Transfusion in traumatic brain injury (TSiTBI Trial)

The incidence of anemia (a decrease in the quantity or quality of red blood cells) is frequent among critically ill patients. Because red blood cells, through the molecules of hemoglobin, are oxygen carriers, a decrease in the availability of oxygen to the different organs is often to fear. In patients with traumatic brain injury, mechanisms regulating oxygen delivery to the brain are affected by the injury. The development of anemia may thus potentially worsen lesions to the brain and blood transfusion may correct anemia. However, clinicians are currently restricting the use of blood transfusion in traumatic brain injury making inferences with non brain-injured populations. Few evidence-based data help clinicians treating patients with traumatic brain injury to determine what minimal red blood cell levels (hemoglobin levels) can be tolerated before a blood transfusion is required. This project aims to conduct a pan-canadian multicenter clinical trial to compare a liberal transfusion strategy (transfusion when the red blood cell levels are not too low with the objective to keep it high) to a restrictive transfusion strategy (transfusion when red blood cell levels are low with the objective to keep it low). We believe that liberal transfusion strategy will allow better oxygen delivery to the brain, prevent secondary cerebral lesions and will improve long-term outcomes. This project is part of a vast research program aiming to identify when and under what circumstances should we give red blood cells following traumatic brain injury.