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Review
. 2020 Dec;46(12):2450-2457.
doi: 10.1007/s00134-020-06303-z. Epub 2020 Nov 12.

Transfusion in the mechanically ventilated patient

Nicole P Juffermans  1   2 , Cécile Aubron  3 , Jacques Duranteau  4 , Alexander P J Vlaar  1   5 , Daryl J Kor  6 , Jennifer A Muszynski  7 , Philip C Spinella  8 , Jean-Louis Vincent  9
Affiliations
Review

Transfusion in the mechanically ventilated patient

Nicole P Juffermans et al. Intensive Care Med. 2020 Dec.

Abstract

Red blood cell transfusions are a frequent intervention in critically ill patients, including in those who are receiving mechanical ventilation. Both these interventions can impact negatively on lung function with risks of transfusion-related acute lung injury (TRALI) and other forms of acute respiratory distress syndrome (ARDS). The interactions between transfusion, mechanical ventilation, TRALI and ARDS are complex and other patient-related (e.g., presence of sepsis or shock, disease severity, and hypervolemia) or blood product-related (e.g., presence of antibodies or biologically active mediators) factors also play a role. We propose several strategies targeted at these factors that may help limit the risks of associated lung injury in critically ill patients being considered for transfusion.

Keywords: Acute respiratory distress syndrome; Anemia; Hypervolemia; Inflammatory response; Oxygen delivery; Transfusion-associated circulatory overload; Transfusion-related acute lung injury.

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Conflict of interest statement

NPJ receives research support from CSL Behring and Octapharma. CA has no conflicts of interest to declare. JD has no conflicts of interest to declare. APJV has no conflicts of interest to declare. DK received RO1 funding to study TRALI/TACO from the National Institutes of Health; is a consultant for the REDS-IV-P study network for the National Institutes of Health; is on the Advisory Committee for Blood and Tissue Safety and Availability for the Department of Health and Human Services; is on the Scientific Advisory Board for Terumo BCT; and wrote the chapter on TRALI for UpToDate. JAM has no conflicts of interest to declare. PCS is a consultant for Hemanext, Entegrion, Secure Transfusion Services. JLV has no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Some suggested methods to limit the risks of lung injury associated with transfusion, based on pathophysiological concepts
See this image and copyright information in PMC

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