title: Incidence, risk factors, and outcome of transfusion-related acute lung injury in critically ill children: a retrospective study.
abstract: OBJECTIVE
  Acute lung injury (ALI) that develops within 6 hours after transfusion (TRALI) is the leading cause of transfusion-related morbidity and mortality. Both incidence and patient and transfusion-related risk factors are well studied in the adult critically ill patient population. Clinical data on TRALI in the pediatric population are sparse and are mainly limited to case reports and hemovigilance reporting systems. The objective of this study was to determine incidence, risk factors, and outcome of TRALI in critically ill children.
  
  
  METHODS
  In a retrospective cohort study, all first-time admissions to the pediatric intensive care unit from January 1, 2009, until December 31, 2012, were screened for onset of TRALI using the consensus criteria.
  
  
  RESULTS
  Of 2294 admitted patients, 304 were transfused, of whom 21 (6.9%) developed TRALI. Compared with transfused control subjects, risk factors for TRALI were mechanical ventilation (odds ratio, 18.94 [2.38-2452.56]), sepsis (odds ratio, 7.20 [2.69-19.69]), and high Pediatric Risk of Mortality III score (odds ratio, 1.05 [1.01-1.10]). Patients with TRALI had a higher mortality and a longer duration of mechanical ventilation when compared with transfused control subjects.
  
  
  CONCLUSIONS
  Transfusion-related ALI is relatively common in critically ill children. The incidence in the pediatric intensive care unit population is similar to that in adult intensive care unit patients. High PRISM score on admission, mechanical ventilation and sepsis were identified as independent risk factors, which may help to assess the risks and benefits of transfusion in critically ill patients.
authors.affiliation: Department of Pediatric Intensive Care, Emma Children's Hospital/Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Hilde D
authors.initials: HD
authors.lastname: Mulder
authors.affiliation: Department of Pediatric Intensive Care, Emma Children's Hospital/Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Quinten J J
authors.initials: QJ
authors.lastname: Augustijn
authors.affiliation: Department of Pediatric Intensive Care, Emma Children's Hospital/Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Job B
authors.initials: JB
authors.lastname: van Woensel
authors.affiliation: Department of Pediatric Intensive Care, Emma Children's Hospital/Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Albert P
authors.initials: AP
authors.lastname: Bos
authors.affiliation: Department of Intensive Care, Academic Medical Centre, Amsterdam, the Netherlands.
authors.forename: Nicole P
authors.initials: NP
authors.lastname: Juffermans
authors.affiliation: Department of Pediatric Intensive Care, Emma Children's Hospital/Academic Medical Centre, Amsterdam, the Netherlands. Electronic address: r.m.vansperen@amc.uva.nl.
authors.forename: Roelie M
authors.initials: RM
authors.lastname: Wösten-van Asperen
mesh_terms: D055371:Acute Lung Injury / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D010949:Plasma; D017713:Platelet Transfusion / Q000009:adverse effects*; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000209:etiology; D013997:Time Factors; D065227:Transfusion Reaction
keywords: Blood products; Critically ill; Intensive care; Lung injury; Pediatric; Transfusions