title: Remote ischemic preconditioning as prevention of transfusion-related acute lung injury.
abstract: Transfusion-related acute lung injury (TRALI) is a serious complication of transfusion medicine, considered now as the leading cause of transfusion-related mortality. It may occur in up to 1 in 5000 transfusions and carries an elevated morbidity and mortality. Clinically it presents as hypoxia and non-cardiogenic pulmonary edema, usually within 6h of transfusion. It consists of an immunological phenomenon involving the activation of neutrophils and endothelial injury, leading to capillary leak and pulmonary edema, mechanisms shared with lung ischemia-reperfusion (IR) injury. Brief and repetitive periods of ischemia in an organ or limb have been shown to protect against subsequent major IR injury in distant organs, a phenomenon called remote ischemic preconditioning (RIPC). Limb RIP has been shown to protect the lung against IR injury trough modulation of endothelial function as well as neutrophil activation and infiltration. The protective effects of RIPC on the lung have been confirmed in clinical trials of orthopedic and cardiothoracic surgery. RIPC is a safe, tolerable and cheap procedure. I propose that limb RIPC could be used as a preventive strategy against the development of TRALI.
authors.affiliation: Departamento de Medicina Interna, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos S/N, Monterrey, NL 64460, Mexico. Electronic address: crcamara83@hotmail.com.
authors.forename: Carlos R
authors.initials: CR
authors.lastname: Camara-Lemarroy
mesh_terms: D055371:Acute Lung Injury / Q000209:etiology / Q000503:physiopathology*; D005121:Extremities / Q000473:pathology; D006801:Humans; D007511:Ischemia / Q000503:physiopathology; D019194:Ischemic Preconditioning; D009504:Neutrophils / Q000378:metabolism; D011652:Pulmonary Circulation; D015427:Reperfusion Injury / Q000517:prevention & control; D013514:Surgical Procedures, Operative; D065227:Transfusion Reaction; D016896:Treatment Outcome