Abstract：
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.
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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：输血相关性急性肺损伤（TRALI）是血浆输注的严重并发症，尽管使用溶剂/洗涤剂混合血浆（SDP）几乎消除了报告的TRALI病例。这项研究的目的是调查用SDP替换隔离的新鲜冷冻血浆（qFFP）后重症监护病房（ICU）中TRALI的发生率。
方法：在两个6个月期间进行了一项回顾性多中心观察前后队列研究，在引入SDP之前（2014年4月至10月）和之后（2015年4月至10月），计入冲刷期。对接受≥1个血浆单位并在24小时内出现低氧血症的患者进行了完整的图表审查。
结果：在研究期间，8944例患者入住ICU。在376名患者中输入了1171个检疫新鲜冷冻血浆（qFFP）单位，和分别，2008年SDP单元对396例患者实施后。在qFFP期间发生了10例TRALI病例，在SDP期间发生了9例。其中血浆被输血。每单位qFFP发病率为0.85%(CI95%:0.33%-1.4%)和0.45%(CI95%:0.21%-0.79%,p=0.221)每个SDP单元。TRALI的一个实例发生在单个SDP单元之后。ICU中发生TRALI的患者的死亡率为70％，而接受至少一次血浆输注的患者的死亡率为22％。
结论：实施SDP降低了涉及血浆产品的TRALI的发生率，虽然不是很重要。临床诊断的TRALI仍然可以在SDP输血后发生。在ICU中发展TRALI与高死亡率相关，因此,临床医生应该保持警惕.
方法：在两个6个月期间进行了一项回顾性多中心观察前后队列研究，在引入SDP之前（2014年4月至10月）和之后（2015年4月至10月），计入冲刷期。对接受≥1个血浆单位并在24小时内出现低氧血症的患者进行了完整的图表审查。
结果：在研究期间，8944例患者入住ICU。在376名患者中输入了1171个检疫新鲜冷冻血浆（qFFP）单位，和分别，2008年SDP单元对396例患者实施后。在qFFP期间发生了10例TRALI病例，在SDP期间发生了9例。其中血浆被输血。每单位qFFP发病率为0.85%(CI95%:0.33%-1.4%)和0.45%(CI95%:0.21%-0.79%,p=0.221)每个SDP单元。TRALI的一个实例发生在单个SDP单元之后。ICU中发生TRALI的患者的死亡率为70％，而接受至少一次血浆输注的患者的死亡率为22％。
结论：实施SDP降低了涉及血浆产品的TRALI的发生率，虽然不是很重要。临床诊断的TRALI仍然可以在SDP输血后发生。在ICU中发展TRALI与高死亡率相关，因此,临床医生应该保持警惕.
