Top

Published in:

01-10-2010 | Original

Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding

Authors: Alexander B. Benson, Gregory L. Austin, Mary Berg, Kim K. McFann, Sila Thomas, Gina Ramirez, Hugo Rosen, Christopher C. Silliman, Marc Moss

Published in: Intensive Care Medicine | Issue 10/2010

Abstract

Purpose

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.

Methods

Patients admitted to a medical ICU for GI bleeding (n = 225) were analyzed for patient- and transfusion-specific risk factors for development of TRALI.

Results

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.

Conclusions

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.

Available only for authorised users

Corwin HL, Gettinger A, Pearl RG, Fink MP, Levy MM, Abraham E, MacIntyre NR, Shabot MM, Duh MS, Shapiro MJ (2004) The CRIT Study: anemia and blood transfusion in the critically ill—current clinical practice in the United States. Crit Care Med 32:39–52CrossRefPubMed

Vincent JL, Baron JF, Reinhart K, Gattinoni L, Thijs L, Webb A, Meier-Hellmann A, Nollet G, Peres-Bota D, ABC (Anemia and Blood Transfusion in Critical Care) Investigators (2002) Anemia and blood transfusion in critically ill patients. JAMA 288:1499–1507CrossRefPubMed

Gajic O, Rana R, Winters JL, Yilmaz M, Mendez JL, Rickman OB, O’Byrne MM, Evenson LK, Malinchoc M, DeGoey SR, Afessa B, Hubmayr RD, Moore SB (2007) Transfusion-related acute lung injury in the critically ill: prospective nested case–control study. Am J Respir Crit Care Med 176:886–891CrossRefPubMed

Sorbi D, Gostout CJ, Peura D, Johnson D, Lanza F, Foutch PG, Schleck CD, Zinsmeister AR (2003) An assessment of the management of acute bleeding varices: a multicenter prospective member-based study. Am J Gastroenterol 98:2424–2434CrossRefPubMed

Garrido A, Marquez JL, Guerrero FJ, Pizarro MA, Leo E, Giraldez A (2006) Transfusion requirements in patients with gastrointestinal bleeding: a study in a Blood Unit at a referral hospital. Rev Esp Enferm Dig 98:760–769CrossRefPubMed

Chaiwat O, Lang JD, Vavilala MS, Wang J, MacKenzie EJ, Jurkovich GJ, Rivara FP (2009) Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. Anesthesiology 110:351–360CrossRefPubMed

Gajic O, Rana R, Mendez JL, Rickman OB, Lymp JF, Hubmayr RD, Moore SB (2004) Acute lung injury after blood transfusion in mechanically ventilated patients. Transfusion 44:1468–1474CrossRefPubMed

Gong MN, Thompson BT, Williams P, Pothier L, Boyce PD, Christiani DC (2005) Clinical predictors of and mortality in acute respiratory distress syndrome: potential role of red cell transfusion. Crit Care Med 33:1191–1198CrossRefPubMed

Vlaar AP, Binnekade JM, Prins D, van Stein D, Hofstra JJ, Schultz MJ, Juffermans NP (2010) Risk factors and outcome of transfusion-related acute lung injury in the critically ill: a nested case–control study. Crit Care Med 38:981–982CrossRef

10.

Marik PE, Corwin HL (2008) Acute lung injury following blood transfusion: expanding the definition. Crit Care Med 36:3080–3084CrossRefPubMed

11.

Moss M, Bucher B, Moore FA, Moore EE, Parsons PE (1996) The role of chronic alcohol abuse in the development of acute respiratory distress syndrome in adults. JAMA 275:50–54CrossRefPubMed

12.

Bernard GR, Artigas A, Brigham KL, Carlet J, Falke K, Hudson L, Lamy M, Legall JR, Morris A, Spragg R (1994) The American-European Consensus Conference on ARDS. Definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149(3 Pt 1):818–824PubMed

13.

Toy P, Popovsky MA, Abraham E, Ambruso DR, Holness LG, Kopko PM, McFarland JG, Nathens AB, Silliman CC, Stroncek D, National Heart, Lung and Blood Institute Working Group on TRALI (2005) Transfusion-related acute lung injury: definition and review. Crit Care Med 33:721–726CrossRefPubMed

14.

Vieillard-Baron A, Chergui K, Rabiller A, Peyrouset O, Page B, Beauchet A, Jardin F (2004) Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients. Intensive Care Med 30:1734–1739PubMed

15.

Barbier C, Loubieres Y, Schmit C, Hayon J, Ricome JL, Jardin F, Vieillard-Baron A (2004) Respiratory changes in inferior vena cava diameter are helpful in predicting fluid responsiveness in ventilated septic patients. Intensive Care Med 30:1740–1746PubMed

16.

Nakazawa H, Ohnishi H, Okazaki H, Hashimoto S, Hotta H, Watanabe T, Ohkawa R, Yatomi Y, Nakajima K, Iwao Y, Takamoto S, Shimizu M, Iijima T (2009) Impact of fresh-frozen plasma from male-only donors versus mixed-sex donors on postoperative respiratory function in surgical patients: a prospective case-controlled study. Transfusion 49:2434–2441CrossRefPubMed

17.

Gajic O, Dara SI, Mendez JL, Adesanya AO, Festic E, Caples SM, Rana R, St Sauver JL, Lymp JF, Afessa B, Hubmayr RD (2004) Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med 32:1817–1824CrossRefPubMed

18.

Khan H, Belsher J, Yilmaz M, Afessa B, Winters JL, Moore SB, Hubmayr RD, Gajic O (2007) Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients. Chest 131:1308–1314CrossRefPubMed

19.

Bosch J, Thabut D, Bendtsen F, D’Amico G, Albillos A, Gonzalez Abraldes J, Fabricius S, Erhardtsen E, de Franchis R, European Study Group on rFVIIa in UGI Haemorrhage (2004) Recombinant factor VIIa for upper gastrointestinal bleeding in patients with cirrhosis: a randomized, double-blind trial. Gastroenterology 127:1123–1130CrossRefPubMed

20.

Tripodi A, Mannucci PM (2007) Abnormalities of hemostasis in chronic liver disease: reappraisal of their clinical significance and need for clinical and laboratory research. J Hepatol 46:727–733CrossRefPubMed

21.

Navarrete C, Lucas G, Soni N, Morgan C, Choo L, Cohen H, Williamson LM, Serious Hazards of Transfusion Steering Group (2009) Ten years of hemovigilance reports of transfusion-related acute lung injury in the United Kingdom and the impact of preferential use of male donor plasma. Transfusion 49:440–452CrossRefPubMed

22.

Eder AF, Herron R, Strupp A, Dy B, Notari EP, Chambers LA, Dodd RY, Benjamin RJ (2007) Transfusion-related acute lung injury surveillance (2003–2005) and the potential impact of the selective use of plasma from male donors in the American Red Cross. Transfusion 47:599–607CrossRefPubMed

23.

Dzik WH, Anderson JK, O’Neill EM, Assmann SF, Kalish LA, Stowell CP (2002) A prospective, randomized clinical trial of universal WBC reduction. Transfusion 42:1114–1122CrossRefPubMed

24.

Watkins TR, Rubenfeld GD, Martin TR, Nester TA, Caldwell E, Billgren J, Ruzinski J, Nathens AB (2008) Effects of leukoreduced blood on acute lung injury after trauma: a randomized controlled trial. Crit Care Med 36:1493–1499CrossRefPubMed

25.

National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL (2006) Comparison of two fluid-management strategies in acute lung injury. New Engl J Med 354:2564–2575CrossRefPubMed

26.

Li G, Kojicic M, Reriani MK, Fernandez Perez ER, Thakur L, Kashyap R, Van Buskirk CM, Gajic O (2009) Long-term survival and quality of life after transfusion associated pulmonary edema in critically ill medical patients. Chest 137:783–789CrossRefPubMed

27.

Mangialardi RJ, Martin GS, Bernard GR, Wheeler AP, Christman BW, Dupont WD, Higgins SB, Swindell BB (2000) Hypoproteinemia predicts acute respiratory distress syndrome development, weight gain, and death in patients with sepsis. Crit Care Med 28:3137–3145CrossRefPubMed

28.

Bernard B, Grange JD, Khac EN, Amiot X, Opolon P, Poynard T (1999) Antibiotic prophylaxis for the prevention of bacterial infections in cirrhotic patients with gastrointestinal bleeding: a meta-analysis. Hepatology 29:1655–1661CrossRefPubMed

29.

Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S, Meade M, Morrison D, Pinsent T, Robillard P, Slinger P (2004) Toward an understanding of transfusion-related acute lung injury: statement of a consensus panel. Transfusion 44:1774–1789CrossRefPubMed

30.

Silliman CC (2006) The two-event model of transfusion-related acute lung injury. Crit Care Med 34(5 Suppl):S124–S131CrossRefPubMed

Title: Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding
Authors: Alexander B. Benson
Gregory L. Austin
Mary Berg
Kim K. McFann
Sila Thomas
Gina Ramirez
Hugo Rosen
Christopher C. Silliman
Marc Moss
Publication date: 01-10-2010
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 10/2010
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-010-1954-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Transfusion-related acute lung injury in ICU patients admitted with gastrointestinal bleeding

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 10/2010

Questions remain regarding mandatory use of macrolides in community-acquired pneumonia

Intensive care-acquired hypernatremia after major cardiothoracic surgery is associated with increased mortality

SDD: don’t be selective in considering pros and cons

Skin rash in a patient with A(H1N1) infection

Hospital mortality is associated with ICU admission time

Non-invasive ventilation in patients with hematological malignancies: the saga continues, but where is the finale?