Correspondence  |   December 2017
Transfusion-associated Circulatory Overload or Degassing?
Author Notes
  • University of Pittsburgh, Presbyterian/Montefiore University Hospital, Pittsburgh, Pennsylvania. boucekcd@anes.upmc.edu
  • (Accepted for publication August 31, 2017.)
    (Accepted for publication August 31, 2017.)×
Article Information
Correspondence
Correspondence   |   December 2017
Transfusion-associated Circulatory Overload or Degassing?
Anesthesiology 12 2017, Vol.127, 1037. doi:10.1097/ALN.0000000000001911
Anesthesiology 12 2017, Vol.127, 1037. doi:10.1097/ALN.0000000000001911
Clifford et al.1  presented a careful case-controlled study of 163 patients who underwent noncardiac surgery and met National Healthcare Safety Network or International Society of Blood Transfusion criteria for transfusion-associated circulatory overload (TACO). They identify emergency surgery, isolated fresh-frozen plasma, and mixed product transfusion along with increasing intraoperative fluid administration as risk factors for TACO.1 
The term TACO carries the intuitive message that too much fluid/blood has been given. How the fluid is given may be equally important. As Varga et al.2  point out, fluids stored at below body temperature release dissolved gas when warmed. Packed red blood cells and plasma hold more dissolved gas due to their lower storage temperature before intravenous administration. Using Henry’s law, they calculated that fluid (saline) at room temperature and then raised to 37°C must outgas 4.7 ml/L, and fluids (packed red blood cells, fresh-frozen plasma) stored at 4°C must outgas 11 ml/L. Using a standard infusion system with a bubble trap, they infused fluids into a warm water bath and were able to collect less than half the gas anticipated to be released based on their calculation. The remaining unreleased gas is carried invisibly in the infusion stream. Prewarming of fluid reduced outgassing.
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