44 Inhalation Injury Does Not Increase Blood Transfusion Requirements Following Burn Injury in Adults

Abstract

Patients with major burns receive numerous red blood cell (RBC) transfusions for many indications, but it is not known whether an accompanying inhalation injury (INHI) influences the amount of blood transfused. The purpose of this study was to examine the effect of INHI on RBC transfusion in burned adults. This was a secondary analysis of a multi-center prospective randomized controlled trial that compared a liberal and restrictive blood transfusion threshold in adults with burns ≥ 20% TBSA. We compared 25 response variables between patients with and without INHI but here focus on the total number of RBC transfusions per patient (nRBC), the number of RBC transfusions per day (RBC/day), and the number of RBC transfusions/%TBSA burn (RBC/%). Generalized estimating equations (GEE) were used to account for clustering by facility. P values for response variable tests were adjusted for multiple comparisons. Multiple regression with GEE was used to identify variables that determined RBC/day. Values are shown as mean ± SD or median [25th,75th Q] as appropriate. Of 345 patients (age 42.9 +/- 16.8 years, %TBSA burn 38.0 +/- 17.6, 20.9% female, and admission APACHE 18.4 +/- 8.1) there were 78 (23%) with INHI. The table compares patients with and without INHI. The regression found that %TBSA burn (p<0.001), age (p=0.004), and requiring at least one day of mechanical ventilation(MV) (p < 0.0001) were significant determinants of RBC/day whereas INHI (p=0.251), and presence of at least one blood stream infection (p=0.107) were not. While patients with INHI tended to get more blood transfusions, this appears to have been determined by burn extent and requiring MV rather than the INHI itself. Presence of an INHI does not independently increase the need for RBC transfusions following a major burn injury. Table a P-values were not adjusted for multiple testing. Table a P-values were not adjusted for multiple testing.