Posttraumatic massive bleeding: a challenging multidisciplinary task

Abstract

Massive bleeding is a key issue in the treatment of trauma and surgery. It does in fact account for more than 50% of all trauma-related deaths within the first 48 h following hospital admission, and it can significantly raise the mortality rate of any kind of surgery. Despite this great clinical relevance, evidence on the management of massive bleeding is surprisingly scarce, and its treatment is often based on empirical grounds. Successful treatment of massive haemorrhage depends on better understanding of the associated physiological changes as well as on good team work between the different specialists involved in the management of such a complex condition. The aim of this article is to provide an overview of the pathophysiology as well as of current treatment options of such a condition, including the new concept of "damage control resuscitation", which integrates permissive hypotension, haemostatic resuscitation and damage control surgery.

Massive Posttraumatic Bleeding: Epidemiology, Causes, Clinical Features, and Therapeutic Management

“…1 Massive hemorrhage has also been variably defined as loss of one blood volume in 24 hours (i.e., approximately 7% of ideal body weight in adults and 9% in children), loss of 50% (i.e., about 2.5 L) of total blood volume in less than 3 hours, or a rate of blood loss of 150 mL/min or 1.5 mL/(kg min) for at least 20 minutes. 2 The estimation of the blood loss may be challenging when isovolemic fluid infusion therapy is suddenly established. In this circumstance, a reliable equation has been proposed by Bourke and Smith, which estimates the total blood loss according to hematocrit variations, as follows: estimated blood loss ¼ estimated blood volume  ln[initial hematocrit/final hematocrit].…”