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Are multiple blood transfusions really a cause of acute respiratory distress syndrome?

Published online by Cambridge University Press:  01 April 2007

C. Sadis ,
M.-J. Dubois ,
C. Mélot ,
M. Lambermont  and
J.-L. Vincent
C. Sadis
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
M.-J. Dubois
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
C. Mélot
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
M. Lambermont
Affiliation:
Blood Transfusion Service, Belgium
J.-L. Vincent
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
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Summary

Background and objectives

Multiple blood transfusions are considered a common cause of acute respiratory distress syndrome (ARDS). We hypothesized that ARDS is more a consequence of ARDS risk factors (in particular circulatory shock) requiring transfusions than a result of the transfusions themselves.

Methods

This retrospective study included 103 patients admitted during a 10-month period to an 858-bed university hospital who received multiple transfusions (more than six units of packed red blood cells in 24 h).

Results

Ten patients developed ARDS; they were more commonly admitted with circulatory shock (36 (38.7%) vs. 8 (80%), P = 0.01), polytrauma (7 (7.5%) vs. 4 (40%), P = 0.01) or thoracic trauma (3 (3.2%) vs. 4 (40%), P = 0.01). The sequential organ-failure assessment (SOFA) score at admission was higher in patients who developed ARDS than in those who did not (9.0 ± 3.1 vs. 5.6 ± 3.4, P < 0.005). The total amount of transfusion in the first 24 h was 14.0 ± 6.8 U in the ARDS patients and 10.6 ± 7.3 U in the other patients (P = 0.17); the differences remained non-significant in the following days. During the first 24 h, patients who developed ARDS received more fresh frozen plasma than those who did not (21.8 ± 10.6 U vs. 10.7 ± 14.7 U, P = 0.02). Patients who developed ARDS had lower PaO2/FiO2 ratios (114 ± 61 mmHg vs. 276 ± 108 mmHg, P = 0.01), lower arterial pH (7.27 ± 0.10 vs. 7.34 ± 0.11, P = 0.06) and higher minute volume (10.6 ± 2.8 L min−1 vs. 7.9 ± 1.8 L min−1, P = 0.03) than patients without ARDS. Multivariable analysis retained thoracic trauma and hypoxaemia during the first 24 h (but not multiple transfusions) as independent risk factors for ARDS.

Conclusions

In this retrospective study, the development of ARDS in massively transfused patients was less related to poly-transfusion than to other factors related to circulatory shock, polytrauma or thoracic trauma. Thoracic trauma and a low PaO2 during the first 24 h were identified as independent risk factors for ARDS.

Keywords

BLOOD TRANSFUSION, adverse effectsRESPIRATORY DISTRESS SYNDROMEADULTACIDOSISTRAUMA
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 355 - 361
Copyright
Copyright © European Society of Anaesthesiology 2006

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References

1.Ware, LB, Matthay, MA. The acute respiratory distress syndrome. N Engl J Med 2000; 342: 1334–1349.CrossRefGoogle ScholarPubMed
2.Weinacker, AB, Vaszar, LT. Acute respiratory distress syndrome: physiology and new management strategies. Annu Rev Med 2001; 52: 221–237.CrossRefGoogle ScholarPubMed
3.Milot, J, Perron, J, Lacasse, Y et al. . Incidence and predictors of ARDS after cardiac surgery. Chest 2001; 119: 884–888.CrossRefGoogle ScholarPubMed
4.Miller, PR, Croce, MA, Kilgo, PD, Scott, J, Fabian, TC. Acute respiratory distress syndrome in blunt trauma: identification of independent risk factors. Am Surg 2002; 68: 845–850.CrossRefGoogle ScholarPubMed
5.Dry, SM, Bechard, KM, Milford, EL, Churchill, WH, Benjamin, RJ. The pathology of transfusion-related acute lung injury. Am J Clin Pathol 1999; 112: 216–221.CrossRefGoogle ScholarPubMed
6.Kleinman, S, Caulfield, T, Chan, P et al. . Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 2004; 44: 1774–1789.CrossRefGoogle ScholarPubMed
7.Toy, P, Popovsky, MA, Abraham, E et al. . Transfusion-related acute lung injury: definition and review. Crit Care Med 2005; 33: 721–726.CrossRefGoogle ScholarPubMed
8.Bernard, GR, Artigas, A, Brigham, KL et al. . Definitions, mechanisms, relevant outcomes, and clinical trial coordination. The American-European Consensus Conference on ARDS. Am J Respir Crit Care Med 1994; 149: 818–824.CrossRefGoogle ScholarPubMed
9.Vincent, JL, Moreno, R, Takala, J et al. . The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 1996; 22: 707–710.CrossRefGoogle ScholarPubMed
10.Sazama, K. Reports of 355 transfusion-associated deaths: 1976 through 1985. Transfusion 1990; 30: 583–590.CrossRefGoogle ScholarPubMed
11.AuBuchon, JP, Kruskall, MS. Transfusion safety: realigning efforts with risks. Transfusion 1997; 37: 1211–1216.CrossRefGoogle ScholarPubMed
12.1997 Committee on Transfusion Medicine of the American Society of Anesthesiologists. Adverse effects of transfusion. Questions and Answers about Transfusion Practices. Park Ridge: American Society of Anesthesiologists, 2002: 16–19.Google Scholar
13.Barnard, RD. Indiscriminate transfusion: a critique case report illustrating hypersensitivity reactions. N Y State J Med 1951; 51: 2399–2402.Google Scholar
14.Popovsky, MA, Abel, MD, Moore, SB. Transfusion-related acute lung injury associated with passive transfer of antileucocyte antibodies. Am Rev Respir Dis 1983; 128: 185–189.CrossRefGoogle Scholar
15.Kopko, PM, Popovsky, MA. Pulmonary injury from transfusion-related acute lung injury. Clin Chest Med 2004; 25: 105–111.CrossRefGoogle ScholarPubMed
16.Kopko, PM, Marshall, CS, MacKenzie, MR, Holland, PV, Popovsky, MA. Transfusion-related acute lung injury: report of a clinical look-back investigation. JAMA 2002; 287: 1968–1971.CrossRefGoogle ScholarPubMed
17.Looney, MR, Gropper, MA, Matthay, MA. Transfusion-related acute lung injury: a review. Chest 2004; 126: 249–258.CrossRefGoogle ScholarPubMed
18.Silliman, CC, Voelkel, NF, Allard, JD et al. . Plasma and lipids from stored packed red blood cells cause acute lung injury in an animal model. J Clin Invest 1998; 101: 1458–1467.CrossRefGoogle ScholarPubMed
19.Popovsky, MA, Moore, SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion 1985; 25: 573–577.CrossRefGoogle ScholarPubMed
20.Hebert, PC, Fergusson, D, Blajchman, MA et al. . Clinical outcomes following institution of the Canadian universal leucoreduction program for red blood cell transfusions. JAMA 2003; 289: 1941–1949.CrossRefGoogle Scholar
21.Yazer, MH, Podlosky, L, Clarke, G, Nahirniak, SM. The effect of prestorage WBC reduction on the rates of febrile nonhemolytic transfusion reactions to platelet concentrates and RBC. Transfusion 2004; 44: 10–15.CrossRefGoogle ScholarPubMed
22.Kawamata, M, Miyabe, M, Omote, K, Sumita, S, Namiki, A. Acute pulmonary edema associated with transfusion of packed red blood cells. Intensive Care Med 1995; 21: 443–446.CrossRefGoogle ScholarPubMed
23.Leger, R, Palm, S, Wulf, H, Vosberg, A, Neppert, J. Transfusion-related lung injury with leucopenic reaction caused by fresh frozen plasma containing anti-NB1. Anesthesiology 1999; 91: 1529–1532.CrossRefGoogle Scholar
24.Virchis, AE, Patel, RK, Contreras, M et al. . Lesson of the week. Acute non-cardiogenic lung oedema after platelet transfusion. BMJ 1997; 314: 880–882.CrossRefGoogle ScholarPubMed
25.van der Werff, YD, van der Houwen, HK, Heijmans, PJ et al. . Postpneumonectomy pulmonary edema. A retrospective analysis of incidence and possible risk factors. Chest 1997; 111: 1278–1284.CrossRefGoogle ScholarPubMed
26.Stainsby, D, MacLennan, S, Hamilton, PJ. Management of massive blood loss: a template guideline. Br J Anaesth 2000; 85: 487–491.CrossRefGoogle ScholarPubMed
27.Dunham, CM, Frankenfield, D, Belzberg, H et al. . Inflammatory markers: superior predictors of adverse outcome in blunt trauma patients? Crit Care Med 1994; 22: 667–672.CrossRefGoogle ScholarPubMed
28.Eberhard, LW, Morabito, DJ, Matthay, MA et al. . Initial severity of metabolic acidosis predicts the development of acute lung injury in severely traumatized patients. Crit Care Med 2000; 28: 125–131.CrossRefGoogle ScholarPubMed
29.Rixen, D, Siegel, JH. Metabolic correlates of oxygen debt predict post trauma early acute respiratory distress syndrome and the related cytokine response. J Trauma 2000; 49: 392–403.CrossRefGoogle Scholar
30.Silliman, CC, Paterson, AJ, Dickey, WO et al. . The association of biologically active lipids with the development of transfusion-related acute lung injury: a retrospective study. Transfusion 1997; 37: 719–726.CrossRefGoogle ScholarPubMed
31.Su, F, Nguyen, ND, Creteur, J et al. . Use of low tidal volume in septic shock may decrease severity of subsequent acute lung injury. Shock 2004; 22: 145–150.CrossRefGoogle ScholarPubMed
32.Donaldson, MD, Seaman, MJ, Park, GR. Massive blood transfusion. Br J Anaesth 1992; 69: 621–630.CrossRefGoogle ScholarPubMed
33.Hewitt, PE, Machin, SJ. ABC of transfusion. Massive blood transfusion. BMJ 1990; 300: 107–109.CrossRefGoogle ScholarPubMed
34.Gong, MN, Thompson, BT, Williams, P et al. . Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med 2005; 33: 1191–1198.CrossRefGoogle ScholarPubMed
35.Nathens, AB. Massive transfusion as a risk factor for acute lung injury: association or causation? Crit Care Med 2006; 34: S144–S150.CrossRefGoogle ScholarPubMed