Interaction between peri-operative blood transfusion, tidal volume, airway pressure and postoperative ARDS: an individual patient data meta-analysis

Neto, Ary Serpa; Juffermans, Nicole P.; Hemmes, Sabrine N.T.; Barbas, C S; Beiderlinden, Martin; Biehl, Michelle; Fernandez-Bustamante, Ana; Futier, Emmanuel; Gajić, Ognjen; Jaber, Samir; Kozian, Alf; Licker, Marc; Lin, Wenqian; Memtsoudis, Stavros G.; Miranda, Dinis Reis; Moine, Pierre; Paparella, Domenico; Ranieri, Marco; Scavonetto, Federica; Schilling, Thomas; Selmo, Gabriele; Severgnini, Paolo; Šprung, Juraj; Sundar, Sugantha; Talmor, Daniel; Treschan, Tanja A.; Unzueta, Carmen; Weingarten, Toby N.; Wolthuis, Esther K.; Wrigge, Hermann; Abreu, Marcelo Gama de; Pelosi, Paolo; Schultz, Marcus J.

doi:10.21037/atm.2018.01.16

Cited by 17 publications

(9 citation statements)

References 55 publications

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“…Although reintubation patients could not be diagnosed with acute ARDS due to the absence of a blood-gas test, several studies have reported the relationship between FFP transfusion and ARDS [ 21 ]. Neto and colleagues found that perioperative FFP transfusion increased the risk of postoperative ARDS [ 22 ]. Thus, FFP transfusion may be correlated with ARDS and reintubation after operation.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

et al. 2021

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Background This study aimed to identify the risk factors and evaluate the prognosis of unplanned reintubation caused by acute airway compromise (AAC) after general anesthesia. Methods This case-control study included surgical patients who underwent unplanned reintubation in the operating room and postanesthesia care unit after general anesthesia between January 1, 2014, and December 31, 2018. Cases due to AAC were matched 1:4 with randomly selected controls. Results A total of 123,068 patients were included, and reintubation due to AAC was performed in 36 patients (approximate incidence 0.03%). Univariable analysis revealed that male sex, age > 65, ASA physical status 3, sepsis, heart disease history, cerebral infarction history, Cormack Lehane grade, surgery type, fresh frozen plasma infusion, increased intubation duration, white blood cell count, and creatinine clearance rate were related to AAC-caused unplanned reintubation. Multivariable analysis revealed that age > 65 (OR = 7.50, 95% CI 2.47–22.81, P < 0.001), ASA physical status 3 (OR = 6.51, 95% CI 1.18–35.92, P = 0.032), head-neck surgery (OR = 4.94, 95% CI 1.33–18.36, P = 0.017) or thoracic surgery (OR = 12.56, 95% CI 2.93–53.90, P < 0.001) and a high fluid load (OR = 3.04, 95% CI 1.16–7.99, P = 0.024) were associated with AAC-caused unplanned reintubation. AAC-caused unplanned reintubation patients had longer postoperative hospital (OR = 5.26, 95% CI 1.57–8.95, P < 0.001) and intensive care unit days (OR = 3.94, 95% CI 1.69–6.18, P < 0.001). Conclusions Age > 65, ASA physical status 3, head-neck or thoracic surgery and high fluid load were found to be associated with AAC-caused unplanned reintubation.

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Section: Discussionmentioning

confidence: 99%

Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

et al. 2021

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“…A restrictive fluid strategy and blood transfusion target of > 70 g·L -1 may be optimal, with vasopressors as required. 4 Uterotonic agents should be used judiciously because of their hemodynamic and respiratory effects. Hemabate and ergometrine increase pulmonary vascular resistance and may cause pulmonary edema.…”

Section: To the Editormentioning

confidence: 99%

General anesthesia for Cesarean delivery in a parturient critically ill with COVID-19: a case report

Kaminski

Turner

Virdee

et al. 2022

Can J Anesth/J Can Anesth

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“…Of note, the interaction between transfusion and mechanical ventilation in the induction of lung injury can occur after just a short period of time. This was shown in a meta-analysis of almost 3,700 patients requiring ventilation for a general surgical procedure, where ventilation with high pulmonary pressures and RBC transfusion were individually associated with occurrence of postoperative ARDS, but their combination was associated with the highest risk of developing ARDS [ 33 ]. There was also a significant interaction between transfusion and airway pressure as a risk factor for ARDS.…”

Section: Introductionmentioning

confidence: 99%

Transfusion in the mechanically ventilated patient

et al. 2020

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Interaction between peri-operative blood transfusion, tidal volume, airway pressure and postoperative ARDS: an individual patient data meta-analysis

Abstract: 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.

Cited by 17 publications

References 55 publications

Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

Risk factors for unplanned reintubation caused by acute airway compromise after general anesthesia: a case-control study

General anesthesia for Cesarean delivery in a parturient critically ill with COVID-19: a case report

Transfusion in the mechanically ventilated patient

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