Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston University School of Medicine, 840 Harrison ave., Dowling 2 South, #2414, Boston, MA, 02118, USA.
Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, USA.
Eur J Trauma Emerg Surg. 2019 Aug;45(4):671-679. doi: 10.1007/s00068-018-0953-4. Epub 2018 Apr 7.
While damage control resuscitation is known to confer a survival advantage in severely injured patients, high-ratio blood component therapy should be initiated only in carefully selected trauma patients, due to the morbidity associated with blood product use. With this project, we aim to identify the effect of platelet transfusion in non-massively transfused bluntly injured patients.
The Glue Grant database was retrospectively queried and severely injured blunt trauma patients who underwent non-massive transfusion were identified. Patients were divided into quartiles depending on platelet volume they were transfused in the first 48 h. Outcomes of interest included mortality; ventilator, Intensive Care Unit (ICU) and hospital length of stay (LOS); infectious and non-infectious complications. Multivariable regression models were fitted for these outcomes, controlling for age, pre-existing comorbidities, injury severity, acute physiologic derangement, neurologic injury burden, and other fluid and blood product resuscitation.
There was no difference in mortality, LOS, or the incidence of multi-organ failure and infectious complications. However, patients receiving ≥ 250 mL of platelets were more likely to develop acute respiratory distress syndrome (ARDS) compared to those who received < 250 mL [odds ratio 1.91 (95% CI 1.10-3.33, p = 0.022)].
Pre-emptive platelet transfusion should be avoided in non-massively transfused blunt injury victims in the absence of true or functional thrombocytopenia, as it increases risk for ARDS with no survival benefit.
虽然控制性复苏在严重创伤患者中被证实具有生存优势，但由于血液制品使用相关的发病率，高比例的血液成分治疗应仅在经过精心选择的创伤患者中启动。通过本项目，我们旨在确定血小板输注对非大量输注钝性损伤患者的影响。
回顾性查询 Glue Grant 数据库，确定接受非大量输血的严重钝性创伤患者。根据他们在前 48 小时内输注的血小板量，将患者分为四分位组。感兴趣的结局包括死亡率；呼吸机、重症监护病房（ICU）和住院时间（LOS）；感染和非感染性并发症。为这些结局拟合多变量回归模型，控制年龄、预先存在的合并症、损伤严重程度、急性生理紊乱、神经损伤负担以及其他液体和血液制品复苏。
死亡率、LOS 或多器官衰竭和感染性并发症的发生率没有差异。然而，与接受<250 毫升血小板的患者相比，接受≥250 毫升血小板的患者更有可能发生急性呼吸窘迫综合征（ARDS）[比值比 1.91（95%置信区间 1.10-3.33，p=0.022)]。
在不存在真正或功能性血小板减少症的情况下，应避免对非大量输注钝性损伤受害者进行预防性血小板输注，因为这会增加 ARDS 的风险，而没有生存获益。
