Leukoreduction is Associated with a Decreased Incidence of Late Onset Acute Respiratory Distress Syndrome after Injury

Transfusions are known to be associated with Acute Respiratory Distress Syndrome (ARDS). Transfusion of leukoreduced products may be associated with a decreased incidence of late posttraumatic ARDS (late ARDS). Data from ventilated and transfused trauma patients were analyzed. Key variables in the first 48 hours of admission were studied for their associations with late ARDS and examined for changes over the 6 year study period. Late ARDS developed in 244 of the 1488 patients studied (16.4%). The incidence in patients given nonleukoreduced (NLR) product was 30.4 per cent (75/247) versus 13.6 per cent (169/1241) for patients not exposed [2.77 (2.02–3.73), P < 0.001]. Exposure to NLR products (50.9% in 2000 vs 1.9% in 2005) and incidence of ARDS (26.3% in 2000 vs 6.3% in 2005) significantly decreased. Treatment variables independently associated with late ARDS were NLR product exposure, Total Parenteral Nutrition exposure, Peak Inspiratory Pressure ≥ 30 mm Hg, fluid balance ≥ 2 liters at 48 hours, and transfusion of ≥ 10 units of any product. NLR product exposure has an association with an increased incidence of late onset posttraumatic ARDS which is independent of large volume transfusions. Leukoreduction should be routinely included in an overall treatment strategy to furthermore mitigate this complication in critically ill trauma patients.

[1]  G. Bernard,et al.  Comparison of two fluid-management strategies in acute lung injury. , 2006, The New England journal of medicine.

[2]  R. Gamelli,et al.  Effect of blood transfusion on outcome after major burn injury: A multicenter study* , 2006, Critical care medicine.

[3]  P. Rhee,et al.  The decreasing incidence and mortality of acute respiratory distress syndrome after injury: a 5-year observational study. , 2005, The Journal of trauma.

[4]  G. Martin,et al.  The role of acute blood transfusion in the development of acute respiratory distress syndrome in patients with severe trauma. , 2005, The Journal of trauma.

[5]  T. Fabian,et al.  Transfusions result in pulmonary morbidity and death after a moderate degree of injury. , 2005, The Journal of trauma.

[6]  D. Christiani,et al.  Clinical predictors of and mortality in acute respiratory distress syndrome: Potential role of red cell transfusion* , 2005, Critical care medicine.

[7]  Ognjen Gajic,et al.  Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients , 2005, Intensive Care Medicine.

[8]  Edward Abraham,et al.  Transfusion-related acute lung injury: definition and review. , 2005, Critical care medicine.

[9]  A. Meyer,et al.  Blood transfusion is an independent predictor of increased mortality in nonoperatively managed blunt hepatic and splenic injuries. , 2005, The Journal of trauma.

[10]  R. S. Smith,et al.  The effect of obesity on outcomes among injured patients. , 2005, The Journal of trauma.

[11]  J. S. St. Sauver,et al.  Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation* , 2004, Critical care medicine.

[12]  R. Brand,et al.  Double-Blind, Randomized Controlled Trial on the Effect of Leukocyte-Depleted Erythrocyte Transfusions in Cardiac Valve Surgery , 2004, Circulation.

[13]  Rod S. Taylor,et al.  The effect of universal leukoreduction on postoperative infections and length of hospital stay in elective orthopedic and cardiac surgery , 2004, Transfusion.

[14]  M. Levy,et al.  The CRIT Study: Anemia and blood transfusion in the critically ill—Current clinical practice in the United States* , 2004, Critical care medicine.

[15]  E. Vamvakas,et al.  WBC‐containing allogeneic blood transfusion and mortality: a meta‐analysis of randomized controlled trials , 2003, Transfusion.

[16]  Thomas M Scalea,et al.  Blood transfusion, independent of shock severity, is associated with worse outcome in trauma. , 2003, The Journal of trauma.

[17]  D. Coyle,et al.  Clinical outcomes following institution of the Canadian universal leukoreduction program for red blood cell transfusions. , 2003, JAMA.

[18]  S. Assmann,et al.  A prospective, randomized clinical trial of universal WBC reduction , 2002, Transfusion.

[19]  N. Topley,et al.  Increased neutrophil migratory activity after major trauma: A factor in the etiology of acute respiratory distress syndrome? , 2002, Critical care medicine.

[20]  T. Scalea,et al.  Acute respiratory distress syndrome among trauma patients: trends in ICU mortality, risk factors, complications and resource utilization , 2001, Intensive Care Medicine.

[21]  W. Cioffi,et al.  A 9-Year, Single-Institution, Retrospective Review of Death Rate and Prognostic Factors in Adult Respiratory Distress Syndrome , 2001, Annals of surgery.

[22]  E. Vamvakas,et al.  Deleterious clinical effects of transfusion-associated immunomodulation: fact or fiction? , 2001, Blood.

[23]  E. Fernández-Mondéjar,et al.  Acute respiratory distress syndrome: resource use and outcomes in 1985 and 1995, trends in mortality and comorbidities. , 2000, Journal of critical care.

[24]  D. Schoenfeld,et al.  Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. , 2000, The New England journal of medicine.

[25]  K. Davis,et al.  Early and late acute respiratory distress syndrome: two distinct clinical entities. , 1999, The Journal of trauma.

[26]  G. Wells,et al.  A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. , 1999, The New England journal of medicine.

[27]  P. Walsh,et al.  Randomized trial comparing packed red cell blood transfusion with and without leukocyte depletion for gastrointestinal surgery. , 1998, American journal of surgery.

[28]  J. Hermans,et al.  Beneficial effects of leukocyte depletion of transfused blood on postoperative complications in patients undergoing cardiac surgery: a randomized clinical trial. , 1998, Circulation.

[29]  A. Paterson,et al.  The association of biologically active lipids with the development of transfusion‐related acute lung injury: a retrospective study , 1997, Transfusion.

[30]  M. Hokland,et al.  A randomized controlled study of the effect of bedside leucocyte depletion on the immunosuppressive effect of whole blood transfusion in patients undergoing elective colorectal surgery , 1996, The British journal of surgery.

[31]  M. Lamy,et al.  Report of the American-European Consensus conference on acute respiratory distress syndrome: definitions, mechanisms, relevant outcomes, and clinical trial coordination. Consensus Committee. , 1994, Journal of critical care.

[32]  M. Léon-Sanz.  Perioperative total parenteral nutrition in surgical patients. , 1992, The New England journal of medicine.

[33]  R. Barrow,et al.  Increased mortality with intravenous supplemental feeding in severely burned patients. , 1989, The Journal of burn care & rehabilitation.

[34]  M. Niederman,et al.  Pathophysiology of the adult respiratory distress syndrome. What have we learned from human studies? , 1986, Critical care clinics.

[35]  T L Petty,et al.  Acute respiratory distress in adults. , 1967, Lancet.

[36]  J. Marshall,et al.  ARDS and the multiple organ dysfunction syndrome. Common mechanisms of a common systemic process. , 2002, Critical care clinics.