Factors associated with acute lung injury in combat casualties receiving massive blood transfusions: a retrospective analysis.
OBJECTIVE
We sought to determine if use of warm fresh whole blood (WFWB), rather than blood component therapy, alters rates of acute lung injury (ALI) in patients with trauma.


METHODS
We retrospectively analyzed rates of ALI in patients undergoing massive blood transfusions while at a combat support hospital. Patients with ALI were compared with those not developing ALI with respect to demographics, trauma type, severity of illness, crystalloid volume given, and exposure to WFWB. Logistic regression was used to identify variables associated with ALI.


RESULTS
The cohort included 591 subjects (mean age, 28 ± 8.1 years; male, 96.7%). Acute lung injury occurred in 11.2%, and 34.4% received WFWB. After adjusting for the type of trauma, severity of illness, and volume of crystalloid administered, WFWB remained independently associated with ALI (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.00-1.13). Nearly two thirds of persons with ALI never received WFWB; factors associated with the use of WFWB were also examined. Severity of illness (AOR, 1.18; 95% CI, 1.02-1.35), crystalloid volume (AOR, 1.12; 95% CI, 1.06-1.18), recombinant factor VIIa use (AOR, 1.94; 95% CI, 1.06-3.57), and US citizenship (AOR, 3.06; 95% CI, 1.74-5.37) correlated with WFWB use.


CONCLUSIONS
Warm fresh whole blood may be associated with an increased risk of ALI, but this is confounded by increased injury and crystalloid use in patients receiving WFWB.
Pulmonary and Critical Care Department, Washington Hospital Center, Georgetown University Medical Center, Washington, DC 20010, USA. chee262@hotmail.com
Chee M
CM
Chan
Andrew F
AF
Shorr
Jeremy G
JG
Perkins
D055371:Acute Lung Injury / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000367:Age Factors; D001753:Blast Injuries / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D001803:Blood Transfusion / Q000379:methods*; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D012189:Retrospective Studies; D012737:Sex Factors; D065227:Transfusion Reaction; D015599:Trauma Severity Indices; D014481:United States