期刊
INTENSIVE CARE MEDICINE
卷 36, 期 10, 页码 1710-1717出版社
SPRINGER
DOI: 10.1007/s00134-010-1954-x
关键词
Transfusion-related acute lung injury; Transfusion complications; Acute respiratory distress syndrome; Variceal bleeding; Chronic liver disease; Plasma transfusion
资金
- National Heart, Lung and Blood Institute, National Institute of Health [K24 HLO89223]
- National Institute of General Medical Sciences, National Institute of Health [GM49222]
Transfusion of blood components is common in patients admitted to the intensive care unit (ICU) for gastrointestinal (GI) bleeding, yet the incidence and risk factors for development of transfusion-related acute lung injury (TRALI) in these patients are unknown. Patients admitted to a medical ICU for GI bleeding (n = 225) were analyzed for patient- and transfusion-specific risk factors for development of TRALI. In transfused patients (n = 150), the incidence of TRALI was 15% [95% confidence interval (CI), 10-21%] and accounted for 76% (22/29) of all acute lung injury (ALI) cases. Transfused patients with end-stage liver disease (ESLD) (n = 72) developed TRALI more frequently than those without ESLD (29% versus 1%, p < 0.01). Fresh frozen plasma (FFP) was temporally associated with TRALI in 86% of cases. Transfusion-specific risk factors for development of TRALI included number of transfused units of FFP and nonleukoreduced red blood cells. Patient-specific risk factors included Model for End-Stage Liver Disease (MELD) score, admission serum albumin level, and presence of ALI risk factors. TRALI is common in critically ill ESLD patients with gastrointestinal bleeding. Nonleukoreduced red blood cells and FFP are significant transfusion-specific risk factors and their use should be re-evaluated in bleeding patients with ESLD.
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