It’s been well known for a while that transfusion can cause acute lung injury (ALI). Now, a cohort study in Chest suggests that red cell transfusion increases mortality in patients with established ALI. The results were adjusted for confounding variables. An accompanying editorial reviews other literature in favor of conservative transfusion strategies and emphasizes the need for controlled trials.
Adverse outcomes associated with RBC transfusion in critically ill patients have driven interest in the use of erythropoietin in such patients. Unfortunately, that strategy has not been shown to be beneficial.
Exceptions to a conservative transfusion strategy in critically ill patients include bleeding, early goal directed therapy for sepsis and coronary artery disease.