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Background: Acute respiratory distress after transfusion is an underreported, but potentially serious complication. Concomitant pre-existing lung injury and frequent transfusions in critically ill and injured patients make identification of transfusion-related pulmonary reactions difficult. Special attention by critical care specialists, haematologists and transfusion medicine experts is therefore warranted. Conclusions: Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are clinical syndromes with predominant pulmonary injury and respiratory distress. Anaphylactic reaction, hemolytic transfusion reaction and transfusion of contaminated blood products also impair lung function but are less frequent. Transfusion in critically ill and injured patient is an independent risk factor for acute lung injury. It remains to be determined whether transfusion is the cause of increased mortality or only an indicator of disease severity