• J Boldt, T Menges, M Wollbrück, S Sonneborn, and G Hempelmann.
• Department of Anesthesiology and Intensive Care Medicine, Justus-Liebig-University Giessen, Germany.
• Chest. 1994 Sep 1; 106 (3): 899903899-903.

ObjectiveThe critically ill patient is at risk to develop coagulation abnormalities at different levels. Platelet dysfunction in these patients is of multifactorial origin, including drug interactions, hormonal response, and infection. The time course of platelet function in severely traumatized patients was studied.DesignProspective.SettingClinical investigation, intensive care unit (ICU) of an university hospital.PatientsTwenty-six consecutive, severely traumatized patients (injury severity score [ISS] > 30 points) were studied. The patients were divided into those who showed an uncomplicated course (n = 16) and those who developed sepsis during the investigation period ("complicated" trauma; n = 10).InterventionsAll therapy (parenteral feeding, antibiotics, volume therapy, ventilation) was comparable for all patients.MeasurementsPlatelet function was assessed by aggregometry (inductors: adenosine diphosphate [ADP], 2.0 mumol/L; collagen, 4 micrograms/ml; epinephrine, 25 mumol/L; NaCl). Aggregometry was carried out from arterial blood samples within 24 h after admission to the ICU ("baseline") and the following 5 days.ResultsStandard coagulation variables (antithrombin III, fibrinogen, platelet count) showed no significant differences between the two groups. Platelet aggregation parameters were already reduced when the patients were admitted to ICU in all patients. In "uncomplicated" patients (without sepsis), aggregation increased during the following 5 days (maximal aggregation: ADP from 41 percent to 54 percent; collagen from 36 percent to 48 percent; epinephrine from 32 percent to 61 percent). Maximum gradient of platelet aggregation had a similar course. In the traumatized patients with sepsis, ADP- and collagen induced aggregation was significantly reduced within the investigation period. All patients with an ADP aggregation of less than 20 percent died.ConclusionsPlatelet function in patients with isolated trauma recovered during the following 5 days. When sepsis complicated trauma, complex derangements in platelet function were present as seen by altered platelet aggregometry despite adequate platelet count.

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