Transfusion-related acute lung injury in patients with burns.
Transfusion-related acute lung injury (TRALI) has not been systematically described in patients with burn injury, and the characterization of TRALI in patients with pre-existing acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) also is lacking. Our aim was to identify TRALI in burn patients and to attempt to characterize transfusion (TXN)-related pulmonary deterioration in burn patients with pre-existing ALI or ARDS. We undertook a retrospective review of mechanically ventilated and transfused burn patients at an adult regional burn center between January 1, 2003, and January 5, 2005. A blinded intensivist independently rated pre- and post-TXN chest radiographs (CXRs). There were 25 patients (age 51 +/- 19 years, %TBSA burns 30 +/- 19, full thickness %BSA 17 +/- 19, with a 24% incidence of smoke inhalation) who received 124 TXNs. New ALI developed within 6 hours after four TXNs. In one TXN, there were no other precipitating causes (eg, infection, inhalation injury), suggesting possible TRALI (incidence 0.8%). Existing ALI or ARDS was present before 63 (51%) of the TXNs. Definite worsening of the CXR and deterioration in the PaO2/FiO2 ratio (18% +/- 4%) within 6 hours of TXN occurred after six transfusions. In two of the TXNs, there were no other precipitating causes, suggesting possible TXN-related pulmonary deterioration (incidence 3.2%). Vigilance must be maintained for TRALI in burn patients. For patients with existing ALI or ARDS, we suggest that worsening of the CXR and reduction in the PaO2/FiO2 ratio by 20% or more within 6 hours of transfusion should be investigated for possible TRALI with appropriate donor investigations.
Higgins
Sally
S
Ross Tilley Burn Centre, Sunnybrook and Women's College Health Sciences Centre, Toronto, Canada.
Fowler
Robert
R
Callum
Jeannie
J
Cartotto
Robert
R
D000328:Adult; D002056:Burns / Q000628:therapy*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D011659:Pulmonary Gas Exchange; D011859:Radiography; D012121:Respiration, Artificial; D012128:Respiratory Distress Syndrome / Q000000981:diagnostic imaging / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D065227:Transfusion Reaction
D010100:Oxygen