Asendan Aort Anevrizmalı Hastada Greft İnterpozisyonu Sonrası Gelişen TRALI ve Noninvaziv Mekanik Ventilasyon Deneyimi

Transfüzyona bağlı akut akciğer hasarı (TRALI), major cerrahi geçiren yüksek riskli hasta grubunda transfüzyona bağlı ölümlerin ikinci en sık nedenidir. Akut hipoksi ve nonkardiyojenik pulmoner ödem tablosu ile ortaya çıkan TRALI, transfüzyon yapılan hastalarda ayırıcı tanıda düşünülmesi gereken önemli bir klinik tablodur. Asendan aort anevrizmalı suprakoroner greft interpozisyonu yapılan hastaya perioperatif ve postoperatif TDP, ES ve trombosit transfüzyonu yapıldı. Sonrasında akut gelişen hipoksi ve bilateral akciğer ödemini takiben pozitif basınçlı mekanik ventilasyon ile solunum destek tedavisi başlandı. Gecikmiş TRALI olarak düşünülen hasta postop 5. günde ekstübe edildi. Non invaziv mekanik solunum desteğine devam edildi. Onuncu günde oksijen ve solunum destek gereksinimi tamamen ortadan kalktı. Özellikle major cerrahi geçiren, yüksek miktarda ES,TDP, trombosit süspansiyonu transfüze edilen hastalarda akut gelişen hipoksi, ARDS tablosunda TRALI akla gelmeli, tedavide noninvaziv mekanik ventilasyon seçeneği düşünülmelidir.

Noninvasive-Mechanical Ventilation Experience of Transfusion Related Acute Lung Injury (TRALI) Developed Following Supracoronary Graft Interposition in a Patient with Ascending Aortic Aneurysm

Transfusion-related acute lung injury (TRALI) is the second leading cause of transfusion-associated mortality in high-risk patients undergoing major surgery. TRALI presenting with acute hypoxia and non-cardiac edema is a vital clinical entity which must be considered in the differential diagnosis in transfusion-associated patients. Fresh frozen plasma, erythrocyte suspension and thrombocyte suspension transfusion were performed during perioperative and postoperative periods to the patient undergoing supracoronary graft interposition due to ascending aortic aneurysm. Respiratory support treatment with positive pressure mechanical ventilation was initiated for acute hypoxia and bilateral pulmonary edema developed immediately after the procedure. The patient thought to have delayed TRALI was extubated on postoperative 5. day. Noninvasive mechanical respiratory support treatment was maintained. On postoperative 10. day the patient did not need any oxygen and ventilatory support. TRALI should be considered in patients with acute onset of hypoxia, ARDS especially in cases undergoing major surgery and transfusion of large amounts of ES, FFP, platelet suspension. Noninvasive mechanical ventilation should be considered as a treatment option.

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