Does plasma transfusion portend pulmonary dysfunction? A tale of two ratios

John P. Sharpe, Jordan A. Weinberg, Louis J. Magnotti, Timothy C. Fabian, Martin Croce

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: An unresolved concern regarding resuscitation in the setting of massive hemorrhage is potential lung injury from the transfusion of relatively more plasma-rich components. However, the association between plasma-to-packed red blood cell (PRBC) ratio and subsequent pulmonary dysfunction remains unclear. The purpose of this study was to evaluate the impact of plasma/PRBC on PaO2-to-FIO2 (P/F) ratio in the setting of massive transfusion (MT). METHODS: During a 5.5-year period, prospective datawere collected on trauma patientswho underwent MT, defined as 10 or more units of PRBC transfusion by completion of hemorrhage control. Deaths within 48 hours of arrival were excluded. Acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) were defined as P/F ratio of less than 300 and less than 200 at 48 hours, respectively. Stepwise multiple regression analysis was performed to determine variables significantly associated with P/F ratio. RESULTS: A total of 199 patients met inclusion criteria; 159 (80%) developed ALI, and 105 (53%) developed ARDS. ALI and ARDS were both associated with subsequent mortality: ARDS at 24% versus no ARDS at 10% ( p < 0.05) and ALI at 21% versus no ALI at 2.5% ( p < 0.05). Paradoxically, patients with P/F ratio of 300 or greater were found to have received more plasma (5.6 U vs. 4.3 U, p < 0.05) and higher plasma-to-PRBC ratio (1:2 vs. 1:3, p < 0.05) at completion of hemorrhage control. Stepwise multiple regression analysis, however, identified age ( p < 0.001) and chest Abbreviated Injury Scale (AIS) score ( p = 0.04), but not plasma/PRBC ( p = 0.10), to be independent determinants of P/F ratio at 48 hours. CONCLUSION: In this cohort ofMT patientswho survived beyond the first 48 hours, pulmonary dysfunction developed in the majority andwas associated with a 10-fold higher risk of subsequent death. However, plasma-to-RBC ratio achieved during hemorrhage control had neither a positive nor a negative impact on subsequent P/F ratio. In fact, only unalterable patient factors including age and severity of thoracic injury were associated with subsequent P/F ratio.

Original languageEnglish (US)
Pages (from-to)32-36
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1
DOIs
StatePublished - Jul 1 2013

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Acute Lung Injury
Adult Respiratory Distress Syndrome
Lung
Erythrocytes
Hemorrhage
Thoracic Injuries
Abbreviated Injury Scale
Regression Analysis
Erythrocyte Transfusion
Age Factors
Lung Injury
Resuscitation
Mortality
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Does plasma transfusion portend pulmonary dysfunction? A tale of two ratios. / Sharpe, John P.; Weinberg, Jordan A.; Magnotti, Louis J.; Fabian, Timothy C.; Croce, Martin.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1, 01.07.2013, p. 32-36.

Research output: Contribution to journalArticle

Sharpe, John P. ; Weinberg, Jordan A. ; Magnotti, Louis J. ; Fabian, Timothy C. ; Croce, Martin. / Does plasma transfusion portend pulmonary dysfunction? A tale of two ratios. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1. pp. 32-36.
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abstract = "BACKGROUND: An unresolved concern regarding resuscitation in the setting of massive hemorrhage is potential lung injury from the transfusion of relatively more plasma-rich components. However, the association between plasma-to-packed red blood cell (PRBC) ratio and subsequent pulmonary dysfunction remains unclear. The purpose of this study was to evaluate the impact of plasma/PRBC on PaO2-to-FIO2 (P/F) ratio in the setting of massive transfusion (MT). METHODS: During a 5.5-year period, prospective datawere collected on trauma patientswho underwent MT, defined as 10 or more units of PRBC transfusion by completion of hemorrhage control. Deaths within 48 hours of arrival were excluded. Acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) were defined as P/F ratio of less than 300 and less than 200 at 48 hours, respectively. Stepwise multiple regression analysis was performed to determine variables significantly associated with P/F ratio. RESULTS: A total of 199 patients met inclusion criteria; 159 (80{\%}) developed ALI, and 105 (53{\%}) developed ARDS. ALI and ARDS were both associated with subsequent mortality: ARDS at 24{\%} versus no ARDS at 10{\%} ( p < 0.05) and ALI at 21{\%} versus no ALI at 2.5{\%} ( p < 0.05). Paradoxically, patients with P/F ratio of 300 or greater were found to have received more plasma (5.6 U vs. 4.3 U, p < 0.05) and higher plasma-to-PRBC ratio (1:2 vs. 1:3, p < 0.05) at completion of hemorrhage control. Stepwise multiple regression analysis, however, identified age ( p < 0.001) and chest Abbreviated Injury Scale (AIS) score ( p = 0.04), but not plasma/PRBC ( p = 0.10), to be independent determinants of P/F ratio at 48 hours. CONCLUSION: In this cohort ofMT patientswho survived beyond the first 48 hours, pulmonary dysfunction developed in the majority andwas associated with a 10-fold higher risk of subsequent death. However, plasma-to-RBC ratio achieved during hemorrhage control had neither a positive nor a negative impact on subsequent P/F ratio. In fact, only unalterable patient factors including age and severity of thoracic injury were associated with subsequent P/F ratio.",
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AU - Sharpe, John P.

AU - Weinberg, Jordan A.

AU - Magnotti, Louis J.

AU - Fabian, Timothy C.

AU - Croce, Martin

PY - 2013/7/1

Y1 - 2013/7/1

N2 - BACKGROUND: An unresolved concern regarding resuscitation in the setting of massive hemorrhage is potential lung injury from the transfusion of relatively more plasma-rich components. However, the association between plasma-to-packed red blood cell (PRBC) ratio and subsequent pulmonary dysfunction remains unclear. The purpose of this study was to evaluate the impact of plasma/PRBC on PaO2-to-FIO2 (P/F) ratio in the setting of massive transfusion (MT). METHODS: During a 5.5-year period, prospective datawere collected on trauma patientswho underwent MT, defined as 10 or more units of PRBC transfusion by completion of hemorrhage control. Deaths within 48 hours of arrival were excluded. Acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) were defined as P/F ratio of less than 300 and less than 200 at 48 hours, respectively. Stepwise multiple regression analysis was performed to determine variables significantly associated with P/F ratio. RESULTS: A total of 199 patients met inclusion criteria; 159 (80%) developed ALI, and 105 (53%) developed ARDS. ALI and ARDS were both associated with subsequent mortality: ARDS at 24% versus no ARDS at 10% ( p < 0.05) and ALI at 21% versus no ALI at 2.5% ( p < 0.05). Paradoxically, patients with P/F ratio of 300 or greater were found to have received more plasma (5.6 U vs. 4.3 U, p < 0.05) and higher plasma-to-PRBC ratio (1:2 vs. 1:3, p < 0.05) at completion of hemorrhage control. Stepwise multiple regression analysis, however, identified age ( p < 0.001) and chest Abbreviated Injury Scale (AIS) score ( p = 0.04), but not plasma/PRBC ( p = 0.10), to be independent determinants of P/F ratio at 48 hours. CONCLUSION: In this cohort ofMT patientswho survived beyond the first 48 hours, pulmonary dysfunction developed in the majority andwas associated with a 10-fold higher risk of subsequent death. However, plasma-to-RBC ratio achieved during hemorrhage control had neither a positive nor a negative impact on subsequent P/F ratio. In fact, only unalterable patient factors including age and severity of thoracic injury were associated with subsequent P/F ratio.

AB - BACKGROUND: An unresolved concern regarding resuscitation in the setting of massive hemorrhage is potential lung injury from the transfusion of relatively more plasma-rich components. However, the association between plasma-to-packed red blood cell (PRBC) ratio and subsequent pulmonary dysfunction remains unclear. The purpose of this study was to evaluate the impact of plasma/PRBC on PaO2-to-FIO2 (P/F) ratio in the setting of massive transfusion (MT). METHODS: During a 5.5-year period, prospective datawere collected on trauma patientswho underwent MT, defined as 10 or more units of PRBC transfusion by completion of hemorrhage control. Deaths within 48 hours of arrival were excluded. Acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) were defined as P/F ratio of less than 300 and less than 200 at 48 hours, respectively. Stepwise multiple regression analysis was performed to determine variables significantly associated with P/F ratio. RESULTS: A total of 199 patients met inclusion criteria; 159 (80%) developed ALI, and 105 (53%) developed ARDS. ALI and ARDS were both associated with subsequent mortality: ARDS at 24% versus no ARDS at 10% ( p < 0.05) and ALI at 21% versus no ALI at 2.5% ( p < 0.05). Paradoxically, patients with P/F ratio of 300 or greater were found to have received more plasma (5.6 U vs. 4.3 U, p < 0.05) and higher plasma-to-PRBC ratio (1:2 vs. 1:3, p < 0.05) at completion of hemorrhage control. Stepwise multiple regression analysis, however, identified age ( p < 0.001) and chest Abbreviated Injury Scale (AIS) score ( p = 0.04), but not plasma/PRBC ( p = 0.10), to be independent determinants of P/F ratio at 48 hours. CONCLUSION: In this cohort ofMT patientswho survived beyond the first 48 hours, pulmonary dysfunction developed in the majority andwas associated with a 10-fold higher risk of subsequent death. However, plasma-to-RBC ratio achieved during hemorrhage control had neither a positive nor a negative impact on subsequent P/F ratio. In fact, only unalterable patient factors including age and severity of thoracic injury were associated with subsequent P/F ratio.

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