Impact of Plasma Transfusion in Trauma Patients Who Do Not Require Massive Transfusion.

摘要

For trauma patients requiring massive blood transfusion, aggressive plasma usage has been demonstrated to confer a survival advantage. The aim of this study was to evaluate the impact of plasma administration in nonmassively transfused patients. STUDY DESIGN: Trauma patients admitted to a Level I trauma center (2000 2005) requiring a nonmassive transfusion (less than 10 U packed RBC [PRBC] within 12 hours of admission) were identified retrospectively. Propensity scores were calculated to match and compare patients receiving plasma in the first 12 hours with those who did not. The 1,716 patients (86.1% of 1,933 who received PRBC transfusion) received a nonmassive trans- fusion. After exclusion of 31 (1.8%) early deaths, 284 patients receiving plasma were matched to patients who did not. There was no improvement in survival with plasma transfusion (17.3% versus 14.1%; p 0.30) irrespective of the plasma-to-PRBC ratio achieved. However, the overall complication rate was significantly higher for patients receiving plasma (26.8% versus 18.3%, odds ratio [OR] 1.7; 95% CI, 1.1 2.4; p 0.016). As the volume of plasma increased, an increase in complications was seen,reaching 37.5% for patients receiving greater than 6U. The ARDS rate specifically was also significantly higher in patients receiving plasma (9.9% versus 3.5%, OR 3.0; 95% CI, 1.4 6.2; p = 0.004]. Patients receiving greater than 6 U plasma had a 12-fold increase in ARDS, a 6-fold increase in multiple organ dysfunction syndrome, and a 4-fold increase in pneumonia and sepsis. CONCLUSIONS: For nonmassively transfused trauma patients, plasma administration was associated with a substantial increase in complications, in particular ARDS, with no improvement in survival. An increase in multiple organ dysfunction, pneumonia, and sepsis was likewise seen as increasing volumes of plasma were transfused.