Transfusion-related acute lung injury and pulmonary edema in critically ill patients: A retrospective study

Rimki Rana, Evans R. Fernández-Pérez, S. Anjum Khan, Sameer Rana, Jeffrey L. Winters, Timothy G. Lesnick, S. Breanndan Moore, Ognjen Gajic

Research output: Contribution to journalArticle

208 Citations (Scopus)

Abstract

BACKGROUND: Using the recent Consensus Panel recommendations, we sought to describe the incidence of transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) in critically ill patients. STUDY DESIGN AND METHODS: Consecutive patients at four intensive care units (ICUs) who did not require respiratory support at the time of transfusion were identified with custom electronic surveillance system that prospectively tracks the time of transfusion and onset of respiratory support. Respiratory failure was defined as the onset of noninvasive or invasive ventilator support within 6 hours of transfusion. Experts blinded to specific transfusion factors categorized the cases of pulmonary edema as permeability edema (suspected or possible TRALI) or hydrostatic edema (TACO) according to predefined algorithm. In a nested case-control design, transfusion variables and lung injury risk factors were compared between the TRALI cases and controls matched by age, sex, and admission diagnosis. RESULTS: There were 8902 units transfused in 1351 patients of whom 94 required new respiratory support within 6 hours of transfusion. Among 49 patients with confirmed acute pulmonary edema, experts identified 7 cases with suspected TRALI, 17 patients with possible TRALI, and 25 cases with TACO. The incidence of suspected TRALI was 1 in 1271 units transfused; possible TRALI, 1 in 534 per unit transfused; and TACO, 1 in 356 per unit transfused. When adjusted for sepsis and fluid balance in a stepwise conditional logistic regression analysis, patients who developed acute lung injury (suspected or possible TRALI) received larger amount of plasma (odds ratio 3.4, 95% confidence interval 1.2-10.2, for each liter infused; p = 0.023). CONCLUSION: In the ICU, pulmonary edema frequently occurs after blood transfusion. The association between infusion of plasma and the development of suspected or possible TRALI may have important implications with regards to etiology and prevention of this syndrome.

Original languageEnglish (US)
Pages (from-to)1478-1483
Number of pages6
JournalTransfusion
Volume46
Issue number9
DOIs
StatePublished - Sep 2006

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Acute Lung Injury
Pulmonary Edema
Critical Illness
Retrospective Studies
Intensive Care Units
Edema
Water-Electrolyte Balance
Incidence
Lung Injury
Mechanical Ventilators
Blood Transfusion
Respiratory Insufficiency
Permeability
Sepsis
Logistic Models
Odds Ratio
Regression Analysis
Confidence Intervals

ASJC Scopus subject areas

  • Hematology
  • Immunology

Cite this

Transfusion-related acute lung injury and pulmonary edema in critically ill patients : A retrospective study. / Rana, Rimki; Fernández-Pérez, Evans R.; Khan, S. Anjum; Rana, Sameer; Winters, Jeffrey L.; Lesnick, Timothy G.; Moore, S. Breanndan; Gajic, Ognjen.

In: Transfusion, Vol. 46, No. 9, 09.2006, p. 1478-1483.

Research output: Contribution to journalArticle

Rana, R, Fernández-Pérez, ER, Khan, SA, Rana, S, Winters, JL, Lesnick, TG, Moore, SB & Gajic, O 2006, 'Transfusion-related acute lung injury and pulmonary edema in critically ill patients: A retrospective study', Transfusion, vol. 46, no. 9, pp. 1478-1483. https://doi.org/10.1111/j.1537-2995.2006.00930.x
Rana, Rimki ; Fernández-Pérez, Evans R. ; Khan, S. Anjum ; Rana, Sameer ; Winters, Jeffrey L. ; Lesnick, Timothy G. ; Moore, S. Breanndan ; Gajic, Ognjen. / Transfusion-related acute lung injury and pulmonary edema in critically ill patients : A retrospective study. In: Transfusion. 2006 ; Vol. 46, No. 9. pp. 1478-1483.
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abstract = "BACKGROUND: Using the recent Consensus Panel recommendations, we sought to describe the incidence of transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) in critically ill patients. STUDY DESIGN AND METHODS: Consecutive patients at four intensive care units (ICUs) who did not require respiratory support at the time of transfusion were identified with custom electronic surveillance system that prospectively tracks the time of transfusion and onset of respiratory support. Respiratory failure was defined as the onset of noninvasive or invasive ventilator support within 6 hours of transfusion. Experts blinded to specific transfusion factors categorized the cases of pulmonary edema as permeability edema (suspected or possible TRALI) or hydrostatic edema (TACO) according to predefined algorithm. In a nested case-control design, transfusion variables and lung injury risk factors were compared between the TRALI cases and controls matched by age, sex, and admission diagnosis. RESULTS: There were 8902 units transfused in 1351 patients of whom 94 required new respiratory support within 6 hours of transfusion. Among 49 patients with confirmed acute pulmonary edema, experts identified 7 cases with suspected TRALI, 17 patients with possible TRALI, and 25 cases with TACO. The incidence of suspected TRALI was 1 in 1271 units transfused; possible TRALI, 1 in 534 per unit transfused; and TACO, 1 in 356 per unit transfused. When adjusted for sepsis and fluid balance in a stepwise conditional logistic regression analysis, patients who developed acute lung injury (suspected or possible TRALI) received larger amount of plasma (odds ratio 3.4, 95{\%} confidence interval 1.2-10.2, for each liter infused; p = 0.023). CONCLUSION: In the ICU, pulmonary edema frequently occurs after blood transfusion. The association between infusion of plasma and the development of suspected or possible TRALI may have important implications with regards to etiology and prevention of this syndrome.",
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AU - Rana, Rimki

AU - Fernández-Pérez, Evans R.

AU - Khan, S. Anjum

AU - Rana, Sameer

AU - Winters, Jeffrey L.

AU - Lesnick, Timothy G.

AU - Moore, S. Breanndan

AU - Gajic, Ognjen

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