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Are multiple blood transfusions really a cause of acute respiratory distress syndrome?

Published online by Cambridge University Press:  01 April 2007

C. Sadis ,
M.-J. Dubois ,
C. Mélot ,
M. Lambermont  and
J.-L. Vincent
C. Sadis
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
M.-J. Dubois
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
C. Mélot
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
M. Lambermont
Affiliation:
Blood Transfusion Service, Belgium
J.-L. Vincent
Affiliation:
Free University of Brussels, Erasme Hospital, Department of Intensive Care, Belgium
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Summary

Background and objectives

Multiple blood transfusions are considered a common cause of acute respiratory distress syndrome (ARDS). We hypothesized that ARDS is more a consequence of ARDS risk factors (in particular circulatory shock) requiring transfusions than a result of the transfusions themselves.

Methods

This retrospective study included 103 patients admitted during a 10-month period to an 858-bed university hospital who received multiple transfusions (more than six units of packed red blood cells in 24 h).

Results

Ten patients developed ARDS; they were more commonly admitted with circulatory shock (36 (38.7%) vs. 8 (80%), P = 0.01), polytrauma (7 (7.5%) vs. 4 (40%), P = 0.01) or thoracic trauma (3 (3.2%) vs. 4 (40%), P = 0.01). The sequential organ-failure assessment (SOFA) score at admission was higher in patients who developed ARDS than in those who did not (9.0 ± 3.1 vs. 5.6 ± 3.4, P < 0.005). The total amount of transfusion in the first 24 h was 14.0 ± 6.8 U in the ARDS patients and 10.6 ± 7.3 U in the other patients (P = 0.17); the differences remained non-significant in the following days. During the first 24 h, patients who developed ARDS received more fresh frozen plasma than those who did not (21.8 ± 10.6 U vs. 10.7 ± 14.7 U, P = 0.02). Patients who developed ARDS had lower PaO2/FiO2 ratios (114 ± 61 mmHg vs. 276 ± 108 mmHg, P = 0.01), lower arterial pH (7.27 ± 0.10 vs. 7.34 ± 0.11, P = 0.06) and higher minute volume (10.6 ± 2.8 L min−1 vs. 7.9 ± 1.8 L min−1, P = 0.03) than patients without ARDS. Multivariable analysis retained thoracic trauma and hypoxaemia during the first 24 h (but not multiple transfusions) as independent risk factors for ARDS.

Conclusions

In this retrospective study, the development of ARDS in massively transfused patients was less related to poly-transfusion than to other factors related to circulatory shock, polytrauma or thoracic trauma. Thoracic trauma and a low PaO2 during the first 24 h were identified as independent risk factors for ARDS.

Keywords

BLOOD TRANSFUSION, adverse effectsRESPIRATORY DISTRESS SYNDROMEADULTACIDOSISTRAUMA
Type
Research Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 4 , April 2007 , pp. 355 - 361
Copyright
Copyright © European Society of Anaesthesiology 2006

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