Plasma Inclusive Resuscitation Is Not Associated With Transfusion-Related Acute Lung Injury Under Updated Guidelines

Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.

Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.

Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (n = 39) compared to late PIR (n = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, P = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, P = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, P = 0.62).

In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.