RBC transfusion is associated with increased risk of respiratory failure after pneumonectomy.
OBJECTIVE
Pneumonectomy is associated with high risk of respiratory complications. Our objective was to determine if transfusions are associated with increased rate of ARDS and respiratory failure in adults undergoing elective pneumonectomy.


METHODS
Retrospective cohort study of consecutive pneumonectomies undertaken at a tertiary hospital (2003-2013). Multivariable logistic regression was performed to adjust for confounding factors.


RESULTS
ARDS and respiratory failure occurred in 12.4% (n = 20) and 19.2% (n = 31) of 161 pneumonectomy patients, respectively, and were more likely to occur in transfused patients (P = 0.03, P < 0.001). pRBCs, FFP and platelets were transfused in 27% (n = 43), 6% (n = 9), and 2% (n = 3), respectively. On multivariable analyses utilizing blood products as continuous and binary variables, pRBC use was the only independent predictor of ARDS with odds ratio (OR) = 1.23 (95%CI:1.08-1.39, P = 0.002) and OR = 2.45 (95%CI:1.10-5.49, P = 0.03), respectively. On multivariable analyses utilizing blood products as continuous and binary variables, pRBCs were the only independent predictor of respiratory failure with OR = 1.37 (95%CI:1.16-1.60, P < 0.001) and OR = 3.17 (95%CI:1.25-8.02, P = 0.02), respectively.


CONCLUSIONS
Peri-operative pRBC use appears to be an independent risk factor for ARDS and respiratory failure after pneumonectomy. There is a significant dose-response relationship. Platelets and FFP did not appear to increase ARDS risk but this may be due to low utilization.
Division of General Surgery, Department of Surgery, Western University, London, Canada.|Division of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada.|University of Manitoba, Winnipeg, Canada.
Biniam
B
Kidane
Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.
Madelaine
M
Plourde
Division of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada.|University of Manitoba, Winnipeg, Canada.
Larissa
L
Leydier
Division of General Surgery, Department of Surgery, Western University, London, Canada.
Sami A
SA
Chadi
London Health Sciences Centre, London, Canada.
Kathleen
K
Eckert
Division of Thoracic Surgery, Department of Surgery, Health Sciences Centre, Winnipeg, Canada.|University of Manitoba, Winnipeg, Canada.
Sadeesh
S
Srinathan
Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.|London Health Sciences Centre, London, Canada.|Division of Critical Care Medicine, Western University, London, Canada.
Dalilah
D
Fortin
Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.|London Health Sciences Centre, London, Canada.
Eric
E
Frechette
Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.|London Health Sciences Centre, London, Canada.
Richard I
RI
Inculet
Division of Thoracic Surgery, Department of Surgery, Western University, London, Canada.|London Health Sciences Centre, London, Canada.
Richard A
RA
Malthaner
D000368:Aged; D015331:Cohort Studies; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011013:Pneumonectomy / Q000009:adverse effects*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies
acute respiratory distress syndrome; perioperative care; pneumonectomy