Potential Uses of Hemoglobin-based Oxygen Carriers in Critical Care Medicine

Hemoglobin-based oxygen carriers (HBOCs) were initially developed to provide an alternative to blood transfusion. With the realization that hemoglobin solutions not only are red blood cell substitutes but also have a number of additional properties, including hemodynamic effects related to their oncotic and nitric oxide–scavenging effects, the broader concept of “hemoglobin therapeutics” was born. Promising effects on oxygen transport and the microcirculation need to be confirmed, and the results of studies with newer, second-generation HBOCs are eagerly awaited. In the meantime, possible adverse effects need to be carefully evaluated before HBOCs can be widely used in the ICU, emergency room, or prehospital setting.