Division of Critical Care Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
Am J Respir Crit Care Med. 2012 Apr 15;185(8):842-50. doi: 10.1164/rccm.201107-1332OC. Epub 2012 Jan 26.
Transfusion-related pulmonary complications are leading causes of morbidity and mortality attributed to transfusion. Observational studies suggest an important role for red blood cell (RBC) storage duration in these adverse outcomes.
To evaluate the impact of RBC storage duration on short-term pulmonary function as well as immunologic and coagulation status in mechanically ventilated patients receiving RBC transfusion.
This is a double-blind, randomized, clinical trial comparing fresh (≤5 d of storage) versus standard issue single-unit RBC transfusion in adult intubated and mechanically ventilated patients. The primary outcome is the change in pulmonary gas exchange as assessed by the partial pressure of arterial oxygen to fraction of inspired oxygen concentration ratio (ΔPa(O(2))/Fi(O(2))). Secondary outcomes include changes in immune and coagulation status.
Fifty patients were randomized to receive fresh RBCs and an additional 50 patients to standard issue RBCs. Median storage age was 4.0 days (interquartile range, 3.0-5.0) and 26.5 days (interquartile range, 21.0-36.0) in the fresh RBC group and standard issue RBC group, respectively. No differences were noted in the primary outcome of ΔPa(O(2))/Fi(O(2)) (difference between the mean ΔPa(O(2))/Fi(O(2)) in the standard issue RBC group vs. the fresh RBC group, -11.5; 95% confidence interval, -35.3 to 12.3; P = 0.22). Similarly, no significant differences were noted in markers of immunologic or coagulation status.
In this randomized clinical trial, no differences were noted in early measures of pulmonary function or in immunologic or coagulation status when comparing fresh versus standard issue single-unit RBC transfusion. Clinical trial registered with ClinicalTrials.gov (NCT00751322).
输血相关的肺并发症是导致输血相关发病率和死亡率的主要原因。观察性研究表明，红细胞（RBC）储存时间在这些不良结局中起着重要作用。
评估 RBC 储存时间对机械通气患者短期肺功能以及免疫和凝血状态的影响。
这是一项在成年插管和机械通气患者中比较新鲜（≤5 天储存）与标准单单位 RBC 输血的双盲、随机、临床试验。主要结局是通过动脉血氧分压与吸入氧浓度比值的变化来评估肺气体交换的变化（ΔPa（O2）/Fi（O2））。次要结局包括免疫和凝血状态的变化。
50 名患者被随机分配接受新鲜 RBC，另外 50 名患者接受标准 RBC。新鲜 RBC 组和标准 RBC 组的中位储存年龄分别为 4.0 天（四分位间距，3.0-5.0）和 26.5 天（四分位间距，21.0-36.0）。在主要结局ΔPa（O2）/Fi（O2）方面，两组间没有差异（标准 RBC 组与新鲜 RBC 组平均ΔPa（O2）/Fi（O2）的差值，-11.5；95%置信区间，-35.3 至 12.3；P = 0.22）。同样，在免疫或凝血状态标志物方面也没有显著差异。
在这项随机临床试验中，与标准单单位 RBC 输血相比，新鲜 RBC 输血在比较早期的肺功能以及免疫和凝血状态方面没有差异。临床试验在 ClinicalTrials.gov 注册（NCT00751322）。
