Conclusion
In this study, tissue oxygenation of the brain and mesenteric region improved after transfusion, independent of Hgb threshold group. While Csat below 50% may be associated with adverse outcomes, future prospective investigation to compare current Hgb threshold-based transfusion practices to an individualized cerebral NIRS measure-based transfusion guideline is warranted. An improved precision medicine approach with cerebral oxygenation monitoring may facilitate a brain protective strategy for transfusion practices.