Pre-clinical study protocol: Blood transfusion in endotoxaemic shock
Nchafatso G. Obonyo,
Liam Byrne,
John-Paul Tung,
Gabriela Simonova,
Sara D. Diab,
Kimble R. Dunster,
Margaret R. Passmore,
Ai-Ching Boon,
Louise See Hoe,
Sanne Engkilde-Pedersen,
Arlanna Esguerra-Lallen,
Mohd H. Fauzi,
Leticia P. Pimenta,
Jonathan E. Millar,
Jonathon P. Fanning,
Frank Van Haren,
Chris M. Anstey,
Louise Cullen,
Jacky Suen,
Kiran Shekar,
Kathryn Maitland,
John F. Fraser
Affiliations
Nchafatso G. Obonyo
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; IDeAL/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Corresponding author at: Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia.
Liam Byrne
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; The Canberra Hospital Intensive Care, Garran, ACT, Australia; Australia National University, Canberra, ACT, Australia
John-Paul Tung
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia; University of Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane City, QLD Australia
Gabriela Simonova
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia; University of Queensland, Brisbane, QLD, Australia
Sara D. Diab
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
Kimble R. Dunster
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane City, QLD Australia
Margaret R. Passmore
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
Ai-Ching Boon
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
Louise See Hoe
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
Sanne Engkilde-Pedersen
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia; Queensland University of Technology, Brisbane City, QLD Australia
Arlanna Esguerra-Lallen
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; Australian Red Cross Blood Service, Kelvin Grove, Brisbane, Queensland, Australia
Mohd H. Fauzi
School of Medical Sciences, Universiti Sains Malaysia Health Campus, Kelantan, Malaysia
Leticia P. Pimenta
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
Jonathan E. Millar
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
Jonathon P. Fanning
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
Frank Van Haren
The Canberra Hospital Intensive Care, Garran, ACT, Australia; Australia National University, Canberra, ACT, Australia; The University of Canberra, Bruce, ACT, Australia
Chris M. Anstey
Sunshine Coast University Hospital Intensive Care, Birtinya, Qld, Australia
Louise Cullen
University of Queensland, Brisbane, QLD, Australia; Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
Jacky Suen
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
Kiran Shekar
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Adult Intensive Care, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
Kathryn Maitland
IDeAL/KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya; Department of Paediatrics, Faculty of Medicine, Imperial College London, United Kingdom
John F. Fraser
Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane City, QLD Australia; Adult Intensive Care, The Prince Charles Hospital, Chermside, Brisbane, QLD, Australia
The Surviving Sepsis Campaign (SCC) and the American College of Critical Care Medicine (ACCM) guidelines recommend blood transfusion in sepsis when the haemoglobin concentration drops below 7.0 g/dL and 10.0 g/dL respectively, while the World Health Organisation (WHO) guideline recommends transfusion in septic shock ‘if intravenous (IV) fluids do not maintain adequate circulation’, as a supportive measure of last resort. Volume expansion using crystalloid and colloid fluid boluses for haemodynamic resuscitation in severe illness/sepsis, has been associated with adverse outcomes in recent literature. However, the volume expansion effect(s) following blood transfusion for haemodynamic circulatory support, in severe illness remain unclear with most previous studies having focused on evaluating effects of either different RBC storage durations (short versus long duration) or haemoglobin thresholds (low versus high threshold) pre-transfusion. • We describe the protocol for a pre-clinical randomised controlled trial designed to examine haemodynamic effect(s) of early volume expansion using packed RBCs (PRBCs) transfusion (before any crystalloids or colloids) in a validated ovine-model of hyperdynamic endotoxaemic shock. • Additional exploration of mechanisms underlying any physiological, haemodynamic, haematological, immunologic and tissue specific-effects of blood transfusion will be undertaken including comparison of effects of short (≤5 days) versus long (≥30 days) storage duration of PRBCs prior to transfusion. Protocol name: RESUS transfusion protocol, Keywords: Blood transfusion, Sepsis, Endotoxaemic shock, Packed red blood cells (PRBCs), Guidelines, Haemoglobin threshold, Storage duration
