title: Transfusions result in pulmonary morbidity and death after a moderate degree of injury.
abstract: 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 (> or =10(5) colonies/mL), and ARDS required Pao2/Fio2 ratio < 200 mm Hg, *** 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38163, USA. mcroce@utmem.edu
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Tolley
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Claridge
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
mesh_terms: D000328:Adult; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007362:Intensive Care Units; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000209:etiology* / Q000401:mortality*; D012372:ROC Curve; D012128:Respiratory Distress Syndrome / Q000209:etiology* / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D065227:Transfusion Reaction; D012122:Ventilators, Mechanical / Q000009:adverse effects*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy*