Retrospective cohort analysis of associations between blood transfusion and postoperative lung injury after cardiac surgery

Objective To explore the associations between blood transfusion and postoperative lung injury after pediatric cardiac surgery. Methods Retrospective reviews were conducted for 492 consecutive children with congenital heart disease(CHD) undergoing cardiopulmonary bypass(CPB). And the associations were analyzed between transfusion of red blood cell(RBC) and plasma, operative approach, age, CPB duration, aortic artery blocking time, lowest temperature, lowest intraoperative hemoglobin(Hct) and morbidity of postoperative lung injury. Results Their demographics were assessed by the Aristotle Basic Complexity(ABC) propensity score. More morbidity of postoperative lung injury was found in patients with more transfusion of RBC & plasma(P 30%(OR=2.76), age≤ 1 year(OR=5.10) and CPB duration >80 min(OR=2.58) were the independent risk factors of postoperative lung injury. More complex surgery had a higher rate of lung injury(ABC level 3 vs 1, P<0.05; ABC level 4 vs 1, P<0.01). The patients with postoperative lung injury had also longer mechanical ventilation duration and intensive care unit(ICU) stay length(P<0.001). The voulme of perioperative blood transfusion in children with preoperative anemia(n=284) was significantly more than that in those without preoperative anemia(n=208)(75.31±2.18 vs 53.59±2.87 ml/kg, P<0.001). Conclusions Transfusion of RBC & plasma is closely correlated with postoperative lung injury. The more transfusion, the higher risk of postoperative lung injury. And a variety of blood conservation measures should be adopted during the perioperative period of pediatric cardiac surgery. Key words: Blood transfusion; Lung injury; Child; Heart diseases, Congenital