Notfall + Rettungsmedizin,
Год журнала:
2024,
Номер
unknown
Опубликована: Окт. 7, 2024
Zusammenfassung
Schwere
Traumata
stellen
ein
medizinisches
und
sozioökonomisches
Problem
mit
hohen
medizinischen
einsatztaktischen
Ansprüchen
dar.
Es
wird
prähospitaler
Fall
multiplen
penetrierenden
Verletzungen
präsentiert,
bei
dem
die
frühzeitige
Hämotherapie
am
Unfallort
zu
einer
Stabilisierung
des
klinischen
Zustands
führte,
einen
sicheren
Transport
ermöglichte
im
Überleben
ohne
neurologisches
Defizit
resultierte.
Current Opinion in Anaesthesiology,
Год журнала:
2024,
Номер
unknown
Опубликована: Янв. 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.
International Journal of Molecular Sciences,
Год журнала:
2023,
Номер
24(24), С. 17522 - 17522
Опубликована: Дек. 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.
Journal of Clinical Medicine,
Год журнала:
2024,
Номер
13(12), С. 3612 - 3612
Опубликована: Июнь 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.
Scandinavian Journal of Trauma Resuscitation and Emergency Medicine,
Год журнала:
2024,
Номер
32(1)
Опубликована: Авг. 19, 2024
Trauma
induced
coagulopathy
remains
to
be
an
important
cause
of
high
transfusion
requirements
and
mortality
shock
endotheliopathy
(SHINE)
has
been
implicated.
Current Opinion in Critical Care,
Год журнала:
2025,
Номер
unknown
Опубликована: Янв. 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.
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.
Russian Sklifosovsky Journal Emergency Medical Care,
Год журнала:
2025,
Номер
13(4), С. 617 - 630
Опубликована: Янв. 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.
Frontiers in Neurology,
Год журнала:
2025,
Номер
16
Опубликована: Май 23, 2025
Early
brain
injury
(EBI)
and
delayed
cerebral
ischemia
(DCI)
are
pivotal
contributors
to
morbidity
mortality
following
aneurysmal
subarachnoid
hemorrhage
(aSAH).
Despite
advances
that
have
reduced
incidence,
aSAH
remains
a
significant
public
health
concern
due
its
early
onset,
leading
prolonged
periods
of
diminished
quality
life
for
affected
individuals.
EBI
mechanisms,
including
endothelial
dysfunction,
blood–brain
barrier
disruption,
edema,
neuro-inflammation,
cortical
spreading
depolarizations,
oxidative
damage,
trigger
cell
death
apoptosis,
setting
the
stage
DCI
development
in
later
clinical
phases.
arises
not
only
from
large-vessel
vasospasm,
but
also
other
complex
pathophysiological
processes,
thrombo-inflammation,
microcirculatory
glycocalyx
disruption.
Recognizing
understanding
these
mechanisms
is
essential,
as
interventions
could
potentially
reduce
long-term
disability
this
population.
This
comprehensive
review
offers
an
in-depth
analysis
mechanisms.
As
our
processes
continues
evolve,
further
research
crucial
improving
outcomes
reducing
impact
aSAH.
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.
International Journal of Molecular Sciences,
Год журнала:
2024,
Номер
25(14), С. 7763 - 7763
Опубликована: Июль 16, 2024
Coagulopathy
and
traumatic
brain
injury
(TBI)
are
complexly
intertwined.
In
isolated
TBI,
coagulopathy
may
contribute
to
hemorrhagic
lesion
development,
progression,
or
recurrence,
as
it
lead
a
particular
pattern
of
called
TBI-induced
(TBI-IC).
We
performed
retrospective
descriptive
evaluation
63
patients
admitted
the
Emergency
Clinical
Hospital
Bucharest
with
diagnosis
moderate/severe
injury.
addition
demographic
data,
all
included
had
complete
paraclinical
that
rotational
thromboelastometric
(ROTEM)
blood-clot
analysis.
The
platelet
component
(PLTEM)
endotheliopathy
activation
stress
index
score
(EASIX)
were
calculated.
These
parameters
presented
comparatively
according
survival
at
30
days
helped
define
two
study
groups:
survivors
non-survivors
days.
contribution
platelets
clot
strength
is
derived
from
maximum
elasticity
(MCE)
firmness
(MCF).
MCE
defined
(MCF
×
100)/(100
-
MCF),
PLTEM
EXTEM
MCE-FIBTEM
MCE.
EASIX
novel
biomarker
recently
studied
in
TBI
patients,
calculated
following
formula:
lactate
dehydrogenase
(U/L)
creatinine
(mg/dL)/platelets
(109
cells/L).
Regarding
there
no
significant
differences
between
non-survivors.
All
ROTEM
related
amplitude
(A5,
A10,
A20,
MCF
FIBTEM
channels)
higher
group
who
survived.
Also,
was
decreased
deceased
(89.71
±
22.86
vs.
132.3
16.56
p
<
0.0001).
cut-off
point
determined
ROC
curve
114.10,
sensitivity
94.74%
specificity
93.18%,
for
detection
negative
prognosis
(death
days).
significantly
survived
event,
median
difference
value
1.15
(p
analysis
this
highlights
2.12,
88.64%
(AUC
=
0.95,
0.0001),
prediction
mortality.
comparative
markers
using
Cox
proportional
hazard
ratio
highlighted
greater
influence
has
on
time
(b
-0.05,
0.0001)
compared
0.49,
0.0026).
present
indicates
potential
TBI-IC
reflecting
mortality
prognosis.
Larger
prospective
studies
needed
confirm
their
combined
prognostic
use
decision-making
reduction
burden
disease
by
adequate
allocation
resources
personalized
timely
manner.