title: Leukoreduction is associated with a decreased incidence of late onset acute respiratory distress syndrome after injury.
abstract: Transfusions are known to be associated with Acute Respiratory Distress Syndrome (ARDS). Transfusion of leukoreduced products may be associated with a decreased incidence of late posttraumatic ARDS (late ARDS). Data from ventilated and transfused trauma patients were analyzed. Key variables in the first 48 hours of admission were studied for their associations with late ARDS and examined for changes over the 6 year study period. Late ARDS developed in 244 of the 1488 patients studied (16.4%). The incidence in patients given nonleukoreduced (NLR) product was 30.4 per cent (75/247) versus 13.6 per cent (169/1241) for patients not exposed [2.77 (2.02-3.73), P < 0.001]. Exposure to NLR products (50.9% in 2000 vs. 1.9% in 2005) and incidence of ARDS (26.3% in 2000 vs. 6.3% in 2005) significantly decreased. Treatment variables independently associated with late ARDS were NLR product exposure, Total Parenteral Nutrition exposure, Peak Inspiratory Pressure > or =30 mm Hg, fluid balance > or =2 liters at 48 hours, and transfusion of > or =10 units of any product. NLR product exposure has an association with an increased incidence of late onset posttraumatic ARDS which is independent of large volume transfusions. Leukoreduction should be routinely included in an overall treatment strategy to furthermore mitigate this complication in critically ill trauma patients.
authors.affiliation: Department of Surgery, Division of Trauma/Surgical Critical Care, Los Angeles County and the University of Southern California Medical Center, Los Angeles, California 90033, USA. pluradd@lha5.navy.mil
authors.forename: David
authors.initials: D
authors.lastname: Plurad
authors.forename: Howard
authors.initials: H
authors.lastname: Belzberg
authors.forename: Ira
authors.initials: I
authors.lastname: Schulman
authors.forename: Donald
authors.initials: D
authors.lastname: Green
authors.forename: Ali
authors.initials: A
authors.lastname: Salim
authors.forename: Kenji
authors.initials: K
authors.lastname: Inaba
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
authors.forename: Demetrios
authors.initials: D
authors.lastname: Demetriades
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D047589:Leukocyte Reduction Procedures; D008297:Male; D012128:Respiratory Distress Syndrome / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications*