Characterizing the Epidemiology of Postoperative Transfusion-related Acute Lung Injury

Abstract

Background Transfusion-related acute lung injury (TRALI) is the leading cause of transfusion-related death in the United States; however, it remains poorly characterized in surgical populations. To better inform perioperative transfusion practice, and to help mitigate perioperative TRALI, the authors aimed to better define its epidemiology before and after TRALI mitigation strategies were introduced. Methods This retrospective cohort study examined outcomes of adult patients undergoing noncardiac surgery with general anesthesia who received intraoperative transfusions during 2004 (n = 1,817) and 2011 (n = 1,562). The demographics and clinical characteristics of transfusion recipients, blood transfusion descriptors, and combined TRALI/possible TRALI incidence rates were evaluated. Univariate analyses were used to compare associations between patient characteristics, transfusion details, and TRALI mitigation strategies with TRALI/possible TRALI incidence rates in a before-and-after study design. Results The incidence of TRALI/possible TRALI was 1.3% (23 of 1,613) in 2004 versus 1.4% (22 of 1,562) in 2011 (P = 0.72), with comparable overall rates in males versus females (1.4% [23 of 1,613] vs. 1.2% [22 of 1,766]) (P = 0.65). Overall, thoracic (3.0% [4 of 133]), vascular (2.7% [10 of 375]), and transplant surgeries (2.2% [4 of 178]) carried the highest rates of TRALI/possible TRALI. Obstetric and gynecologic surgical patients had no TRALI episodes. TRALI/possible TRALI incidence increased with larger volumes of blood product transfused (P < 0.001). Conclusions Perioperative TRALI/possible TRALI is more common than previously reported and its risk increases with greater volumes of blood component therapies. No significant reduction in the combined incidence of TRALI/possible TRALI occurred between 2004 and 2011, despite the introduction of TRALI mitigation strategies. Future efforts to identify specific risk factors for TRALI/possible TRALI in surgical populations may reduce the burden of this life-threatening complication.

Noninvasive-Mechanical Ventilation Experience of Transfusion Related Acute Lung Injury (TRALI) after The Patient Undergoing Supracoronary Graft Interposition due to Ascending Aortic Aneurysm

“…Son zamanlarda klinik takiplerin istenilen seviyeye gelmesi ve yoğun bakım süreçlerinin iyi işletilmesi ile transfüzyona bağlı komplikasyonların sıklığı çok azalmakla beraber, yüksek riskli major cerrahilerin (aortik vasküler, transplantasyon cerrahisi, özefagus ve akciğer rezeksiyonları gibi) daha sık yapılır hâle gelmesi ile TRALI, transfüzyonun major komplikasyonlarından biri olarak daha sık görülür hâle gelmiş-tir [6] .…”

A Clinical Decision Support System for Preventing Adverse Reactions to Blood Transfusion

“…This indirect measurement approach is necessary because of the requirement that the system be nonintrusive to the end user -we cannot simply ask the provider if they've made a decision about a transfusion at the time of an alert. It is also necessary because TACO and TRALI are frequently overlooked in clinical practice and are widely considered to have significantly underreported incidences [3,4,10,11]. This obviates comparing incidence rates based on directly charted diagnoses before and after deployment as an appropriate performance metric.…”

“…For the retrospective chart review we will follow a procedure similar to that used in [3][4][5]. Using data from the Perioperative Datamart, a natural language processing (NLP) enhanced version of a surveillance algorithm [13] will identify patients who are likely to have suffered transfusionrelated complications.…”

“…Two adverse reactions in particular, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), described in [1], are especially problematic: Between 2009 and 2013, TRALI accounted for 30-45% of reported transfusion-related fatalities, and TACO accounted for 13-34% [2]. Furthermore, recent studies [3,4] of a non-cardiac surgical patient subpopulation found that those experiencing TACO or TRALI stay in both the ICU and hospital roughly twice as long as those who do not, and have in-hospital mortality rates that are respectively 3.5 and 10 times greater. Consequently, these adverse events not only put the patients at a much higher risk of mortality and poor quality of life outcomes, but also lead to increased utilization of healthcare services potentially leading to an increase in healthcare cost and expenditure.…”

Ensemble learning approaches to predicting complications of blood transfusion

“…Two adverse reactions in particular, transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO), described in [3], are especially problematic: Between 2009 and 2013, TRALI accounted for 30–45% of reported transfusion-related fatalities, and TACO accounted for 13–34% [2]. Furthermore, recent studies [4, 5] of a non-cardiac surgical patient subpopulation found that those experiencing TACO or TRALI stay in both the ICU and hospital roughly twice as long as those who do not, and have in-hospital mortality rates that are respectively 3.5 and 10 times greater. Consequently, these adverse events not only put the patients at a much higher risk of mortality and poor quality of life outcomes, but also lead to increased utilization of healthcare services potentially leading to an increase in healthcare cost and expenditure.…”