根据最新指南，血浆包容性复苏与输血相关急性肺损伤无关。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research Pub Date : 2024-11-12 DOI:10.1016/j.jss.2024.08.011

Desiree N. Pinto MD, MPH , Caitlin Mehta BS , Edward J. Kelly MD , Shane K. Mathew MD , Bonnie C. Carney PhD , Melissa M. McLawhorn RN, BSN , Lauren T. Moffatt PhD , Taryn E. Travis MD , Jeffrey W. Shupp MD , Shawn Tejiram MD

{"title":"根据最新指南，血浆包容性复苏与输血相关急性肺损伤无关。","authors":"Desiree N. Pinto MD, MPH , Caitlin Mehta BS , Edward J. Kelly MD , Shane K. Mathew MD , Bonnie C. Carney PhD , Melissa M. McLawhorn RN, BSN , Lauren T. Moffatt PhD , Taryn E. Travis MD , Jeffrey W. Shupp MD , Shawn Tejiram MD","doi":"10.1016/j.jss.2024.08.011","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.</div></div><div><h3>Methods</h3><div>Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.</div></div><div><h3>Results</h3><div>Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (<em>n</em> = 39) compared to late PIR (<em>n</em> = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, <em>P</em> = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, <em>P</em> = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, <em>P</em> = 0.62).</div></div><div><h3>Conclusions</h3><div>In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 81-89"},"PeriodicalIF":1.8000,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Plasma Inclusive Resuscitation is Not Associated With Transfusion-Related Acute Lung Injury Under Updated Guidelines\",\"authors\":\"Desiree N. Pinto MD, MPH , Caitlin Mehta BS , Edward J. Kelly MD , Shane K. Mathew MD , Bonnie C. Carney PhD , Melissa M. McLawhorn RN, BSN , Lauren T. Moffatt PhD , Taryn E. Travis MD , Jeffrey W. Shupp MD , Shawn Tejiram MD\",\"doi\":\"10.1016/j.jss.2024.08.011\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.</div></div><div><h3>Methods</h3><div>Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.</div></div><div><h3>Results</h3><div>Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (<em>n</em> = 39) compared to late PIR (<em>n</em> = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, <em>P</em> = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, <em>P</em> = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, <em>P</em> = 0.62).</div></div><div><h3>Conclusions</h3><div>In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.</div></div>\",\"PeriodicalId\":17030,\"journal\":{\"name\":\"Journal of Surgical Research\",\"volume\":\"304 \",\"pages\":\"Pages 81-89\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2024-11-12\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Surgical Research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0022480424005213\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Surgical Research","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0022480424005213","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

摘要

简介：血浆包容性复苏（PIR）使用新鲜冰冻血浆作为晶体液的辅助手段来治疗烧伤休克，与其他胶体相比具有潜在的优势。然而，输血相关急性肺损伤（TRALI）的安全性问题依然存在。本研究的目的是根据最新的加拿大血液服务共识定义，评估严重烧伤患者队列中 TRALI 与 PIR 之间的关联：对2018年至2022年期间在烧伤中心需要PIR的烧伤患者进行了回顾性研究。为了评估 TRALI，记录了与急性低氧血症、双侧肺水肿、左心房高压以及 PIR 后 6 小时内呼吸状态变化相关的数据。为了确定与 PIR 时间相关的其他风险和益处，对早期（0-8 h）和晚期（8-24 h）启动 PIR 的复苏量和结果进行了比较：结果：在纳入研究的 88 名患者中，根据最新定义，没有患者出现 TRALI I 型或 II 型。早期 PIR（39 人）与晚期 PIR（49 人）相比，总体表面积百分比（TBSA，36.3%，26.0%，P = 0.01）更高。早期 PIR 的预测 24 小时血容量更高（10.1 升，6.3 升，P = 0.049），但观察到的 24 小时血容量（cc/kg/%TBSA）并无显著差异（5.2，5.3，P = 0.62）：结论：在一组接受 PIR 的严重烧伤患者中，根据最新的加拿大血液服务共识定义，没有患者出现 TRALI I 型或 II 型。尽管总烧伤面积（TBSA）较高，但较早使用 PIR 与较高的复苏量无关。为了更好地确定与 PIR 相关的潜在风险和益处，有必要开展进一步的研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Plasma Inclusive Resuscitation is Not Associated With Transfusion-Related Acute Lung Injury Under Updated Guidelines

Introduction

Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.

Methods

Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.

Results

Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (n = 39) compared to late PIR (n = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, P = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, P = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, P = 0.62).

Conclusions

In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Surgical Research 医学-外科

CiteScore

3.90

自引率

4.50%

发文量

627

审稿时长

138 days

期刊介绍： The Journal of Surgical Research: Clinical and Laboratory Investigation publishes original articles concerned with clinical and laboratory investigations relevant to surgical practice and teaching. The journal emphasizes reports of clinical investigations or fundamental research bearing directly on surgical management that will be of general interest to a broad range of surgeons and surgical researchers. The articles presented need not have been the products of surgeons or of surgical laboratories. The Journal of Surgical Research also features review articles and special articles relating to educational, research, or social issues of interest to the academic surgical community.