Transfusions result in pulmonary morbidity and death after a moderate degree of injury
Transfusions result in pulmonary morbidity and death after a moderate degree of injury
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DOI：
10.1097/01.ta.0000171459.21450.dc
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发表时间：
2005-07-01
影响因子：
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通讯作者：
Fabian, TC
中科院分区：
文献类型：
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作者：
Croce, MA;Tolley, EA;Fabian, TC
背景：先前的研究表明，输血（Tx）与创伤患者的感染和呼吸系统并发症有关。然而，这些研究难以解释，因为样本量小，纳入了创伤性休克中的严重受伤患者，以及各种不相关的低发病率/死亡率感染的组合，如伤口、导管相关和尿路感染作为结局。为了消除这些混杂变量，本研究评估了延迟Tx与严重，明确的呼吸系统并发症（呼吸机相关性肺炎[VAP]和急性呼吸窘迫综合征[ARDS]）和重症监护病房（ICU）入院队列中的死亡，（损伤严重度评分[ISS] < 25）入院后最初48小时内未接受Tx的钝性创伤。钝性损伤和ISS < 25的患者在7年的时间内入住ICU，从登记处确定，如果在入院后48小时内接受任何Tx或死亡，则排除。VAP需要定量支气管肺泡灌洗培养（>= 10（5）菌落/mL），ARDS需要Pao（2）/FIO 2比值< 200 mm Hg，0400无充血性心力衰竭，弥漫性双侧浸润，气道峰压> 50 cm H2O才能诊断。结果：9126例钝性损伤进入ICU，5,260例（58%）符合研究标准（72%为男性）。年龄、ISS和格拉斯哥昏迷量表评分的平均值分别为39、12和14。有778例（15%）接受了延迟治疗。VAP、ARDS和死亡的发生率分别为5%、1%和1%。Logistic回归分析确定年龄，碱过剩，胸部简明损伤量表评分，ISS，和任何输血为VAP的显着预测因子;胸部简明损伤量表评分和输血为ARDS的显着预测因子;和年龄和输血为death.Conclusion的显着预测因子：延迟输血是独立相关的VAP，ARDS和创伤患者的死亡，无论损伤的严重程度。这些数据要求在复苏后采取明智的输血政策，并强调需要安全有效的血液替代品和输血替代品。
Background:Prior studies have suggested that blood transfusion (Tx) is associated with infectious and respiratory complications in trauma patients. However, these studies are difficult to interpret because of small sample size, inclusion of severely injured patients in traumatic shock, and combination of a variety of unrelated low-morbidity/mortality infections, such as wound, catheter-related, and urinary tract infection as outcomes. To eliminate these confounding variables, this study evaluates the association between delayed Tx and serious, well-defined respiratory complications (ventilator-associated pneumonia [VAP] and acute respiratory distress syndrome [ARDS]) and death in a cohort of intensive care unit (ICU) admissions with less severe (Injury Severity Score [ISS] < 25) blunt trauma who received no Tx within the initial 48 hours after admission.Methods: Patients with blunt injury and ISS < 25 admitted to the ICU over a 7-year period were identified from the registry and excluded if within 48 hours from admission they received any Tx or if they died. VAP required quantitative bronchoalveolar lavage culture (,>= 10(5) colonies/mL), and ARDS required Pao(2)/FIO2 ratio < 200 mm Hg, 0400 no congestive heart failure, diffuse bilateral infiltrates, and peak airway pressure > 50 cm H2O for diagnosis. Outcomes were VAP, ARDS, and death.Results:Nine thousand one hundred twenty-six with blunt injury were ICU admissions, and 5,260 (58%) met study criteria (72% male). Means for age, ISS, and Glasgow Coma Scale score were 39, 12, and 14, respectively. There were 778 (15%) who received delayed Tx. Incidences of VAP, ARDS, and death were 5%, 1%, and 1%, respectively. Logistic regression analysis identified age, base excess, chest Abbreviated Injury Scale score, ISS, and any transfusion as significant predictors for VAP; chest Abbreviated Injury Scale score and transfusion as significant predictors for ARDS; and age and transfusion as significant predictors for death.Conclusion: Delayed transfusion is independently associated with VAP, ARDS, and death in trauma patients regardless of injury severity. These data mandate a judicious transfusion policy after resuscitation and emphasize the need for safe and effective blood substitutes and transfusion alternatives.