Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma

Onuma Chaiwat, John D. Lang, Monica S. Vavilala, Jin Wang, Ellen J. MacKenzie, Gregory Jurkovich, Frederick P. Rivara

Research output: Contribution to journalArticle

99 Citations (Scopus)

Abstract

BACKGROUND: Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. METHODS: For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. RESULTS: A total of 521 (4.6%) of 14070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6ĝ€"10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6ĝ€"10 units: adjusted odds ratio 2.5, 95% CI 1.12ĝ€"5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1ĝ€"6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06; 95% CI 1.03ĝ€"1.10). CONCLUSIONS: Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

Original languageEnglish (US)
Pages (from-to)351-360
Number of pages10
JournalAnesthesiology
Volume110
Issue number2
DOIs
StatePublished - Feb 1 2009
Externally publishedYes

Fingerprint

Erythrocyte Transfusion
Adult Respiratory Distress Syndrome
Wounds and Injuries
Erythrocytes
Odds Ratio
Thoracic Injuries
Multiple Trauma
Pneumonia
Costs and Cost Analysis

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Chaiwat, O., Lang, J. D., Vavilala, M. S., Wang, J., MacKenzie, E. J., Jurkovich, G., & Rivara, F. P. (2009). Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. Anesthesiology, 110(2), 351-360. https://doi.org/10.1097/ALN.0b013e3181948a97

Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. / Chaiwat, Onuma; Lang, John D.; Vavilala, Monica S.; Wang, Jin; MacKenzie, Ellen J.; Jurkovich, Gregory; Rivara, Frederick P.

In: Anesthesiology, Vol. 110, No. 2, 01.02.2009, p. 351-360.

Research output: Contribution to journalArticle

Chaiwat, O, Lang, JD, Vavilala, MS, Wang, J, MacKenzie, EJ, Jurkovich, G & Rivara, FP 2009, 'Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma', Anesthesiology, vol. 110, no. 2, pp. 351-360. https://doi.org/10.1097/ALN.0b013e3181948a97
Chaiwat, Onuma ; Lang, John D. ; Vavilala, Monica S. ; Wang, Jin ; MacKenzie, Ellen J. ; Jurkovich, Gregory ; Rivara, Frederick P. / Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma. In: Anesthesiology. 2009 ; Vol. 110, No. 2. pp. 351-360.
@article{2ecd7c7c26184f9dbfdd1b6f818c3776,
title = "Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma",
abstract = "BACKGROUND: Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. METHODS: For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. RESULTS: A total of 521 (4.6{\%}) of 14070 patients developed ARDS, and 331 patients (63.5{\%}) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6ĝ€{"}10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6ĝ€{"}10 units: adjusted odds ratio 2.5, 95{\%} CI 1.12ĝ€{"}5.3; patients who received more than 10 units: odds ratio 2.6, 95{\%} CI 1.1ĝ€{"}6.4). Each additional unit of PRBCs transfused conferred a 6{\%} higher risk of ARDS (adjusted odds ratio 1.06; 95{\%} CI 1.03ĝ€{"}1.10). CONCLUSIONS: Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.",
author = "Onuma Chaiwat and Lang, {John D.} and Vavilala, {Monica S.} and Jin Wang and MacKenzie, {Ellen J.} and Gregory Jurkovich and Rivara, {Frederick P.}",
year = "2009",
month = "2",
day = "1",
doi = "10.1097/ALN.0b013e3181948a97",
language = "English (US)",
volume = "110",
pages = "351--360",
journal = "Anesthesiology",
issn = "0003-3022",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma

AU - Chaiwat, Onuma

AU - Lang, John D.

AU - Vavilala, Monica S.

AU - Wang, Jin

AU - MacKenzie, Ellen J.

AU - Jurkovich, Gregory

AU - Rivara, Frederick P.

PY - 2009/2/1

Y1 - 2009/2/1

N2 - BACKGROUND: Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. METHODS: For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. RESULTS: A total of 521 (4.6%) of 14070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6ĝ€"10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6ĝ€"10 units: adjusted odds ratio 2.5, 95% CI 1.12ĝ€"5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1ĝ€"6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06; 95% CI 1.03ĝ€"1.10). CONCLUSIONS: Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

AB - BACKGROUND: Transfusion of packed red blood cells (PRBCs) is a risk factor for acute respiratory distress syndrome (ARDS) in trauma patients. Yet, there is a paucity of information regarding the risk of ARDS with incremental PRBCs exposure. METHODS: For this retrospective analysis, eligible patients from National Study on Costs and Outcomes of Trauma were included. Our main exposure was defined as units of PRBCs transfused during the first 24 h after admission. The main outcome was ARDS. RESULTS: A total of 521 (4.6%) of 14070 patients developed ARDS, and 331 patients (63.5%) who developed ARDS received PRBCs transfusion. Injury severity, thoracic injury, polytrauma, and pneumonia receiving more than 5 units of fresh frozen plasma and 6ĝ€"10 units of PRBCs were independent predictors of ARDS. Patients receiving more than 5 units of PRBCs had higher risk of developing ARDS (patients who received 6ĝ€"10 units: adjusted odds ratio 2.5, 95% CI 1.12ĝ€"5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1ĝ€"6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06; 95% CI 1.03ĝ€"1.10). CONCLUSIONS: Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even 1 unit may be warranted to reduce the risk of ARDS in injured patients.

UR - http://www.scopus.com/inward/record.url?scp=61549123681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=61549123681&partnerID=8YFLogxK

U2 - 10.1097/ALN.0b013e3181948a97

DO - 10.1097/ALN.0b013e3181948a97

M3 - Article

VL - 110

SP - 351

EP - 360

JO - Anesthesiology

JF - Anesthesiology

SN - 0003-3022

IS - 2

ER -