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Pulmonary effects of red blood cell transfusion in critically ill, non‐bleeding patients
Author(s) -
Cornet A. D.,
Zwart E.,
Kingma S. D. K.,
Groeneveld A. B. Johan
Publication year - 2010
Publication title -
transfusion medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.471
H-Index - 59
eISSN - 1365-3148
pISSN - 0958-7578
DOI - 10.1111/j.1365-3148.2010.01000.x
Subject(s) - medicine , intensive care unit , critically ill , mechanical ventilation , anesthesia , oxygenation , blood transfusion , red blood cell transfusion , population , red blood cell , retrospective cohort study , intensive care medicine , surgery , environmental health
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.