Physiological Predictors of Death in Exsanguinating Trauma Patients Undergoing Conventional Trauma Surgery

Krishna, Govind; Sleigh, James W.; Rahman, Haseeb

doi:10.1046/j.1440-1622.1998.01468.x

Cited by 37 publications

(21 citation statements)

References 16 publications

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“…Hypothermia is associated with an increased risk of severe bleeding, and hypothermia in trauma patients represents an independent risk factor for bleeding and death [195]. The effects of hypothermia include altered platelet function, impaired coagulation factor function (a 1ºC drop in temperature is associated with a 10% drop in function), enzyme inhibition and fibrinolysis [196,197].…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsA comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.Please see related letter by Morel et alhttp://ccforum.com/content/17/4/442

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Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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“…Hypothermia is associated with an increased risk of severe bleeding, and hypothermia in trauma patients represents an independent risk factor for bleeding and death [205]. The effects of hypothermia include altered platelet function, impaired coagulation factor function (a 1°C drop in temperature is associated with a 10% drop in function), enzyme inhibition and fibrinolysis [206,207].…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding following major trauma: an updated European guideline

et al. 2010

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsThis guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.

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“…Although a persisting base deficit has been associated with increased mortality,12 18 to what degree a chloride driven acidosis influences mortality remains an open question. With this in mind, all one can conclude at present is that the use of large volumes of “non-physiological” chloride rich solutions such as normal saline or albumin, may potentiate metabolic acidosis, making BD interpretation misleading.…”

Section: Discussionmentioning

confidence: 99%

“…7 12 13 This quantitatively represents the concentration of unmeasured strong anions as a result of tissue metabolic acid production. The strong ion approach has been validated experimentally and clinically in both healthy and critically ill patients 6…”

Section: The Strong Ion Approach To Acid–base Balancementioning

confidence: 99%

Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation

Skellett

Mayer

Durward

et al. 2000

Archives of Disease in Childhood

107

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Base deficit is a parameter often used to guide further treatment in acidotic children and is taken as a measure of how "sick" they are. Five children with septic shock are presented who had persisting base deficit after large volume resuscitation with 0.9% saline. Stewart's strong ion theory of acid-base balance is able to quantify the causes of metabolic acidosis and is used to show that our patients had a hyperchloraemic metabolic acidosis. We show how the chloride content of the saline loads given to our patients caused this hyperchloraemia. It is concluded that 0.9% saline and other chloride rich fluids may not be ideal resuscitation fluids; if used, clinicians must be aware of their potential to cause a persistent base deficit. (Arch Dis Child 2000;83:514-516)

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Physiological Predictors of Death in Exsanguinating Trauma Patients Undergoing Conventional Trauma Surgery

Abstract: At the above mentioned levels of physiological compromise, patient survival after conventional trauma surgery can be predicted to be very unlikely. Damage-control measures would be worth attempting.

Cited by 37 publications

References 16 publications

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Management of bleeding following major trauma: an updated European guideline

Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation

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