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Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma

Onuma Chaiwat1, John D Lang, Monica S Vavilala

  • 1Department of Anesthesiology, University of Washington School of Medicine, Seattle, Washington 98195-6540, USA.

Anesthesiology
|January 24, 2009
PubMed

Insights

Transfusing packed red blood cells (PRBCs) increases acute respiratory distress syndrome (ARDS) risk in trauma patients. Reducing PRBCs exposure, even by one unit, may lower ARDS incidence in injured individuals.

Area of Science:

  • Trauma critical care
  • Transfusion medicine
  • Pulmonary complications

Background:

  • Packed red blood cell (PRBC) transfusion is a known risk factor for acute respiratory distress syndrome (ARDS) in trauma patients.
  • Limited data exists on the specific risk associated with increasing units of PRBCs transfused.

Purpose of the Study:

  • To investigate the association between the volume of PRBCs transfused and the risk of developing ARDS in trauma patients.
  • To identify predictors of ARDS in the context of PRBC transfusion.

Main Methods:

  • Retrospective analysis of patients from the National Study on Costs and Outcomes of Trauma.
  • Exposure defined as units of PRBCs transfused within 24 hours of admission.
  • Outcome assessed was the development of ARDS.

Main Results:

  • 521 (4.6%) of 14,070 patients developed ARDS; 63.5% of ARDS patients received PRBCs.
  • High PRBCs transfusion volumes (6-10 units: aOR 2.5; >10 units: aOR 2.6) were independent predictors of ARDS.
  • Each additional PRBCs unit increased ARDS risk by 6% (aOR 1.06).

Conclusions:

  • Early PRBC transfusion is an independent predictor of ARDS in adult trauma patients.
  • Conservative transfusion strategies reducing PRBC exposure may mitigate ARDS risk.
  • Minimizing PRBC units transfused could be beneficial for trauma patient outcomes.
Abstract

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