수혈 관련 급성 폐손상이 동반된 외상환자에서 체외막 산화기의 적용 경험

Application of Extracorporeal Membranous Oxygenation in Trauma Patient with Possible Transfusion Related Acute Lung Injury (TRALI)

  • 이대상 (성균관대학교 의과대학 삼성서울병원 중환자의학과) ;
  • 박치민 (성균관대학교 의과대학 삼성서울병원 중환자의학과)
  • Lee, Dae-Sang (Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Chi-Min (Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2014.11.25
  • 심사 : 2015.01.06
  • 발행 : 2015.03.31

초록

The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.

키워드

참고문헌

  1. Popovsky MA, Abel MD, Moore SB. Transfusion-related acute lung injury associated with passive transfer of antileukocyte antibodies. Am Rev Respir Dis 1983; 128: 185-9. https://doi.org/10.1164/arrd.1983.128.1.185
  2. Vlaar AP, Juffermans NP. Transfusion-related acute lung injury: a clinical review. Lancet 2013; 382: 984-94. https://doi.org/10.1016/S0140-6736(12)62197-7
  3. Hill JD, De Leval MR, Fallat RJ, Bramson ML, Eberhart RC, Schulte HD, et al. Acute respiratory insufficiency. Treatment with prolonged extracorporeal oxygenation. J Thorac Cardiovasc Surg 1972; 64: 551-62.
  4. Kuroda H, Masuda Y, Imaizumi H, Kozuka Y, Asai Y, Namiki A. Successful extracorporeal membranous oxygenation for a patient with life-threatening transfusion-related acute lung injury. J Anesth 2009; 23: 424-6. https://doi.org/10.1007/s00540-009-0760-5
  5. Popovsky MA, Moore SB. Diagnostic and pathogenetic considerations in transfusion-related acute lung injury. Transfusion 1985; 25: 573-7. https://doi.org/10.1046/j.1537-2995.1985.25686071434.x
  6. Kleinman S, Caulfield T, Chan P, Davenport R, McFarland J, McPhedran S, et al. Toward an understanding of transfusionrelated acute lung injury: statement of a consensus panel. Transfusion 2004; 44: 1774-89. https://doi.org/10.1111/j.0041-1132.2004.04347.x
  7. Kopko PM, Popovsky MA, MacKenzie MR, Paglieroni TG, Muto KN, Holland PV. HLA class II antibodies in transfusion-related acute lung injury. Transfusion 2001; 41: 1244-8. https://doi.org/10.1046/j.1537-2995.2001.41101244.x
  8. Marques MB, Tuncer HH, Divers SG, Baker AC, Harrison DK. Acute transient leukopenia as a sign of TRALI. Am J Hematol 2005; 80: 90-1. https://doi.org/10.1002/ajh.20378
  9. Silliman CC, Dickey WO, Paterson AJ, Thurman GW, Clay KL, Johnson CA, et al. Analysis of the priming activity of lipids generated during routine storage of platelet concentrates. Transfusion 1996; 36: 133-9. https://doi.org/10.1046/j.1537-2995.1996.36296181925.x
  10. Looney MR, Gropper MA, Matthay MA. Transfusion-related acute lung injury: a review. Chest 2004; 126: 249-58. https://doi.org/10.1378/chest.126.1.249