From the Guidelines
The treatment for Transfusion-Associated Circulatory Overload (TACO) should focus on managing fluid overload and supporting respiratory function, with diuretics, particularly intravenous furosemide, being the cornerstone of treatment to reduce fluid volume. Immediately stop the transfusion when TACO is suspected. Position the patient upright to improve breathing. Administer supplemental oxygen to maintain adequate saturation levels.
Key Treatment Strategies
- Diuretics: intravenous furosemide at 20-40mg (or 0.5-1mg/kg) is recommended to reduce fluid volume 1.
- For severe cases, non-invasive positive pressure ventilation (CPAP or BiPAP) may be necessary, with settings typically starting at 5-10 cmH2O of PEEP.
- In critical situations, mechanical ventilation might be required.
- Nitrates like nitroglycerin (starting at 5-10 mcg/min IV and titrating upward) can help reduce preload and improve symptoms.
- Morphine (2-4mg IV) may be used cautiously for severe dyspnea and anxiety.
Monitoring and Prevention
- Monitor vital signs, oxygen saturation, and urine output closely.
- TACO occurs when the cardiovascular system cannot accommodate the additional volume from transfusion, leading to pulmonary edema.
- Prevention is crucial for high-risk patients (elderly, cardiac or renal dysfunction) by using slower transfusion rates (1-2mL/kg/hr) and considering prophylactic diuretics, as fluid overload has been shown to cause increased morbidity and mortality in various intensive care settings 1.
From the Research
Treatment for TACO
- The treatment for Transfusion-Associated Circulatory Overload (TACO) is not explicitly stated in the provided studies, but the prevention and management strategies are discussed 2, 3, 4, 5, 6.
Prevention Strategies
- Restrictive transfusion practice may affect the occurrence and severity of TACO in critically ill patients 4.
- Surveillance and evidence-based strategies such as clinical decision support systems have the potential to reduce the incidence of TACO and mitigate its effects 3.
- Developing appropriate guidelines that apply to specific patient populations, such as oncology patients, should be considered 5.
Management Strategies
- Bedside nurses play a key role in the prevention, identification, and reporting of TACO 3.
- Practical suggestions for conducting bedside transfusion surveillance and future directions for improving transfusion care are presented 3.
- Implementation of tools that can predict TACO can help in early recognition and mitigation of TACO 5.
Risk Factors
- TACO is associated with chronic renal failure, past history of heart failure, hemorrhagic shock, number of blood products transfused, and fluid balance per hour 2.
- Other risk factors include cardiovascular comorbidities, acute kidney injury, emergency surgery, pretransfusion diuretic use, and plasma transfusion 4.
- Oncology patients have unique factors that may lead to diagnosis of TACO, such as hematology malignancy, receipt of cardiotoxic chemotherapy, and preexisting oxygen use 5.