Shock : molecular, cellular, and systemic pathobiological aspects and therapeutic approaches : the official journal the Shock Society, the European Shock Society, the Brazilian Shock Society, the International Federation of Shock Societies
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Trauma remains the leading cause of death with bleeding as the primary cause of preventable mortality during the first 24 h following trauma. When death occurs, it happens quickly, typically within the first 6 h after injury. One of four patients to arrive in the emergency department after trauma is already in the state of acute traumatic coagulopathy and shock. ⋯ In contrast, there is an iatrogenic coagulopathy that occurs secondary to uncritical volume therapy leading to acidosis, hypothermia, and hemodilution. This coagulopathy then may be an integral part of the "vicious cycle" when combined with acidosis and hypothermia. The present article summarizes an update on the principal mechanisms and triggers of the coagulopathy of trauma including traumatic brain injury.
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Comparative Study
Hemostatic function of apheresis platelets stored at 4 °C and 22 °C.
Platelet refrigeration decreases the risk of bacterial contamination and may preserve function better than standard-of-care room temperature (RT) storage. Benefits could include lower transfusion-related complications, decreased costs, improved hemostasis in acutely bleeding patients, and extended shelf life. In this study, we compared the effects of 22°C and 4°C storage on the functional and activation status of apheresis platelets. ⋯ Apheresis platelets stored at 4°C maintain more viable metabolic characteristics, are hemostatically more effective, and release fewer proinflammatory mediators than apheresis platelets stored at RT over 5 days. Given the superior bacteriologic safety of refrigerated products, these data suggest that cold-stored platelets may improve outcomes for acutely bleeding patients.
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Toward the end of World War I and during World War II, whole-blood transfusions were the primary agent in the treatment of military traumatic hemorrhage. However, after World War II, the fractionation of whole blood into its components became widely accepted and replaced whole-blood transfusion to better accommodate specific blood deficiencies, logistics, and financial reasons. This transition occurred with very few clinical trials to determine which patient populations or scenarios would or would not benefit from the change. ⋯ In addition, several recent military studies suggest a survival advantage of early use of whole blood, but the safety concerns have limited is widespread civilian use. Based on extensive military experience as well as recent published literature, low-titer leukocyte reduced cold-store type O whole blood carries low adverse risks and maintains its hemostatic properties for up to 21 days. A prospective randomized trial comparing whole blood versus ratio balanced component therapy is proposed with rationale provided.
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Increasing evidence suggests that dysnatremia at intensive care unit (ICU) admission may predict mortality. Little information is available, however, on the potential effect of dysnatremia correction. This is an observational multicenter cohort study in patients admitted between 2005 and 2012 to 18 French ICUs. ⋯ Median correction rate from days 1 to 3 was 2.58 mmol/L per day (interquartile range, 0.67 - 4.55). Higher natremia correction rate was associated with lower crude and adjusted day 28 mortality rates (OR per mmol/L per day, 0.97; 95% CI, 0.94 - 1.00; P = 0.04; and OR per mmol/L per day, 0.93; 95% CI, 0.90 - 0.97; P = 0.0003, respectively). Our results indicate that dysnatremia correction is independently associated with survival, with the effect being greater with faster correction rates of up to 12 mmol/L per day.
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This year, the Trauma Hemostasis and Oxygenation Research Network had its third annual conference from June 17 to 19 at the Solstrand Hotel, near Bergen, Norway. It was sponsored and organized by the Norwegian Naval Special Operation Commando together with the Norwegian Air Ambulance Foundation. The Trauma Hemostasis and Oxygenation Research Network is composed of more than 150 members from 16 countries who all have a common interest in the prevention and treatment of traumatic hemorrhagic shock. The network is multidisciplinary to include members from both the military and civilian medical community representing areas of surgery, critical care, emergency medicine, transfusion medicine, anesthesiology, hematology, and basic science.