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Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma - 10/2/2009

Anesthesiology 2009; 110: 351-60


Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. However, there is little information regarding the risk of ARDS with incremental PRBCs exposure.


The authors carried out a retrospective analysis, in which eligible patients from the National Study on Costs and Outcomes of Trauma were included. The main exposure was defined as units of PRBCs transfused during the first 24 hours after admission, and the main outcome was ARDS.


A total of 521 (4.6%) of 14,070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received a transfusion of PRBCs. Injury severity, thoracic injury, polytrauma and pneumonia receiving more than 5 units of fresh frozen plasma and 6-10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had a higher risk of developing ARDS (patients who received 6-10 units: adjusted odds ratio [OR] 2.5, 95% confidence interval [CI] 1.12-5.3; patients who received more than 10 units: OR 2.6, 95% CI 1.1-6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted OR 1.06; 95% CI 1.03-1.10).


The authors conclude that early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients, and that conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

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