TRALI – Treatment and Outcome

Treatment:

• If the reaction is recognized during transfusion, then the transfusion should be stopped immediately.
• The treatment of TRALI is primarily supportive and similar to that for other forms of ALI. Supplemental oxygen is an essential part of treatment. For mild cases, supportive care may suffice.
• For more severe cases, intravenous fluids, vasopressor agents, and mechanical ventilation may be necessary. Mechanical ventilatory support may be required in more than 70% of patients. A low tidal volume, lung protective strategy has been advised for these patients.
• Generally, administration of diuretics is detrimental and must be avoided, as the pulmonary edema is not because of fluid overload. The only setting where diuretics may possibly be indicated is in the patient with fluid overload who develops TRALI.
• The use of steroids remains controversial.
• Anecdotally, cardiopulmonary bypass and extracorporeal membrane oxygenation have been successfully used.
• Prostaglandin administration and plasmapheresis have only been anecdotally reported and cannot be routinely recommended.

Outcome:

Compared with ARDS, TRALI is a transient phenomenon and has lower mortality; the majority of patients recover within 4 days with supportive care. There does not appear to be late pulmonary fibrosis or parenchymal destruction; long-term lung function in survivors appears to be the same as patients who did not experience TRALI. However, in a minority of cases, (5% to 15%), the disease is fatal .

Ref: Journal of Intensive Care Medicine / Vol. 23, No. 2, March/April 2008

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