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Intensive Care Medicine

Published in:

01-04-2011 | Review

Coagulation management in multiple trauma: a systematic review

Authors: Heiko Lier, Bernd W. Böttiger, Jochen Hinkelbein, Henning Krep, Michael Bernhard

Published in: Intensive Care Medicine | Issue 4/2011

Abstract

Purpose

The management of trauma patients suffering from active bleeding has improved with a better understanding of trauma-induced coagulopathy. The aim of this manuscript is to give recommendations for coagulation management.

Methods

A systematic literature search in the PubMed database was performed for articles published between January 2000 and August 2009. A total of 230 articles were included in the present systematic review.

Conclusions

The “coagulopathy of trauma” is a discrete disease which has a decisive influence on survival. Diagnosis and therapy of deranged coagulation should start immediately after admission to the emergency department. A specific protocol for massive transfusion should be introduced and continued. Loss of body temperature should be prevented and treated. Acidaemia should be prevented and treated by appropriate shock therapy. If massive transfusion is performed using fresh frozen plasma (FFP), a ratio of FFP to pRBC (packed red blood cells) of 1:2–1:1 should be achieved. Fibrinogen should be substituted at levels of <1.5 g/L. For patients suffering from active bleeding, permissive hypotension (i.e. mean arterial pressure ~65 mmHg) may be aimed for until surgical cessation of bleeding. This option is contraindicated in injuries of the central nervous system and in patients with coronary heart disease, or with known hypertension. Thrombelastography or -metry may be performed to guide coagulation diagnosis and substitution. Hypocalcaemia <0.9 mmol/L should be avoided and may be treated. For actively bleeding patients, pRBC may be given at haemoglobin <10 g/L (6.2 mmol/L) and haematocrit may be targeted at 30%.

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Title: Coagulation management in multiple trauma: a systematic review
Authors: Heiko Lier
Bernd W. Böttiger
Jochen Hinkelbein
Henning Krep
Michael Bernhard
Publication date: 01-04-2011
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2139-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Coagulation management in multiple trauma: a systematic review

Abstract

Purpose

Methods

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Conclusions

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