Resuscitative Strategies in Traumatic Hemorrhagic Shock

Overview

Journal Ann Intensive Care

Specialty Critical Care

Date 2013 Jan 15

PMID 23311726

Citations 52

Authors

Adrien Bougle

Anatole Harrois

Jacques Duranteau

Affiliations

Soon will be listed here.

Abstract

Managing trauma patients with hemorrhagic shock is complex and difficult. Despite our knowledge of the pathophysiology of hemorrhagic shock in trauma patients that we have accumulated during recent decades, the mortality rate of these patients remains high. In the acute phase of hemorrhage, the therapeutic priority is to stop the bleeding as quickly as possible. As long as this bleeding is uncontrolled, the physician must maintain oxygen delivery to limit tissue hypoxia, inflammation, and organ dysfunction. This process involves fluid resuscitation, the use of vasopressors, and blood transfusion to prevent or correct acute coagulopathy of trauma. The optimal resuscitative strategy is controversial. To move forward, we need to establish optimal therapeutic approaches with clear objectives for fluid resuscitation, blood pressure, and hemoglobin levels to guide resuscitation and limit the risk of fluid overload and transfusion.

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References

Gelman S, Mushlin P . Catecholamine-induced changes in the splanchnic circulation affecting systemic hemodynamics. Anesthesiology. 2004; 100(2):434-9. DOI: 10.1097/00000542-200402000-00036. View

Vincent J, Rossaint R, Riou B, Ozier Y, Zideman D, Spahn D . Recommendations on the use of recombinant activated factor VII as an adjunctive treatment for massive bleeding--a European perspective. Crit Care. 2006; 10(4):R120. PMC: 1750973. DOI: 10.1186/cc5026. View

Brenni M, Worn M, Bruesch M, Spahn D, Ganter M . Successful rotational thromboelastometry-guided treatment of traumatic haemorrhage, hyperfibrinolysis and coagulopathy. Acta Anaesthesiol Scand. 2009; 54(1):111-7. DOI: 10.1111/j.1399-6576.2009.02132.x. View

Handy J, Soni N . Physiological effects of hyperchloraemia and acidosis. Br J Anaesth. 2008; 101(2):141-50. DOI: 10.1093/bja/aen148. View

Imai Y, Satoh K, Taira N . Role of the peripheral vasculature in changes in venous return caused by isoproterenol, norepinephrine, and methoxamine in anesthetized dogs. Circ Res. 1978; 43(4):553-61. DOI: 10.1161/01.res.43.4.553. View

Young M, Riddez L, Kjellstrom B, Bursell J, Winslow F, Lohman J . MalPEG-hemoglobin (MP4) improves hemodynamics, acid-base status, and survival after uncontrolled hemorrhage in anesthetized swine. Crit Care Med. 2005; 33(8):1794-804. DOI: 10.1097/01.ccm.0000172648.55309.13. View

Toy P, Gajic O, Bacchetti P, Looney M, Gropper M, Hubmayr R . Transfusion-related acute lung injury: incidence and risk factors. Blood. 2011; 119(7):1757-67. PMC: 3286351. DOI: 10.1182/blood-2011-08-370932. View

Watson G, Sperry J, Rosengart M, Minei J, Harbrecht B, Moore E . Fresh frozen plasma is independently associated with a higher risk of multiple organ failure and acute respiratory distress syndrome. J Trauma. 2009; 67(2):221-7. DOI: 10.1097/TA.0b013e3181ad5957. View

Kashuk J, Moore E, Johnson J, Haenel J, Wilson M, Moore J . Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma:packed red blood cells the answer?. J Trauma. 2008; 65(2):261-70. DOI: 10.1097/TA.0b013e31817de3e1. View

10.

Hebert P, Wells G, Blajchman M, Marshall J, Martin C, Pagliarello G . A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med. 1999; 340(6):409-17. DOI: 10.1056/NEJM199902113400601. View

11.

Schochl H, Nienaber U, Hofer G, Voelckel W, Jambor C, Scharbert G . Goal-directed coagulation management of major trauma patients using thromboelastometry (ROTEM)-guided administration of fibrinogen concentrate and prothrombin complex concentrate. Crit Care. 2010; 14(2):R55. PMC: 2887173. DOI: 10.1186/cc8948. View

12.

Carroll R, Craft R, Langdon R, Clanton C, Snider C, Wellons D . Early evaluation of acute traumatic coagulopathy by thrombelastography. Transl Res. 2009; 154(1):34-9. DOI: 10.1016/j.trsl.2009.04.001. View

13.

Bickell W, Wall Jr M, Pepe P, Martin R, Ginger V, Allen M . Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994; 331(17):1105-9. DOI: 10.1056/NEJM199410273311701. View

14.

Haut E, Kalish B, Cotton B, Efron D, Haider A, Stevens K . Prehospital intravenous fluid administration is associated with higher mortality in trauma patients: a National Trauma Data Bank analysis. Ann Surg. 2010; 253(2):371-7. DOI: 10.1097/SLA.0b013e318207c24f. View

15.

Finfer S, Bellomo R, Boyce N, French J, Myburgh J, Norton R . A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N Engl J Med. 2004; 350(22):2247-56. DOI: 10.1056/NEJMoa040232. View

16.

Smith M, Stiefel M, Magge S, Frangos S, Bloom S, Gracias V . Packed red blood cell transfusion increases local cerebral oxygenation. Crit Care Med. 2005; 33(5):1104-8. DOI: 10.1097/01.ccm.0000162685.60609.49. View

17.

Perel P, Roberts I . Colloids versus crystalloids for fluid resuscitation in critically ill patients. Cochrane Database Syst Rev. 2011; (3):CD000567. DOI: 10.1002/14651858.CD000567.pub4. View

18.

Sperry J, Minei J, Frankel H, West M, Harbrecht B, Moore E . Early use of vasopressors after injury: caution before constriction. J Trauma. 2008; 64(1):9-14. DOI: 10.1097/TA.0b013e31815dd029. View

19.

Dutton R, Mackenzie C, Scalea T . Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma. 2002; 52(6):1141-6. DOI: 10.1097/00005373-200206000-00020. View

20.

Brohi K, Cohen M, Davenport R . Acute coagulopathy of trauma: mechanism, identification and effect. Curr Opin Crit Care. 2007; 13(6):680-5. DOI: 10.1097/MCC.0b013e3282f1e78f. View