Severe Trauma-Induced Coagulopathy: Molecular Mechanisms Underlying Critical Illness

Abstract

Trauma remains one of the leading causes of death in adults despite the implementation of preventive measures and innovations in trauma systems. The etiology of coagulopathy in trauma patients is multifactorial and related to the kind of injury and nature of resuscitation. Trauma-induced coagulopathy (TIC) is a biochemical response involving dysregulated coagulation, altered fibrinolysis, systemic endothelial dysfunction, platelet dysfunction, and inflammatory responses due to trauma. The aim of this review is to report the pathophysiology, early diagnosis and treatment of TIC. A literature search was performed using different databases to identify relevant studies in indexed scientific journals. We reviewed the main pathophysiological mechanisms involved in the early development of TIC. Diagnostic methods have also been reported which allow early targeted therapy with pharmaceutical hemostatic agents such as TEG-based goal-directed resuscitation and fibrinolysis management. TIC is a result of a complex interaction between different pathophysiological processes. New evidence in the field of trauma immunology can, in part, help explain the intricacy of the processes that occur after trauma. However, although our knowledge of TIC has grown, improving outcomes for trauma patients, many questions still need to be answered by ongoing studies.

Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review

“…presenting with acute respiratory failure, the interstitial syndrome identified by LUS could be difficult to be attributed to COVID-19 pneumonia rather than to a decompensated previous illness [80]. A recently published systematic review including 66 articles with a pool of 4687 patients observed that the most frequent ultrasound findings in COVID-19 patients were B-lines and pleural abnormalities and confirmed the association between a high LUS score at admission and unfavourable outcomes [84][85][86]. In a retrospective study including 93 patients with a suspected COVID-19 infection admitted to the ED, LUS was found to have sensitivity and negative predictive value (93.3% and 94.1%, respectively) similar to a CT but, instead, a much lower specificity, positive predictive value, and accuracy (21.3%, 19.2%, and 33.3%, respectively) [87].…”

Safety and Metabolic Tolerance of Citrate Anticoagulation in Critically Ill Polytrauma Patients with Acute Kidney Injury Requiring an Early Continuous Kidney Replacement Therapy

“…Conversely, in the group Citrate, the blood flow rate was low to minimize the load of citrate, and this soft dialysis could play a role in ensuring the observed association with better systemic hemodynamic stability. Thirdly, it is well known that polytrauma patients present a state of severe endothelial injury, coagulation derangements, and systemic inflammation [ 37 ]. In this clinical context, some evidence supported the idea that citrate, in comparison with heparin, could improve the biocompatibility of the extracorporeal circuit, limiting the interaction between the filter membrane and the blood components [ 38 ].…”

Blood Transfusion for Major Trauma in Emergency Department

“…Patients with post-traumatic bleeding can develop hemorrhagic shock due to blood volume depletion and subsequent reduction in oxygen delivery to the microvessels and microcirculation, leading to a state of metabolic acidosis [22]. Isolated and transient hemorrhagic shock may be tolerated [23]. Hypocoagulopathy derived from the replacement of blood loss with large volumes of fluids and blood supports that lead to dilution of proteins and enzymes required for the formation of clots [24].…”