Massive transfusion in trauma

Current Opinion in Anaesthesiology, Journal Year: 2024, Volume and Issue: unknown

Published: Jan. 22, 2024

Purpose of review The purpose this is to provide an overview currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion. Recent findings Severe trauma patients require transfusion, but consensual international definitions shock and transfusion are missing. Current literature defines as minimum 3–4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis should trauma-induced coagulopathy substitution substantiated deficiencies. Summary To initiate therapy immediately protocols helpful focusing early control using hemostatic dressing tourniquets, correction metabolic derangements decrease according assays gases analysis tranexamic acid, fibrinogen concentrate, cells, plasma platelets recommended. Alternatively, the use whole possible. If needed, further support prothrombin complex, factor XIII or desmopressin suggested.

Language: Английский

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Shear Stress and Endothelial Mechanotransduction in Trauma Patients with Hemorrhagic Shock: Hidden Coagulopathy Pathways and Novel Therapeutic Strategies

International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(24), P. 17522 - 17522

Published: Dec. 15, 2023

Massive trauma remains a leading cause of death and global public health burden. Post-traumatic coagulopathy may be present even before the onset resuscitation, correlates with severity trauma. Several mechanisms have been proposed to explain development abnormal coagulation processes, but heterogeneity in injuries patient profiles makes it difficult define dominant mechanism. Regardless pattern death, significant role pathophysiology pathogenesis attributed exposure endothelial cells physical forces mechanical stimuli their local environment. In these conditions, cellular responses are translated into biochemical signals that induce/aggravate oxidative stress, inflammation, coagulopathy. Microvascular shear stress-induced alterations could treated or prevented by use innovative pharmacologic strategies effectively target shear-mediated dysfunction, including shear-responsive drug delivery systems novel antioxidants, targeting venous side circulation exploit beneficial antithrombogenic profile cells.

Language: Английский

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Injury induced endotheliopathy: overview, diagnosis, and management

Current Opinion in Critical Care, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 6, 2025

Purpose of review This aims to examine recent advances in the understanding injury-induced endotheliopathy and therapeutics mitigate its development critically injured patients. Recent findings Clinical studies have clearly demonstrated that syndecan-1 ectodomains can be found circulation after various types trauma injury correlates with worse outcomes. As mechanisms are better understood, pathologic hyperadhesive forms von Willebrand factor, along a relative deficiency cleaving enzyme, disintegrin metalloprotease thrombospondin type I motifs, member 13 (ADAMTS13), emerged as additional biomarkers. Therapeutics date focused primarily on protective effects fresh frozen plasma constituents restore glycocalyx. Human recombinant ADAMTS13 holds promise, do synthetic variants heparan sulfate activated protein C, although all data preclinical. Summary Injury-induced represents an important response trauma. Key biomarkers, such syndecan-1, aid diagnosis, but testing is not yet available clinically. being identified show promise. To date, has been most widely studied; however, like for endotheliopathy, it studied preclinical setting.

Language: Английский

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Targeting Inflammation After Hemorrhagic Shock as a Molecular and Experimental Journey to Improve Outcomes: A Review

Cureus, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 21, 2025

Hemorrhagic shock continues to be a major contributor trauma-related fatalities globally, posing significant and intricate pathophysiological challenge. The condition is marked by injury blood loss, which activate molecular cascades that can quickly become harmful. inflammatory response exhibits biphasic pattern, beginning with hyper-inflammatory phase transitions into immunosuppression, obstacles effective therapeutic interventions. This review article explores the mechanisms driving inflammation in hemorrhagic shock, emphasizing cellular signaling pathways, endothelial dysfunction, immune activation. We discuss role of biomarkers tracking disease progression stratifying risk, focus on markers dysfunction mediators as potential prognostic tools. Additionally, we assess strategies, spanning traditional approaches like hemostatic resuscitation advanced immunomodulatory treatments. Despite promising advancements monitoring targeted therapies, challenges persist bridging experimental findings clinical applications. Future efforts must prioritize understanding dynamic pathways refining timing interventions improve outcomes management.

Language: Английский

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Endothelial Dysfunction in Trauma: Pathogenesis, Clinical Significance, Diagnosis and Treatment

Russian Sklifosovsky Journal Emergency Medical Care, Journal Year: 2025, Volume and Issue: 13(4), P. 617 - 630

Published: Jan. 28, 2025

Severe trauma is a major medical and social problem. injures the leading cause of death in people under age 44. Many survivors become disabled. Apart from immediate victims at prehospital stage, in-hospital mortality usually due to hemorrhagic shock, coagulopathy, systemic inflammation, both infectious non-infectious nature, multiple organ failure. In last decade, significant role endothelial dysfunction development these pathological processes has been recognized. Endothelial refers excessive activation endothelium, accompanied by multisystem manifestations. This literature review presents current data on physiology normal pathogenesis trauma, its increased vascular permeability methods for diagnosis correction.

Language: Английский

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Integrating Genome-Scale Metabolic Models with Patient Plasma Metabolome to Study Endothelial Metabolism In Situ

Published: March 4, 2024

Abstract: Patient blood samples are invaluable in clinical omics databases, yet current methodologies often fail to fully uncover the molecular mechanisms driving patient pathology. While Genome-scale Metabolic Models (GEMs) show promise systems medicine by integrating various data, having only exometabolomic data remains a limiting factor. To address this gap, we introduce comprehensive pipeline GEMs with plasma metabolome. This constructs case-specific using literature-based and patient-specific metabolomic data. Novel computational methods, including adaptive sampling an in-house developed algorithm for rational exploration of sampled space solutions, enhance integration accuracy while improving performance. Model characterization involves task analysis combination clustering methods identify critical cellular functions. The new was applied cohort trauma patients investigates shock-induced endotheliopathy metabolome By analyzing endothelial cell metabolism comprehensively, identified substrates contributed development targeted therapeutic strategies. Our study demonstrates efficacy into models analyze disease contexts. approach offers deeper understanding metabolic dysregulations provides insights diseases components potential treatments.

Language: Английский

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The Role of Viscoelastic Testing in Assessing Hemostasis: A Challenge to Standard Laboratory Assays?

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(12), P. 3612 - 3612

Published: June 20, 2024

Viscoelastic testing is increasingly being used in clinical and research settings to assess hemostasis. Indeed, there are potential situations which viscoelastic reportedly superior standard routine laboratory for We report the current platforms terminology, as well providing a concise narrative review of published evidence guide its use various settings. Notably, increasing utility assessment direct oral anticoagulants, bleeding associated with chronic liver disease, orthotopic transplantation, cardiac surgery, trauma, obstetrics pediatrics.

Language: Английский

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Beyond Trauma-Induced Coagulopathy: Detection of Auto-Heparinization as a Marker of Endotheliopathy Using Rotational Thromboelastometry

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(14), P. 4219 - 4219

Published: July 19, 2024

Background/Objectives: The complexity of trauma-induced coagulopathy (TIC) is a result the unique interactions between patient, trauma, and resuscitation-related causes. main objective trauma resuscitation to create optimal milieu for both development immediate reparatory mechanisms prevention further secondary injuries. Endotheliopathy represents one hallmarks coagulopathy, comprises endothelial dysfunction, abnormal coagulation, inflammation, all which arise after severe hemorrhagic shock. Methods: We retrospectively descriptively evaluated 217 patients admitted Bucharest Clinical Emergency Hospital who met Berlin criteria diagnosis multiple trauma. Patients with high suspicion auto-heparinization were identified according dynamic clinical para-clinical evolution subsequently tested using rotational thromboelastometry (ROTEM). ratio clot formation time (CT) was used, obtained on two channels interest (INTEM/HEPTEM). Results: Among mean age 43.43 ± 15.45 years injury severity score (ISS) 36.98 1.875, 42 had reasonable auto-heparinization, later confirmed by INTEM/HEPTEM clotting in 28 cases (12.9% from entire study population). A linear regression analysis highlighted that serum lactate (estimated 0.02, p = 0.0098) noradrenaline requirement 0.03, 0.0053) influenced CT (INTEM/HEPTEM) ratio. Conclusions: There subset only levels patients’ need vasopressor use, reinforcing relationship shock, hypoperfusion, derangements. This emphasizes response each patient has

Language: Английский

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Early Fibrinogen Replacement to Treat the Endotheliopathy of Trauma: Novel Resuscitation Strategies in Severe Trauma

Anesthesiology, Journal Year: 2023, Volume and Issue: 139(5), P. 675 - 683

Published: Oct. 6, 2023

The authors provide a comprehensive review of the endothelial glycocalyx, components that may be targeted to improve clinical outcomes, and next steps for evaluation in human subjects.

Language: Английский

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Damage Control Resuscitation in Traumatic Hemorrhage: It Is More Than Fixing the Holes and Filling the Tank

Anesthesiology, Journal Year: 2023, Volume and Issue: 140(3), P. 586 - 598

Published: Nov. 20, 2023

Summary StatementDamage control resuscitation is the foundation of hemorrhagic shock management and includes early administration plasma, tranexamic acid, limited crystalloid-containing products.

Language: Английский

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