TRALI as a Cause of Massive Tracheal Secretions during Cardiac Surgery

Yuichiro Hirata＊	Kenichi Imasaka＊	Ryuya Nomura＊
Tomofumi Fukuda＊	Yuma Motomatsu＊	Shigeki Morita＊

(Department of Cardiovascular Surgery, Clinical Research Institute, Kyushu Medical Center, National Hospital Organization＊, Fukuoka, Japan)

A 46 year-old man underwent double valve replacement for valve insufficiency due to infective endocarditis. Upon withdrawal from extracorporeal circulation and administration of 8 units of fresh frozen plasma, a large amount of yellow serous secretion was aspirated from the trachea, and rapid and exacerbated oxygenation was observed. We determined that the patient was not congested, based on his hemodynamics; instead, he appeared to have acquired transfusion-related acute lung injury （TRALI）. The patient was given a steroid infusion. By the time the patient returned to the intensive care unit, his oxygenation capacity improved and the secretions from his trachea decreased. The patient was weaned off the ventilator on the second post-operative day. Inhaled nitric oxide was very effective in improving oxygenation. We conjectured that TRALI should be recognized as a differential diagnosis for poor oxygenation after withdrawal from extracorporeal circulation.

 

Jpn. J. Cardiovasc Surg. 51 : 96-99 （2022）

Keywords：TRALI ; congestive heart failure ; inhaled nitric oxide