in the perioperative setting remains poorly understood. QUESTIONS/PURPOSES: The aim of this study was to determine changes in muscle tissue oxygenation saturation (SmO2) in response to perioperative blood transfusions. PATIENTS AND METHODS: Patients undergoing total knee arthroplasty were enrolled. SmO2, continuous hemoglobin (SpHb), stroke volume (SV), cardiac index, and standard hemodynamic parameters including heart rate (HR), mean arterial blood pressure (MAP), and arterial oxygen saturation (SO2) were recorded. To assess fluid responsiveness, a passive leg raise (PLR) test was performed before the transfusions were started. RESULTS: Twenty-eight patients were included in the analysis. Mean (+/-SD) SmO2 before transfusion was 63.18 +/- 10.04%, SpHb was 9.27 +/- 1.16 g/dl, and cardiac index was 2.62 +/- 0.75 L/min/m(2). A significant increase during the course of blood transfusion was found for SmO2 (+3.44 +/- 5.81% [95% confidence interval (CI) 1.04 to 5.84], p = 0.007), SpHb (0.74 +/- 0.92 g/dl [95% CI 0.35 to 1.12], p < 0.001), and cardiac index (0.38 +/- 0.51 L/min/m2 [95% CI 0.15 to 0.60], p = 0.002), respectively. However, the correlation between SmO2 and SpHb over the course of the transfusion was negligible (rho = 0.25 [95% CI -0.03 to 0.48]). A similar lack of correlation was found when analyzing data of those patients who showed a positive leg raise test before the start of the transfusion (rho = 0.37 [95% CI -0.11 to 0.84]). CONCLUSION: We detected a statistically significant increase in SmO2 during the course of a single unit blood transfusion compared to baseline. However, there was no evidence of a correlation between longitudinal SmO2 and SpHb measurements.