Evaluation of Oxygen Extraction Rate As A Guide Red Blood Cell Transfusion Strategy in Intensive Care Unit: A Protocol For A Prospective Observational Study

Abstract Background Restrictive and liberal transfusion approaches to hemoglobin targets have used when deciding on red blood cell transfusions in patients who do not have acute bleeding and have a hemodynamically stable course in the ICU. However, physiologic trigger points that evaluate tissue oxygenation when deciding on blood transfusion in patients have also been among the important topics of research in recent years. In this study, we will evaluate the O 2 ER, which is an important indicator of the balance between oxygen delivery and consumption in tissues. Whether oxygen extraction rate can be used as a trigger for blood transfusion will be determined by clinical outcomes in ICU patients. If physiologic transfusion targets are feasible, the risks of unnecessary transfusions can be avoided with individualized targets. Also, the decision to transfuse blood can be made without delay in patients requiring red blood cell transfusion. Methods/Design We will perform a prospective, single-center, observational cohort study of 65 patients receiving red blood cell transfusions in the intensive care unit. Markers such as CaO 2 , CcvO 2 , O 2 ER, AV-O 2 difference and NIRS will be measured before and 15 minutes after transfusion. We will investigate whether blood transfusion is really necessary and the frequency of transfusion-related events occur in patients with an O 2 ER ratio less than 30% and equal to 30% or above. All patients will be followed up to 90 days after transfusion. Ethics committee approval was obtained from Izmir Katip Celebi University Non-Interventional Clinical Studies Institutional Review Board. All patients must provide written informed consent prior to enrollment in the study. Discussion The existence of a direct relationship between individualized, patient-based oxygen extraction rates and the decision to transfuse red blood cells and reduce transfusion-related complications may imply that physiologically based blood transfusion targets should be established and routinely incorporated into existing transfusion decision-making protocols. Trial registration number NCT05798130