This study aims to examine the incidence of transfusion related acute lung injury (TRALI) in burns resuscitation using fresh frozen plasma (FFP). The authors conducted a retrospective chart review of patients who met their requirement of ‘severe burn‘, that being a TBSA burn of at least 40% (30% if there was an inhalational component), who were resuscitated with the O’Mara FFP regime. This cohort was then evaluated for evidence of TRALI which was defined as a new episode of acute lung injury occurring during or within six hours of completed resuscitation. Patients were excluded if there were other potential causes of TRALI e.g. aspiration. Out of 83 patients treated with FFP, 65 were excluded and 18 patients studied. Of these, one patient was found with TRALI (5.5% cohort). Evaluating the studies methodology the authors’ definition of a severe burn would seem very reasonable. However, it is interesting to note that part of the severe burn definition included 30% burns with an inhalational component, yet the studies exclusion criteria include associated factors such as toxic inhalation, including smoke. These inclusion / exclusion factors would seem diametrically opposed; it is unclear how a 30% burn with a documented inhalation component could possibly be included in the study. It would appear sensible to simply have had the definition of severe burn as those of 40% or more with no inhalational component. Unfortunately like many studies in this area there is a paucity of study subjects to examine, leaving the analysis underpowered.

In this study only a single patient was identified out of a total of 18. This small number does not allow for robust analysis or interpretation of results. Overall, however, the paper is well written and reaches reasonable and logical conclusions given the small study numbers. The authors should be congratulated for attempting to address this ongoing and difficult debate within burns circles regarding colloid versus crystalloid resuscitation. They clearly articulate the arguments and factors surrounding the controversial use of colloids in burns and the article is certainly informative from this viewpoint. Undoubtedly further research using large cohorts of patients is required in order to provide answers. 

TRALI following fresh frozen plasma resuscitation from burn shock.
Jones LM, Deluga N, Bhatti P, et al.
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Marc-James Hallam

St John's Hospital, Livingstone, UK.

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