Interaction between peri-operative blood transfusion, tidal volume, airway pressure and postoperative ARDS: an individual patient data meta-analysis
Por:
Neto, AS, Juffermans, NP, Hemmes, SNT, Barbas, CSV, Beiderlinden, M, Biehl, M, Fernandez-Bustamante, A, Futier, E, Gajic, O, Jaber, S, Kozian, A, Licker, M, Lin, WQ, Memtsoudis, SG, Miranda, DR, Moine, P, Paparella, D, Ranieri, M, Scavonetto, F, Schilling, T, Selmo, G, Severgnini, P, Sprung, J, Sundar, S, Talmor, D, Treschan, T, Unzueta, C, Weingarten, TN, Wolthuis, EK, Wrigge, H, de Abreu, MG, Pelosi, P, Schultz, MJ, PROVE Network Investigators
Publicada:
1 ene 2018
Resumen:
Background: Transfusion of blood products and mechanical ventilation with injurious settings are considered risk factors for postoperative lung injury in surgical Patients.
Methods: A systematic review and individual patient data meta-analysis was done to determine the independent effects of peri-operative transfusion of blood products, intra-operative tidal volume and airway pressure in adult patients undergoing mechanical ventilation for general surgery, as well as their interactions on the occurrence of postoperative acute respiratory distress syndrome (ARDS). Observational studies and randomized trials were identified by a systematic search of MEDLINE, CINAHL, Web of Science, and CENTRAL and screened for inclusion into a meta-analysis. Individual patient data were obtained from the corresponding authors. Patients were stratified according to whether they received transfusion in the perioperative period [ red blood cell concentrates (RBC) and/or fresh frozen plasma (FFP)], tidal volume size [<= 7 mL/kg predicted body weight (PBW), 7-10 and > 10 mL/kg PBW] and airway pressure level used during surgery (<= 15, 15-20 and > 20 cmH(2)O). The primary outcome was development of postoperative ARDS.
Results: Seventeen investigations were included (3,659 patients). Postoperative ARDS occurred in 40 (7.2%) patients who received at least one blood product compared to 40 patients (2.5%) who did not [ adjusted hazard ratio (HR), 2.32; 95% confidence interval (CI), 1.25-4.33; P=0.008]. Incidence of postoperative ARDS was highest in patients ventilated with tidal volumes of > 10 mL/kg PBW and having airway pressures of > 20 cmH(2)O receiving both RBC and FFP, and lowest in patients ventilated with tidal volume of <= 7 mL/kg PBW and having airway pressures of <= 15 cmH(2)O with no transfusion. There was a significant interaction between transfusion and airway pressure level (P=0.002) on the risk of postoperative ARDS.
Conclusions: Peri-operative transfusion of blood products is associated with an increased risk of postoperative ARDS, which seems more dependent on airway pressure than tidal volume size.
Filiaciones:
Neto, AS:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, Amsterdam, Netherlands
ABC, Fac Med, Program Postgrad Res & Innovat, Sao Paulo, Brazil
Hosp Israelita Albert Einstein, Dept Crit Care Med, Sao Paulo, Brazil
Juffermans, NP:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, Amsterdam, Netherlands
Hemmes, SNT:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, Amsterdam, Netherlands
Barbas, CSV:
Hosp Israelita Albert Einstein, Dept Crit Care Med, Sao Paulo, Brazil
Beiderlinden, M:
Dusseldorf Univ Hosp, Dept Anaesthesiol, Dusseldorf, Germany
Marienhospital Osnabruck, Dept Anaesthesiol, Osnabruck, Germany
Biehl, M:
Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA
Fernandez-Bustamante, A:
Univ Colorado, Dept Anesthesiol, Aurora, CO USA
Futier, E:
Estaing Univ Hosp, Dept Anesthesiol & Crit Care Med, Clermont Ferrand, France
Gajic, O:
Mayo Clin, Div Pulm & Crit Care Med, Rochester, MN USA
Jaber, S:
St Eloi Univ Hosp, Dept Crit Care Med & Anesthesiol SAR B, Montpellier, France
Kozian, A:
Otto Von Guericke Univ, Dept Anesthesiol & Intens Care Med, Magdeburg, Germany
Licker, M:
Univ Hosp Geneva, Fac Med, Dept Anaesthesiol Pharmacol & Intens Care, Geneva, Switzerland
Lin, WQ:
Sun Yat Sen Univ Canc Ctr, State Key Lab Oncol South China, Guangzhou 510060, Guangdong, Peoples R China
Memtsoudis, SG:
Cornell Univ, Hosp Special Surg, Weill Med Coll, Dept Anesthesiol, New York, NY 10021 USA
Miranda, DR:
Erasmus MC, Dept Intens Care, Rotterdam, Netherlands
Moine, P:
Univ Colorado, Dept Anesthesiol, Aurora, CO USA
Paparella, D:
Univ Bari Aldo Moro, Dept Emergency & Organ Transplant DETO, Div Cardiac Surg, Bari, Italy
Ranieri, M:
Sapienza Univ Rome, Policlin Umberto Hosp 1, Department Anesthesia & Intens Care Med, Rome, Italy
Scavonetto, F:
Mayo Clin, Mayo Clin Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Mayo Clin Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Schilling, T:
Otto Von Guericke Univ, Dept Anesthesiol & Intens Care Med, Magdeburg, Germany
Selmo, G:
Univ Insubria, Dept Environm Hlth & Safety, Varese, Italy
Severgnini, P:
Univ Insubria, Dept Environm Hlth & Safety, Varese, Italy
Sprung, J:
Mayo Clin, Mayo Clin Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Mayo Clin Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Sundar, S:
Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA
Harvard Med Sch, Boston, MA USA
Talmor, D:
Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA
Harvard Med Sch, Boston, MA USA
Treschan, T:
Dusseldorf Univ Hosp, Dept Anaesthesiol, Dusseldorf, Germany
Unzueta, C:
Hosp Sant Pau, Dept Anaesthesiol & Intens Care, Barcelona, Spain
Weingarten, TN:
Mayo Clin, Mayo Clin Coll Med, Dept Anesthesiol, Rochester, MN USA
Mayo Clin, Mayo Clin Coll Med, Anesthesia Clin Res Unit, Rochester, MN USA
Wolthuis, EK:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, Amsterdam, Netherlands
Wrigge, H:
Univ Leipzig, Dept Anesthesiol & Intens Care Med, Leipzig, Germany
de Abreu, MG:
Tech Univ Dresden, Univ Hosp Carl Gustav Carus, Dept Anesthesiol & Intens Care Med, Dresden, Germany
Pelosi, P:
Univ Genoa, IRCCS San Martino IST, Dept Surg Sci & Integrated Diagnost, Genoa, Italy
Schultz, MJ:
Univ Amsterdam, Acad Med Ctr, Dept Intens Care, Amsterdam, Netherlands
Univ Amsterdam, Acad Med Ctr, Lab Expt Intens Care & Anesthesiol, Amsterdam, Netherlands
Green Published
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