Effect of blood transfusion on respiratory failure in severe trauma patients: A post hoc analysis of a randomized multicenter trial in Japan

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• Picked for Emergency Medicine (top studies of the week, 1 November 2026): Transfusion exposure and respiratory failure in severe bleeding trauma
• Picked for Critical Care and Intensive Care Medicine (top studies of the week, 1 November 2026): Transfusion strategy and respiratory failure after severe trauma

Abstract

BACKGROUND: Severe trauma patients often need a large amount of blood transfusion including red blood cells (RBCs), fresh frozen plasma (FFP) and platelet. The blood transfusion can cause serious transfusion-related adverse events including respiratory complications, however, the risks of blood transfusion in trauma patients have not been well documented. We evaluated the hypothesis that the amount of blood transfusion during the acute post-injury phase was associated with respiratory failure among severe trauma patients at risk of active bleeding using a database of a randomized multicenter trial. METHODS: We used data from the Restrictive Transfusion Strategy for Critically Injured Patients (RESTRIC) trial, a cluster-randomized, crossover, non-inferiority multicenter trial conducted in Japan from May 7, 2019 to October 31, 2021 in Japan. The trial enrolled adult trauma patients transferred to the emergency department with severe bleeding or suspected severe bleeding and circulatory shock. All patients registered in this trial were included in this study. The primary outcome measure was the occurrence of respiratory failure within 7 days after admission. A logistic regression analysis on respiratory failure adjusted for sex, Injury Severity Score (ISS), chest Abbreviated Injury Scale (AIS) score, and the amount of RBCs, FFP, and platelet transfusions within 24 h was performed. RESULTS: Of 417 trauma patients, 40 (9.8%) developed respiratory failure. Logistic regression analysis revealed that sex, chest AIS score, and platelet transfusion volume were associated with respiratory failure with 7 days after admission after adjustment (odds ratio [OR]: 0.300, 95% confidence interval [CI]: 0.113-0.794, p = 0.015, OR: 1.732, 95% CI: 1.267-2.367, p < 0.001, OR: 1.071, 95% CI: 1.021-1.122, p = 0.005 respectively). ISS, RBC, and FFP transfusions were not associated with respiratory failure (all p ≥ 0.05). CONCLUSION: Among severe trauma patients with severe bleeding or circulatory shock transferred to the emergency department, platelet transfusion volume within 24 h may be a risk factor for respiratory failure within 7 days after admission. In contrast, RBC and FFP transfusions were not associated with respiratory failure.

Abstract as published, via PubMed.