Massive transfusion in trauma

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.

Язык: 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, 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.

Язык: Английский

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

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.

Язык: Английский

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Injury induced endotheliopathy: overview, diagnosis, and management

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.

Язык: Английский

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

Cureus, Год журнала: 2025, Номер unknown

Опубликована: Янв. 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.

Язык: Английский

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

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.

Язык: Английский

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Pathophysiological mechanisms underlying early brain injury and delayed cerebral ischemia in the aftermath of aneurysmal subarachnoid hemorrhage: a comprehensive analysis

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.

Язык: Английский

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Trauma induced coagulopathy is limited to only one out of four shock induced endotheliopathy (SHINE) phenotypes among moderate-severely injured trauma patients: an exploratory analysis

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.

Язык: Английский

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

Опубликована: Март 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.

Язык: Английский

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Platelet Contribution and Endothelial Activation and Stress Index-Potential Mortality Predictors in Traumatic Brain Injury

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.

Язык: Английский

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