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Transfusion-Associated Circulatory Overload in ICUs

A Scoping Review of Incidence, Risk Factors, and Outcomes

De Cloedt, Lise, MD1; Savy, Nadia, MD, MSc1,2; Gauvin, France, MD, MSc, FRCPC1; Taylor, Stephen, MD3; Lacroix, Jacques, MD, FRCPC, FAAP1; Emeriaud, Guillaume, MD, PhD1

doi: 10.1097/CCM.0000000000003743
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Transfusion-associated circulatory overload is the most frequent serious adverse transfusion reaction, with an incidence close to 1% of transfused patients in the general adult population. Patients in ICUs are probably more at risk of transfusion-associated circulatory overload as they are more frequently transfused and associated with more comorbidities. However, the epidemiology of transfusion-associated circulatory overload in ICU is not well characterized, leading to a risk of underdiagnosis.

Objectives: We conducted a scoping review to describe the incidence, risk factors, and outcomes of transfusion-associated circulatory overload in PICU and adult ICU.

Data Sources: PubMed, Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and EBSCO CINAHL COMPLETE.

Study Selection: Two reviewers independently screened each article for inclusion criteria. Studies were eligible if they reported data on incidence, risk factors, or outcomes of transfusion-associated circulatory overload in at least 10 ICU patients.

Data Synthesis: Among 5,926 studies identified, nine were included. Five studies were prospective, and four were retrospective. The definition of transfusion-associated circulatory overload varied among studies. The pooled incidence of transfusion-associated circulatory overload was of 5.5% (95% CI, 2.6–9.4%) in adult ICUs (four studies, 2,252 patients, high heterogeneity). In PICUs, two studies (345 patients) reported 0 cases, and a third study (136 patients) reported variable incidences between 1.5% and 76%, depending on diagnostic criteria. Risk factors for transfusion-associated circulatory overload included positive fluid balance, the number and type of products transfused, rate of transfusion, and cardiovascular and renal comorbidities. Transfusion-associated circulatory overload was associated with increased ICU and hospital lengths of stay, whereas the association with mortality was not consistent.

Conclusions: Transfusion-associated circulatory overload is frequent in ICU patients and is associated with adverse outcomes. The lack of a pediatric-adjusted definition of transfusion-associated circulatory overload may lead to a risk of underdiagnosis of this condition in PICUs. Further research is warranted to improve the knowledge of transfusion-associated circulatory overload and the safety of transfusion in ICU patients.

1Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Université de Montreéal, Montréal, QC, Canada.

2Department of Pediatrics, Centre hospitalier universitaire de Clermont-Ferrant, Université Clermont I, Clermont-Ferrand, France.

3Department of Radiology, Hôpital Ambroise Paré, Mons, Belgium.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Dr. Emeriaud’s institution received funding from a scholarship award by the Fonds de Recherche du Québec—Santé, and he disclosed he is currently leading a feasibility study in neonatal ventilation which is financially supported by Maquet Critical Care. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: guillaume.emeriaud@umontreal.ca

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