Transfusion related acute lung injury (TRALI) caused by red blood cell transfusion involving residual plasma anti-HLA antibodies: a report on two cases and general considerations.
(1/1061)
TRALI is considered a serious hazard among immune complications of blood transfusion and its occurrence is admitted to be globally underestimated. Each type of blood product is likely to cause TRALI. We report here on two consecutive observations of TRALI caused by red blood cell concentrates, in which anti-HLA class I and class II antibodies resulting from post-gravitational allo-immunization were evidenced in donors. HLA class I and II antigenic community between recipients and donors' husbands were found and strong reacting IgG antibodies directed at several of those common antigens were detected in the donors' serum. Both donors had more than 3 pregnancies, raising the issue of blood donor selection or of plasma reduction for cellular products. (+info)
Mechanisms of pulmonary dysfunction after on-pump and off-pump cardiac surgery: a prospective cohort study.
(2/1061)
BACKGROUND: Pulmonary dysfunction following cardiac surgery is believed to be caused, at least in part, by a lung vascular injury and/or atelectasis following cardiopulmonary bypass (CPB) perfusion and collapse of non-ventilated lungs. METHODS: To test this hypothesis, we studied the postoperative pulmonary leak index (PLI) for 67Ga-transferrin and (transpulmonary) extravascular lung water (EVLW) in consecutive patients undergoing on-pump (n = 31) and off-pump (n = 8) cardiac surgery. We also studied transfusion history, radiographs, ventilatory and gas exchange variables. RESULTS: The postoperative PLI and EVLW were elevated above normal in 42 and 29% after on-pump surgery and 63 and 37% after off-pump surgery, respectively (ns). Transfusion of red blood cell (RBC) concentrates, PLI, EVLW, occurrence of atelectasis, ventilatory variables and duration of mechanical ventilation did not differ between groups, whereas patients with atelectasis had higher venous admixture and airway pressures than patients without atelectasis (P = 0.037 and 0.049). The PLI related to number of RBC concentrates infused (P = 0.025). CONCLUSION: The lung vascular injury in about half of patients after cardiac surgery is not caused by CPB perfusion but by trauma necessitating RBC transfusion, so that off-pump surgery may not afford a benefit in this respect. However, atelectasis rather than lung vascular injury is a major determinant of postoperative pulmonary dysfunction, irrespective of CPB perfusion. (+info)
Toward early identification of acute lung injury in the emergency department.
(3/1061)
BACKGROUND: There are no studies evaluating the epidemiology of pediatric acute lung injury (ALI) in the emergency department (ED), where early identification and interventions are most likely to be helpful. The purpose of this study was to describe the epidemiology of the ALI precursor acute hypoxemic respiratory failure (AHRF) in the ED. METHODS: We analyzed 11,664 pediatric patient records from 16 EDs. Records were selected if oxygen saturation (SpO(2)) was recorded during the visit. Virtual partial pressure of oxygen (pO(2)) was calculated from SpO(2), thus allowing calculation of ratios of pO(2) to fraction of inspired oxygen (FiO(2)) (PFRs). Patients with a PFR < 300 were classified as having AHRF. Univariate analyses and logistic regression were used to test the association of clinical factors with the presence of AHRF and intubation. RESULTS: AHRF criteria (ie, PFR < 300) were met in 121 (2.9%) of the 4,184 patients with an oxygenation measurement. The following variables were independently associated with ALI: higher Pediatric Risk of Admission II score (adjusted odds ratio [95% confidence interval (CI)] = 1.12 [1.08-1.16]; p < .001), higher heart rate (1.02 [1.01-1.03]; p = .009), a positive chest radiograph (2.35 [1.02-5.43]; p = .045), and lower temperature (0.49 [0.36-0.68]; p < .001).The final model had an R(2) = .20. CONCLUSION: We found nonintubated AHRF to be prevalent in the ED. The low R(2) for the regression model for AHRF underscores the lack of criteria for early identification of patients with respiratory compromise. Our findings represent an important first step toward establishing the true incidence of ALI in the pediatric ED. (+info)
Keratinocyte growth factor protects against Clara cell injury induced by naphthalene.
(4/1061)