Rana Rimki, Fernández-Pérez Evans R, Khan S Anjum, Rana Sameer, Winters Jeffrey L, Lesnick Timothy G, Moore S Breanndan, Gajic Ognjen
Division of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Transfusion. 2006 Sep;46(9):1478-83. doi: 10.1111/j.1537-2995.2006.00930.x.
Using the recent Consensus Panel recommendations, we sought to describe the incidence of transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) in critically ill patients.
Consecutive patients at four intensive care units (ICUs) who did not require respiratory support at the time of transfusion were identified with custom electronic surveillance system that prospectively tracks the time of transfusion and onset of respiratory support. Respiratory failure was defined as the onset of noninvasive or invasive ventilator support within 6 hours of transfusion. Experts blinded to specific transfusion factors categorized the cases of pulmonary edema as permeability edema (suspected or possible TRALI) or hydrostatic edema (TACO) according to predefined algorithm. In a nested case-control design, transfusion variables and lung injury risk factors were compared between the TRALI cases and controls matched by age, sex, and admission diagnosis.
There were 8902 units transfused in 1351 patients of whom 94 required new respiratory support within 6 hours of transfusion. Among 49 patients with confirmed acute pulmonary edema, experts identified 7 cases with suspected TRALI, 17 patients with possible TRALI, and 25 cases with TACO. The incidence of suspected TRALI was 1 in 1271 units transfused; possible TRALI, 1 in 534 per unit transfused; and TACO, 1 in 356 per unit transfused. When adjusted for sepsis and fluid balance in a stepwise conditional logistic regression analysis, patients who developed acute lung injury (suspected or possible TRALI) received larger amount of plasma (odds ratio 3.4, 95% confidence interval 1.2-10.2, for each liter infused; p = 0.023).
In the ICU, pulmonary edema frequently occurs after blood transfusion. The association between infusion of plasma and the development of suspected or possible TRALI may have important implications with regards to etiology and prevention of this syndrome.
根据最近的共识小组建议，我们试图描述重症患者中输血相关急性肺损伤（TRALI）和输血相关循环超负荷（TACO）的发生率。
使用定制的电子监测系统识别四个重症监护病房（ICU）中在输血时不需要呼吸支持的连续患者，该系统前瞻性地跟踪输血时间和呼吸支持的开始时间。呼吸衰竭定义为输血后6小时内开始无创或有创通气支持。对特定输血因素不知情的专家根据预定义算法将肺水肿病例分类为渗透性水肿（疑似或可能的TRALI）或静水压性水肿（TACO）。在巢式病例对照设计中，比较了TRALI病例与按年龄、性别和入院诊断匹配的对照组之间的输血变量和肺损伤危险因素。
1351例患者共输注8902单位血液，其中94例在输血后6小时内需要新的呼吸支持。在49例确诊为急性肺水肿的患者中，专家确定7例疑似TRALI，17例可能TRALI，25例TACO。疑似TRALI的发生率为每输注1271单位1例；可能的TRALI为每输注534单位1例；TACO为每输注356单位1例。在逐步条件逻辑回归分析中对脓毒症和液体平衡进行校正后，发生急性肺损伤（疑似或可能的TRALI）的患者输注了更多的血浆（每输注1升的比值比为3.4，95%置信区间为1.2 - 10.2；p = 0.023）。
在ICU中，输血后肺水肿很常见。输注血浆与疑似或可能的TRALI发生之间的关联可能对该综合征的病因和预防具有重要意义。
