Incidence of transfusion-related acute lung injury temporally associated with solvent/detergent plasma use in the ICU: A retrospective before and after implementation study.

Autor: Klanderman RB; Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.; Department of Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands., van Mourik N; Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands., Eggermont D; Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands., Peters AL; Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands., Tuinman PR; Department of Intensive Care, Amsterdam University Medical Centers - VUmc, Amsterdam, The Netherlands., Bosman R; Department of Intensive Care, Onze Lieve Vrouwe Gasthuis - Locatie Oost, Amsterdam, The Netherlands., Endeman H; Department of Intensive Care, Onze Lieve Vrouwe Gasthuis - Locatie Oost, Amsterdam, The Netherlands., Cremer OL; Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands., Arbous SM; Department of Intensive Care, Leiden University Medical Center, Leiden, The Netherlands., Vlaar APJ; Department of Intensive Care, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.; Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers - AMC, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2022 Sep; Vol. 62 (9), pp. 1752-1762. Date of Electronic Publication: 2022 Aug 02.
DOI: 10.1111/trf.17049
Abstrakt: Background: Transfusion-related acute lung injury (TRALI) is a severe complication of plasma transfusion, though the use of solvent/detergent pooled plasma (SDP) has nearly eliminated reported TRALI cases. The goal of this study was to investigate the incidence of TRALI in intensive care units (ICU) following the replacement of quarantined fresh frozen plasma (qFFP) by SDP.
Study Design and Methods: A retrospective multicenter observational before-after cohort study was performed during two 6-month periods, before (April-October 2014) and after the introduction of SDP (April-October 2015), accounting for a washout period. A full chart review was performed for patients who received ≥1 plasma units and developed hypoxemia within 24 h.
Results: During the study period, 8944 patients were admitted to the ICU. Exactly 1171 quarantine fresh frozen plasma (qFFP) units were transfused in 376 patients, and respectively, 2008 SDP units to 396 patients after implementation. Ten TRALI cases occurred during the qFFP and nine cases occurred during the SDP period, in which plasma was transfused. The incidence was 0.85% (CI95%: 0.33%-1.4%) per unit qFFP and 0.45% (CI95%: 0.21%-0.79%, p = 0.221) per SDP unit. One instance of TRALI occurred after a single SDP unit. Mortality was 70% for patients developing TRALI in the ICU compared with 22% in patients receiving at least one plasma transfusion.
Conclusion: Implementation of SDP lowered the incidence of TRALI in which plasma products were implicated, though not significantly. Clinically diagnosed TRALI can still occur following SDP transfusion. Developing TRALI in the ICU was associated with high mortality rates, therefore, clinicians should remain vigilant.
(© 2022 The Authors. Transfusion published by Wiley Periodicals LLC on behalf of AABB.)
Databáze: MEDLINE
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