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Optimizing transfusion strategies in damage control resuscitation: current insights

From clinical and laboratory studies of specific coagulation defects induced by injury, damage control resuscitation (DCR) emerged as the most effective management strategy for hemorrhagic shock. DCR of the trauma patient who has sustained massive blood loss consists of 1) hemorrhage control; 2) per...

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Autores principales: Pohlman, Timothy H, Fecher, Alison M, Arreola-Garcia, Cecivon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Dove Medical Press 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108342/
https://www.ncbi.nlm.nih.gov/pubmed/30154676
http://dx.doi.org/10.2147/JBM.S165394
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author Pohlman, Timothy H
Fecher, Alison M
Arreola-Garcia, Cecivon
author_facet Pohlman, Timothy H
Fecher, Alison M
Arreola-Garcia, Cecivon
author_sort Pohlman, Timothy H
collection PubMed
description From clinical and laboratory studies of specific coagulation defects induced by injury, damage control resuscitation (DCR) emerged as the most effective management strategy for hemorrhagic shock. DCR of the trauma patient who has sustained massive blood loss consists of 1) hemorrhage control; 2) permissive hypotension; and 3) the prevention and correction of trauma-induced coagulopathies, referred to collectively here as acute coagulopathy of trauma (ACOT). Trauma patients with ACOT have higher transfusion requirements, may eventually require massive transfusion, and are at higher risk of exsanguinating. Distinct impairments in the hemostatic system associated with trauma include acquired quantitative and qualitative platelet defects, hypocoagulable and hypercoagulable states, and dysregulation of the fibrinolytic system giving rise to hyperfibrinolysis or a phenomenon referred to as fibrinolytic shutdown. Furthermore, ACOT is a component of a systemic host defense dysregulation syndrome that bears several phenotypic features comparable with other acute systemic physiological insults such as sepsis, myocardial infarction, and postcardiac arrest syndrome. Progress in the science of resuscitation has been continuing at an accelerated rate, and clinicians who manage catastrophic blood loss may be incompletely informed of important advances that pertain to DCR. Therefore, we review recent findings that further characterize the pathophysiology of ACOT and describe the application of this new information to optimization of resuscitation strategies for the patient in hemorrhagic shock.
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spelling pubmed-61083422018-08-28 Optimizing transfusion strategies in damage control resuscitation: current insights Pohlman, Timothy H Fecher, Alison M Arreola-Garcia, Cecivon J Blood Med Review From clinical and laboratory studies of specific coagulation defects induced by injury, damage control resuscitation (DCR) emerged as the most effective management strategy for hemorrhagic shock. DCR of the trauma patient who has sustained massive blood loss consists of 1) hemorrhage control; 2) permissive hypotension; and 3) the prevention and correction of trauma-induced coagulopathies, referred to collectively here as acute coagulopathy of trauma (ACOT). Trauma patients with ACOT have higher transfusion requirements, may eventually require massive transfusion, and are at higher risk of exsanguinating. Distinct impairments in the hemostatic system associated with trauma include acquired quantitative and qualitative platelet defects, hypocoagulable and hypercoagulable states, and dysregulation of the fibrinolytic system giving rise to hyperfibrinolysis or a phenomenon referred to as fibrinolytic shutdown. Furthermore, ACOT is a component of a systemic host defense dysregulation syndrome that bears several phenotypic features comparable with other acute systemic physiological insults such as sepsis, myocardial infarction, and postcardiac arrest syndrome. Progress in the science of resuscitation has been continuing at an accelerated rate, and clinicians who manage catastrophic blood loss may be incompletely informed of important advances that pertain to DCR. Therefore, we review recent findings that further characterize the pathophysiology of ACOT and describe the application of this new information to optimization of resuscitation strategies for the patient in hemorrhagic shock. Dove Medical Press 2018-08-20 /pmc/articles/PMC6108342/ /pubmed/30154676 http://dx.doi.org/10.2147/JBM.S165394 Text en © 2018 Pohlman et al. This work is published and licensed by Dove Medical Press Limited The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
spellingShingle Review
Pohlman, Timothy H
Fecher, Alison M
Arreola-Garcia, Cecivon
Optimizing transfusion strategies in damage control resuscitation: current insights
title Optimizing transfusion strategies in damage control resuscitation: current insights
title_full Optimizing transfusion strategies in damage control resuscitation: current insights
title_fullStr Optimizing transfusion strategies in damage control resuscitation: current insights
title_full_unstemmed Optimizing transfusion strategies in damage control resuscitation: current insights
title_short Optimizing transfusion strategies in damage control resuscitation: current insights
title_sort optimizing transfusion strategies in damage control resuscitation: current insights
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108342/
https://www.ncbi.nlm.nih.gov/pubmed/30154676
http://dx.doi.org/10.2147/JBM.S165394
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