HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Colleen Koch Tomislav Mihaljevic Lars Svensson Eugene H. Blackstone Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Koch, C. Articles by Blackstone, E. H. Search for Related Content PubMed PubMed Citation Articles by Koch, C. Articles by Blackstone, E. H. Related Collections Cardiac - other

---

Original Articles: Adult Cardiac

Transfusion and Pulmonary Morbidity After Cardiac Surgery

^a Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, Ohio
^b Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
^c Department of Laboratory Medicine and Clinical Pathology, Cleveland Clinic, Cleveland, Ohio
^d Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio

Accepted for publication July 10, 2009.

^_* Address correspondence to Dr Koch, Department of Cardiothoracic Anesthesia, J4-245, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (Email: kochc{at}ccf.org).

Background: True lung injury is among the leading causes of transfusion-related mortality. Pulmonary morbidity after cardiac surgery has been related to damaging effects of cardiopulmonary bypass and transfusion, but is confounded by cardiac-related events that may not reflect true lung injury. Thus, cardiac surgery poses unique challenges to criteria-specific diagnosis of transfusion-related acute lung injury (TRALI). Our objective was to determine the prevalence of pulmonary morbidity related to transfusion and whether TRALI consensus-criteria are applicable to cardiac surgery.

Methods: A total of 16,847 patients underwent on-pump, coronary artery bypass grafting (CABG), valve, or CABG-valve surgery from September 1998 to February 1, 2006. We performed four propensity-score-matching analyses with logistic regression on probability of receiving a transfusion: total hospital red blood cell (RBC) and fresh frozen plasma (FFP) transfusion and intraoperative RBC and FFP transfusion. Outcomes included traditional cardiac-surgery-defined pulmonary morbidity and ratio of arterial partial pressure of oxygen to fractional inspired oxygen concentration (PaO ₂/FiO ₂), a criterion for TRALI.

Results: Patients receiving RBC transfusion had more risk-adjusted pulmonary complications: respiratory distress 4.8% vs 1.5%, p < 0.001; respiratory failure 2.2% vs 0.39%, p < 0.0001; longer intubation times, 9.9 hours vs 7.5 hours, p < 0.0001; acute respiratory distress syndrome, 0.64% vs 0.21%, p = 0.015; and reintubation, 5.6% vs 1.3%, p < 0.0001. The FFP was similarly related to more pulmonary complications after surgery. By TRALI criteria, the majority manifested "lung injury" (PaO ₂/FiO ₂ ratio < 300) but unrelated to transfusion (65% vs 64%).

Conclusions: Transfusion is associated with many measures of postoperative pulmonary morbidity. Yet the PaO ₂/FiO ₂ ratio as important criterion of TRALI is unrelated to transfusion. Thus, due to the nature of cardiac surgery, application of consensus guided diagnosis of TRALI is problematic.

This article has been cited by other articles:

				R. S. Stephens, A. S. Shah, and G. J. R. Whitman Lung Injury and Acute Respiratory Distress Syndrome After Cardiac Surgery Ann. Thorac. Surg., March 1, 2013; 95(3): 1122 - 1129. [Abstract] [Full Text] [PDF]

				G. Loor, C. G. Koch, J. F. Sabik III, L. Li, and E. H. Blackstone Implications and management of anemia in cardiac surgery: Current state of knowledge J. Thorac. Cardiovasc. Surg., September 1, 2012; 144(3): 538 - 546. [Full Text] [PDF]

				G. Loor, L. Li, J. F. Sabik III, J. Rajeswaran, E. H. Blackstone, and C. G. Koch Nadir hematocrit during cardiopulmonary bypass: End-organ dysfunction and mortality J. Thorac. Cardiovasc. Surg., September 1, 2012; 144(3): 654 - 662.e4. [Abstract] [Full Text] [PDF]

				G. Paone, R. Brewer, P. F. Theurer, G. F. Bell, C. M. Cogan, R. L. Prager, and Michigan Society of Thoracic and Cardiovascular Su Preoperative predicted risk does not fully explain the association between red blood cell transfusion and mortality in coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., January 1, 2012; 143(1): 178 - 185. [Abstract] [Full Text] [PDF]

				A. Shander, M. Javidroozi, S. Ozawa, and G. M. T. Hare What is really dangerous: anaemia or transfusion? Br. J. Anaesth., December 1, 2011; 107(suppl_1): i41 - i59. [Abstract] [Full Text] [PDF]

				A. Alfirevic, M. Xu, D. Johnston, P. Figueroa, and C. G. Koch Transfusion Increases the Risk for Vasoplegia After Cardiac Operations Ann. Thorac. Surg., September 1, 2011; 92(3): 812 - 819. [Abstract] [Full Text] [PDF]

				A. Ballotta, H. Kandil, T. Generali, L. Menicanti, G. Pelissero, M. Ranucci, and Surgical and Clinical Outcome Research (SCORE) Gro Tracheostomy After Cardiac Operations: In-Hospital and Long-Term Survival Ann. Thorac. Surg., August 1, 2011; 92(2): 528 - 533. [Abstract] [Full Text] [PDF]

				S. A. Falk and A. T. Cheung Invited Commentary Ann. Thorac. Surg., August 1, 2011; 92(2): 533 - 534. [Full Text] [PDF]

				A. Vivacqua, C. G. Koch, A. M. Yousuf, E. R. Nowicki, P. L. Houghtaling, E. H. Blackstone, and J. F. Sabik III Morbidity of Bleeding After Cardiac Surgery: Is It Blood Transfusion, Reoperation for Bleeding, or Both? Ann. Thorac. Surg., June 1, 2011; 91(6): 1780 - 1790. [Abstract] [Full Text] [PDF]

				G. J. Fitzmaurice and H. D. Parissis Platelet Transfusion Associated With Acute Lung Injury After Coronary Artery Bypass Grafting Ann. Thorac. Surg., June 1, 2011; 91(6): 1977 - 1979. [Abstract] [Full Text] [PDF]

				A. P. J. Vlaar, J. J. Hofstra, R. M. Determann, D. P. Veelo, F. Paulus, W. Kulik, J. Korevaar, B. A. de Mol, M. M. W. Koopman, L. Porcelijn, et al. The incidence, risk factors, and outcome of transfusion-related acute lung injury in a cohort of cardiac surgery patients: a prospective nested case-control study Blood, April 21, 2011; 117(16): 4218 - 4225. [Abstract] [Full Text] [PDF]

				B. H. Shaz, S. R. Stowell, and C. D. Hillyer Transfusion-related acute lung injury: from bedside to bench and back Blood, February 3, 2011; 117(5): 1463 - 1471. [Abstract] [Full Text] [PDF]

				R. Hall and C. D. Mazer Review Article: Antiplatelet Drugs: A Review of Their Pharmacology and Management in the Perioperative Period Anesth. Analg., February 1, 2011; 112(2): 292 - 318. [Abstract] [Full Text] [PDF]

				D. M. Moskowitz, J. N. McCullough, A. Shander, J. J. Klein, C. A. Bodian, R. S. Goldweit, and M. A. Ergin The Impact of Blood Conservation on Outcomes in Cardiac Surgery: Is It Safe and Effective? Ann. Thorac. Surg., August 1, 2010; 90(2): 451 - 458. [Abstract] [Full Text] [PDF]