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VOLUME 21 , ISSUE 8 ( 2017 ) > List of Articles

RESEARCH ARTICLE

Association of massive transfusion for resuscitation in gastrointestinal bleeding with transfusion-related acute lung injury

Akram Khan, James J. Case, Nasreen Khan, Michael Delrahim, Jasmina Dizdarevic, Dane J. Nichols, Martin A. Schreiber, Thomas G. Deloughery

Keywords : Blood transfusion, gastrointestinal bleeding, Intensive Care Unit, massive transfusion, outcomes, resuscitation

Citation Information : Khan A, Case JJ, Khan N, Delrahim M, Dizdarevic J, Nichols DJ, Schreiber MA, Deloughery TG. Association of massive transfusion for resuscitation in gastrointestinal bleeding with transfusion-related acute lung injury. Indian J Crit Care Med 2017; 21 (8):506-513.

DOI: 10.4103/ijccm.IJCCM_380_16

License: CC BY-ND 3.0

Published Online: 01-09-2018

Copyright Statement:  Copyright © 2017; The Author(s).


Abstract

Background and Aims: This study aimed to understand the use of massive transfusion (MT) for gastrointestinal bleeding (GIB). Patients and Methods: We performed a retrospective analysis of patients admitted to our medical Intensive Care Unit (ICU) with GIB for the type of bleeding, quantity of blood products transfused, and risk of transfusion-related acute lung injury (TRALI) and death. MT was defined as transfusion of 10 or more units of red blood cell (RBC) within a 24-h period in a 1-unit RBC: 1-unit fresh frozen plasma: and 1-unit platelet ratio. TRALI was defined as development of acute lung injury (ALI), within 6 h of transfusion, with new bilateral pulmonary infiltrates, absence of circulatory overload, or other explanation for ALI. Results: In a 43-month interval, 169 patients were admitted to the ICU with GIB and received blood products, of whom 13 received MT. Ten patients developed TRALI, of whom 7 (70%) had received MT. MT was associated with an increased risk of TRALI (odds ratio [OR]: 17.9, 95% confidence interval [CI]: 2.9–111.2, P = 0.002) after adjusting for age, sex, body mass index, baseline vitals, and laboratory data. Death was predicted by MT (OR: 5.6, 95% CI: 1.6–19.7, P = 0.007), TRALI (OR: 2.3, 95% CI: 1.1–4.6, P = 0.02), and Acute Physiologic Chronic Health Evaluation II score (OR: 1.17 per unit increase, 95% CI: 1.09–1.26, P < 0.001) after adjusting for age and sex. Conclusions: MT for GIB is associated with an increased risk of TRALI and death. Prospective studies assessing the use of MT in this population are needed to understand and improve outcomes.


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  1. Sihler KC, Napolitano LM. Complications of massive transfusion. Chest 2010;137:209-20.
  2. Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S, et al. Toward an understanding of transfusion-related acute lung injury: Statement of a consensus panel. Transfusion 2004;44:1774-89.
  3. Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, et al. Transfusion-related acute lung injury: Definition and review. Crit Care Med 2005;33:721-6.
  4. Benson AB, Austin GL, Berg M, McFann KK, Thomas S, Ramirez G, et al. Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding. Intensive Care Med 2010;36:1710-7.
  5. Gajic O, Rana R, Winters JL, Yilmaz M, Mendez JL, Rickman OB, et al. Transfusion-related acute lung injury in the critically ill: Prospective nested case-control study. Am J Respir Crit Care Med 2007;176:886-91.
  6. Chaiwat O, Lang JD, Vavilala MS, Wang J, MacKenzie EJ, Jurkovich GJ, et al. Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. Anesthesiology 2009;110:351-60.
  7. Gajic O, Rana R, Mendez JL, Rickman OB, Lymp JF, Hubmayr RD, et al. Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion 2004;44:1468-74.
  8. Vlaar AP, Binnekade JM, Prins D, van Stein D, Hofstra JJ, Schultz MJ, et al. Risk factors and outcome of transfusion-related acute lung injury in the critically ill: A nested case-control study. Crit Care Med 2010;38:771-8.
  9. Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 2004;32:1817-24.
  10. Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB, et al. Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 2007;131:1308-14.
  11. Miller TE. New evidence in trauma resuscitation-is 1:1:1 the answer? Perioper Med (Lond) 2013;2:13.
  12. McDaniel LM, Neal MD, Sperry JL, Alarcon LH, Forsythe RM, Triulzi D, et al. Use of a massive transfusion protocol in nontrauma patients: Activate away. J Am Coll Surg 2013;216:1103-9.
  13. Malone DL, Hess JR, Fingerhut A. Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol. J Trauma 2006;60 6 Suppl:S91-6.
  14. Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, et al. The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 1994;149:818-24.
  15. Ellis RK. Determination of PO2 from saturation. J Appl Physiol 1989;67:902.
  16. Severinghaus JW. Simple, accurate equations for human blood O2 dissociation computations. J Appl Physiol Respir Environ Exerc Physiol 1979;46:599-602.
  17. Rice TW, Wheeler AP, Bernard GR, Hayden DL, Schoenfeld DA, Ware LB; National Institutes of Health, et al. Comparison of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or ARDS. Chest 2007;132:410-7.
  18. Pandharipande PP, Shintani AK, Hagerman HE, St. Jacques PJ, Rice TW, Sanders NW, et al. Derivation and validation of SpO2/FiO2 ratio to impute for pao2/FiO2 ratio in the respiratory component of the sequential organ failure assessment score. Crit Care Med 2009;37:1317-21.
  19. Brown SM, Grissom CK, Moss M, Rice TW, Schoenfeld D, Hou PC, et al. Nonlinear imputation of Pao2/FiO2 from SpO2/FiO2 among patients with acute respiratory distress syndrome. Chest 2016;150:307-13.
  20. Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: Application of survival models to liver allocation. Liver Transpl 2001;7:567-80.
  21. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818-29.
  22. Afessa B, Gajic O, Keegan MT, Seferian EG, Hubmayr RD, Peters SG. Impact of introducing multiple evidence-based clinical practice protocols in a medical Intensive Care Unit: A retrospective cohort study. BMC Emerg Med 2007;7:10.
  23. Rubenfeld GD, Angus DC, Pinsky MR, Curtis JR, Connors AF Jr., Bernard GR, et al. Outcomes research in critical care: Results of the American Thoracic Society Critical Care Assembly Workshop on Outcomes Research. The Members of the Outcomes Research Workshop. Am J Respir Crit Care Med 1999;160:358-67.
  24. Fatalities Reported to FDA Following Blood Collection and Transfusion: Annual Summary for Fiscal Year 2012; 2014.
  25. Toy P, Gajic O, Bacchetti P, Looney MR, Gropper MA, Hubmayr R, et al. Transfusion-related acute lung injury: Incidence and risk factors. Blood 2012;119:1757-67.
  26. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001;33:464-70.
  27. Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med 2008;359:1018-26.
  28. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs. a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA 2015;313:471-82.
  29. Tremblay A, Bandi V. Impact of body mass index on outcomes following critical care. Chest 2003;123:1202-7.
  30. Garrouste-Orgeas M, Troché G, Azoulay E, Caubel A, de Lassence A, Cheval C, et al. Body mass index. An additional prognostic factor in ICU patients. Intensive Care Med 2004;30:437-43.
  31. Goulenok C, Monchi M, Chiche JD, Mira JP, Dhainaut JF, Cariou A, et al. Influence of overweight on ICU mortality: A prospective study. Chest 2004;125:1441-5.
  32. Pickkers P, de Keizer N, Dusseljee J, Weerheijm D, van der Hoeven JG, Peek N, et al. Body mass index is associated with hospital mortality in critically ill patients: An observational cohort study. Crit Care Med 2013;41:1878-83.
  33. Akinnusi ME, Pineda LA, El Solh AA. Effect of obesity on intensive care morbidity and mortality: A meta-analysis. Crit Care Med 2008;36:151-8.
  34. Narick C, Triulzi DJ, Yazer MH. Transfusion-associated circulatory overload after plasma transfusion. Transfusion 2012;52:160-5.
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