Effects of leukoreduced blood on acute lung injury after trauma: A randomized controlled trial
Effects of leukoreduced blood on acute lung injury after trauma: A randomized controlled trial
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DOI：
10.1097/ccm.0b013e318170a9ce
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发表时间：
2008-05-01
影响因子：
8.8
通讯作者：
Nathens, Avery B.
中科院分区：
文献类型：
--
作者：
Watkins, Timothy R.;Rubenfeld, Gordon D.;Nathens, Avery B.
目的：创伤后输血的需求与急性肺损伤的风险增加有关。残留的白细胞污染红细胞是这种综合征的潜在介质。本试验的目的是检验我们的假设，即预储存白细胞减少血液将降低创伤后肺损伤率。设计：双盲，随机，对照临床试验。设定：大学附属的一级创伤中心在金郡，西雅图，WA.患者：二百六十八受伤的患者，需要红细胞输血在24小时内injure.Interventions：预存储白细胞减少与标准同种异体bloodtransfusions.Measurements和主要结果：我们比较了急性肺损伤和急性呼吸窘迫综合征的发病率在早期（72小时）伤后的时间点。在一个子集中，我们比较了干预组之间的表面活性蛋白D和血管性血友病因子抗原的血浆水平。急性肺损伤（相对风险[RR] 1.06，95%置信区间[CI].69-1.640）和急性呼吸窘迫综合征（RR.96，95% CI 0.48-1.91）的发生率在损伤后早期干预组之间无统计学差异。同样，在损伤后晚期，未观察到去白细胞输血对急性肺损伤（RR. 88，95% CI. 54 - 1. 44）或急性呼吸窘迫综合征（RR. 95，95% CI. 58 - 1. 57）发生率的统计学显著影响。干预组间无呼吸机天数或其他呼吸机参数无显著差异。没有统计学显着影响leukoreduced血液表面活性蛋白-D或血管性血友病因子抗原的血浆水平被identified.Conclusions：预存储leukoreduction有没有影响的发病率或肺损伤的时间或血浆措施的全身肺泡和内皮炎症的创伤患者需要输血的人口。输血和肺损伤之间的关系不能用涉及输注白细胞存在的机械途径来解释。
Objective: The requirement for a blood transfusion after trauma is associated with an increased risk of acute lung injury. Residual leukocytes contaminating red cells are potential mediators of this syndrome. The goal of this trial was to test our hypothesis that prestorage leukoreduction of blood would reduce rates of posttraumatic lung injury.Design: Double blind, randomized, controlled clinical trial. Setting: University-affiliated level I trauma center in King County, Seattle, WA.Patients: Two hundred sixty-eight injured patients requiring red blood cell transfusion within 24 hrs of injury.Interventions: Prestorage leukoreduced vs. standard allogeneic blood transfusions.Measurements and Main Results: We compared the incidence of acute lung injury and acute respiratory distress syndrome at early (72 hrs) time points after injury. In a subset, we compared plasma levels of surfactant protein-D and von Willebrand factor antigen between intervention arms. Rates of acute lung injury (relative risk [RR] 1.06, 95% confidence interval [CI].69-1.640) and acute respiratory distress syndrome (RR.96, 95% Cl 0.48-1.91) were not statistically different between intervention arms early after injury. Similarly, no statistically significant effect of leukoreduced transfusion on rates of acute lung injury (RR.88, 95% CI.54-1.44) or acute respiratory distress syndrome (RR.95, 95% CI.58-1.57) was observed to occur late after injury. There was no significant difference in the number of ventilator-free days or in other ventilator parameters between intervention arms. No statistically significant effect of leukoreduced blood on plasma levels of surfactant protein-D or von Willebrand factor antigen was identified.Conclusions: Prestorage leukoreduction had no effect on the incidence or timing of lung injury or on plasma measures of systemic alveolar and endothelial inflammation in a population of trauma patients requiring transfusion. The relationship between transfusion and lung injury is not obviously explained by mechanistic pathways involving the presence of transfused leukocytes.