Pulmonary and Critical Care Department, Washington Hospital Center, Georgetown University Medical Center, Washington, DC 20010, USA.
J Crit Care. 2012 Aug;27(4):419.e7-14. doi: 10.1016/j.jcrc.2011.11.010. Epub 2012 Jan 9.
We sought to determine if use of warm fresh whole blood (WFWB), rather than blood component therapy, alters rates of acute lung injury (ALI) in patients with trauma.
We retrospectively analyzed rates of ALI in patients undergoing massive blood transfusions while at a combat support hospital. Patients with ALI were compared with those not developing ALI with respect to demographics, trauma type, severity of illness, crystalloid volume given, and exposure to WFWB. Logistic regression was used to identify variables associated with ALI.
The cohort included 591 subjects (mean age, 28 ± 8.1 years; male, 96.7%). Acute lung injury occurred in 11.2%, and 34.4% received WFWB. After adjusting for the type of trauma, severity of illness, and volume of crystalloid administered, WFWB remained independently associated with ALI (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.00-1.13). Nearly two thirds of persons with ALI never received WFWB; factors associated with the use of WFWB were also examined. Severity of illness (AOR, 1.18; 95% CI, 1.02-1.35), crystalloid volume (AOR, 1.12; 95% CI, 1.06-1.18), recombinant factor VIIa use (AOR, 1.94; 95% CI, 1.06-3.57), and US citizenship (AOR, 3.06; 95% CI, 1.74-5.37) correlated with WFWB use.
Warm fresh whole blood may be associated with an increased risk of ALI, but this is confounded by increased injury and crystalloid use in patients receiving WFWB.
我们旨在确定在创伤患者中使用温热新鲜全血（WFWB）而非血液成分治疗是否会改变急性肺损伤（ALI）的发生率。
我们回顾性分析了在一家战斗支援医院接受大量输血的患者中 ALI 的发生率。将发生 ALI 的患者与未发生 ALI 的患者进行比较，比较内容包括人口统计学特征、创伤类型、疾病严重程度、给予的晶体液量以及是否暴露于 WFWB。使用逻辑回归来确定与 ALI 相关的变量。
该队列包括 591 名患者（平均年龄为 28 ± 8.1 岁；男性占 96.7%）。ALI 的发生率为 11.2%，34.4%的患者接受了 WFWB。在调整了创伤类型、疾病严重程度和给予的晶体液量后，WFWB 仍然与 ALI 独立相关（调整后的优势比 [AOR]，1.06；95%置信区间 [CI]，1.00-1.13）。近三分之二的 ALI 患者从未接受过 WFWB；还检查了与 WFWB 使用相关的因素。疾病严重程度（AOR，1.18；95%CI，1.02-1.35）、晶体液量（AOR，1.12；95%CI，1.06-1.18）、重组因子 VIIa 应用（AOR，1.94；95%CI，1.06-3.57）和美国公民身份（AOR，3.06；95%CI，1.74-5.37）与 WFWB 的使用相关。
温热新鲜全血可能与 ALI 的风险增加相关，但这与接受 WFWB 的患者的损伤和晶体液用量增加有关。
