Early Packed Red Blood Cell Transfusion and Acute Respiratory Distress Syndrome after Trauma
Early Packed Red Blood Cell Transfusion and Acute Respiratory Distress Syndrome after Trauma
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DOI：
10.1097/aln.0b013e3181948a97
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发表时间：
2009-02-01
期刊：
影响因子：
8.8
通讯作者：
Rivara, Frederick P.
中科院分区：
文献类型：
--
作者：
Chaiwat, Onuma;Lang, John D.;Rivara, Frederick P.
背景：填充红细胞（红细胞）输血是创伤患者急性呼吸窘迫综合征（ARDS）的一个危险因素。然而，关于红细胞暴露增加的ARDS风险的信息缺乏。方法：回顾性分析纳入了国家创伤成本和结局研究中符合条件的患者。我们的主要暴露被定义为入院后24小时内输血的红细胞单位。主要结局为ARDS。结果：14070例患者中有521例（4.6%）发生ARDS。发生ARDS的331例（63.5%）患者接受了红细胞输血。损伤严重程度、胸部损伤、多发创伤和肺炎（新鲜冷冻血浆≥5单位、红细胞≥6-10单位）是ARDS的独立预测因素。接受5个单位以上红细胞治疗的患者发生ARDS的风险较高（接受6-10个单位的患者：校正优势比为2.5,95% CI为1.12-5.3；接受10个单位以上的患者：优势比为2.6,95% CI为1.1-6.4）。输血每增加一个单位的红细胞，发生ARDS的风险增加6%（校正优势比1.06 95% CI 1.03-1.10）。结论：早期输血红细胞是成人创伤患者ARDS的独立预测因子。保守的输血策略可以减少即使是1单位的PRBC暴露，以降低受伤患者发生ARDS的风险。
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 It 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 that 5 units of fresh frozen plasma and 6-10 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 6-10 units: adjusted odds ratio 2.5, 95% CI 1.12-5.3; patients who received more than 10 units: odds ratio 2.6, 95% CI 1.1-6.4). Each additional unit of PRBCs transfused conferred a 6% higher risk of ARDS (adjusted odds ratio 1.06 95% CI 1.03-1.10).Conclusions: Early transfusion of PRBCs is an independent predictor of ARDS in adult trauma patients. Conservative transfusion strategies that decrease PRBC exposure by even I unit may he warranted to reduce the risk of ARDS in injured patients.