Impact of whole blood transfusion on hemodynamics, oxygenation and cerebral inflammation in a model of Traumatic Brain Injury and Hemorrhagic Shock

• Grant number: 24/10599-1
• Support Opportunities: Regular Research Grants
• Start date: December 01, 2024
• End date: November 30, 2026
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Luiz Marcelo Sá Malbouisson
• Grantee: Luiz Marcelo Sá Malbouisson
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: Ana Paula de Carvalho Canela Balzi ; Denise Aya Otsuki ; Lucia da Conceição Andrade ; Talita Rojas Cunha Sanches ; Vivian Henriques do Amaral ; Wellingson Silva Paiva

Abstract

The restoration of brain perfusion and tissue oxygenation is a determining factor in the neurological outcome of patients who present with traumatic brain injury (TBI) and hemorrhagic shock (HC). In a porcine model of hemorrhagic shock, without associated neurological injury (FAPESP research no. 2011/00348-1)(1), it was observed that the use of either fluids or vasoactive drugs were equally effective in restoring brain perfusion. However, only treatment with terlipressin was associated with a lower expression of brain markers of edema and apoptosis. In a second porcine model, this time with neurological injury compatible with severe TBI (FAPESP research no. 2013/07832-1)(2), it was observed that the treatment of hemorrhagic shock with infusion of fluids and/or terlipressin improved systemic hemodynamics and blood pressure levels, but did not reverse the hypoperfusion of the brain parenchyma. This was possibly due to dysfunction of cerebral vasoregulation, promoting an inability to meet cerebral metabolic demands. However, the role of red blood cell transfusion in restoring adequate neuronal tissue oxygenation and its role in preventing inflammatory and ischemic phenomena as a result of severe TBI is unclear. (AU)