Pulmonary effects of red blood cell transfusion in critically ill, non-bleeding patients.
The aim of the study is to evaluate the effects of red blood cell (RBC) transfusions on pulmonary parameters in critically ill, non-bleeding patients. Retrospective chart analysis was performed on critically ill patients without overt bleeding in the intensive care unit (ICU) of a university hospital. In 83 patients in a 5-month period, who had received at least 1 RBC unit and stayed at least 24 h in the ICU, 199 transfusions of median 2 RBCs per transfusion (n = 504) were studied. Pulmonary parameters were retrieved during the period between 24 h before the start of transfusion and 24-48 h after transfusion. Outcome was assessed. The P(a)O(2)/F(I)O(2) dose-dependently decreased from 250 +/- 105 at baseline to 240 +/- 102 mmHg at 24 h after RBC transfusion (P = 0.003), irrespective of acute lung injury at baseline and RBC storage time. The lung injury score (LIS) also increased dose-dependently, whereas, at 48 h, oxygenation and LIS largely returned to baseline. For every seven RBCs transfused, the LIS transiently increased by 1 unit. There were no changes in haemodynamics, lung mechanics or chest radiography. The total number of RBCs given in the ICU did not directly contribute to ICU and 1-year mortality prediction. Transfusion of RBCs decreases oxygenation thereby increasing the LIS, dose-dependently and transiently, in a heterogeneous population of critically ill, non-bleeding patients, independent of prior cardiorespiratory status and RBC storage time. The effects are subtle, may go unseen and unreported and may represent subclinical transfusion-related acute lung injury. They do not adversely affect outcome, even at 1-year follow-up.
Department of Intensive Care and Institute for Cardiovascular Research, Vrije Universiteit Medical Center, 1081 HV Amsterdam, The Netherlands.
A D
AD
Cornet
E
E
Zwart
S D K
SD
Kingma
A B Johan
AB
Groeneveld
D055371:Acute Lung Injury / Q000209:etiology / Q000503:physiopathology; D000368:Aged; D001810:Blood Volume; D003422:Critical Care; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology; D007902:Length of Stay / Q000706:statistics & numerical data; D047589:Leukocyte Reduction Procedures; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D012121:Respiration, Artificial; D012143:Respiratory Physiological Phenomena; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016037:Single-Blind Method