Friday March 5, 2010
TRALI - not very uncommon!
Objectives: To determine the incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of critically ill patients.
Design: In a retrospective cohort study, patients with transfusion-related acute lung injury were identified using the consensus criteria of acute lung injury within 6 hrs after transfusion. Inclusion criterion was a length of intensive care unit admission more than 48 hrs. Patients developing transfusion-related acute lung injury were matched (on age, sex, and admission diagnosis) to transfused control subjects and patients developing acute lung injury from another origin.
Measurements and Main Results:
- Of 5208 admitted patients, 2024 patients had a length of stay more than 48 hrs, of whom 109 were suspected transfusion-related acute lung injury cases.
- Compared with transfused control subjects, risk factors for transfusion-related acute lung injury were emergency cardiac surgery, hematologic malignancy, massive transfusion, sepsis , mechanical ventilation and high Acute Physiology and Chronic Health Evaluation II score
- The volume of platelets and plasma transfused was associated with transfusion-related acute lung injury in the univariate analysis. However, this association disappeared in the multivariate analysis.
- Compared with acute lung injury control subjects, risk factors for transfusion-related acute lung injury were sepsis and high Acute Physiology and Chronic Health Evaluation II score whereas pneumonia was a negative predictive factor.
- Patients with transfusion-related acute lung injury had a longer duration of mechanical ventilation compared with transfused control subjects and acute lung injury control subjects
- Also, 90-day survival of patients with transfusion-related acute lung injury was lower compared with transfused control subjects and acute lung injury control subjects
Conclusions: Transfusion-related acute lung injury is common in critically ill patients. Transfusion-related acute lung injury may contribute to an adverse outcome associated with transfusion. This study identifies transfusion-related acute lung injury risk factors, which may aid in assessing the risks and benefits of transfusion in critically ill patients.
Risk factors and outcome of transfusion-related acute lung injury in the critically ill: A nested case-control study - Critical Care Medicine: March 2010 - Volume 38 - Issue 3 - pp 771-778
