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Hypothermia AND coagulation

Boris Shenkman, Ivan Budnik, Yulia Einav, Hagit Hauschner, Mykhaylo Andrejchin, Uriel Martinowitz
BACKGROUND: Trauma-induced coagulopathy (TIC) is commonly seen among patients with severe injury. The dynamic process of TIC is characterized by variability of the features of the disease. METHODS: A model of TIC was created. Hemodilution was produced by mixing the blood with 40% TRIS/saline solution, fibrinolysis by treating the blood with 160 ng/mL tPA, acidosis by adding 1.2 mg/mL lactic acid achieving pH 7.0-7.1, and hypothermia by running the assay at 31 °C...
October 25, 2016: Journal of Trauma and Acute Care Surgery
Xiaoqi Zhao, Tianxiang Gu, Zongyi Xiu, Enyi Shi, Lei Yu
Objective: To summarize the effect of mild hypothermia on function of the organs in patients with multiple organ dysfunction syndrome after cardiopulmonary bypass surgery. Methods: The patients were randomly divided into two groups, northermia group (n=71) and hypothermia group (n=89). We immediately began cooling the hypothermia group when test results showed multiple organ dysfunction syndrome, meanwhile all patients of two groups were drawn blood to test blood gas, liver and kidney function, blood coagulation function, and evaluated the cardiac function using echocardiography from 12 to 36 hours...
May 2016: Brazilian Journal of Cardiovascular Surgery
Y E Chee, S E Liu, M G Irwin
Management of acute coagulopathy and blood loss during major vascular procedures poses a significant haemostatic challenge to anaesthetists. The acute coagulopathy is multifactorial in origin with tissue injury and hypotension as the precipitating factors, followed by dilution, hypothermia, acidemia, hyperfibrinolysis and systemic inflammatory response, all acting as a self-perpetuating spiral of events. The problem is confounded by the high prevalence of antithrombotic agent use in these patients and intraoperative heparin administration...
September 2016: British Journal of Anaesthesia
Fabrice Vanhuyse, Nicolas Ducrocq, Huguette Louis, Narimane Al Kattani, Nicolas Laurent, Frédérique Joineau-Groubatch, Aude Falanga, Juan-Pablo Maureira, Antoine Kimmoun, Nicolas Girerd, Nguyen Tran, Bruno Levy
Cardiogenic shock (CS) patients treated with ECMO have severe cardiac failure, associated with ischemia-reperfusion. The use of moderate hypothermia during ischemia-reperfusion syndrome is supported by experimental data. We therefore studied the effects of moderate hypothermia on cardiac and vascular function in pig ischemic CS treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Cardiogenic shock was induced in 12 anesthetized pigs by coronary ligation. After one hour of CS, VA-ECMO was initiated and pigs were randomized to normothermia (38°C) or moderate hypothermia (34°C) during 8 hours...
August 2, 2016: Shock
Pınar Kendigelen, Zeynep Kamalak, Deniz Abat
Early management of rapid massive hemorrhage requires early administration of blood products and rapid surgical control of bleeding. Professionals in peripheral hospitals with limited resources often work under conditions similar to those in the military. Described in the present report are 3 cases in which warm fresh whole blood (WFWB) was used in patients with massive bleeding who presented to a peripheral hospital that had no blood products suitable for emergency conditions. Described first is the case of a 16-year-old female patient who underwent emergency cesarean section...
March 2016: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Fanny Vardon, Ségolène Mrozek, Thomas Geeraerts, Olivier Fourcade
Hypothermia, along with acidosis and coagulopathy, is part of the lethal triad that worsen the prognosis of severe trauma patients. While accidental hypothermia is easy to identify by a simple measurement, it is no less pernicious if it is not detected or treated in the initial phase of patient care. It is a multifactorial process and is a factor of mortality in severe trauma cases. The consequences of hypothermia are many: it modifies myocardial contractions and may induce arrhythmias; it contributes to trauma-induced coagulopathy; from an immunological point of view, it diminishes inflammatory response and increases the chance of pneumonia in the patient; it inhibits the elimination of anaesthetic drugs and can complicate the calculation of dosing requirements; and it leads to an over-estimation of coagulation factor activities...
May 13, 2016: Anaesthesia, Critical Care & Pain Medicine
Anni Nørgaard Jeppesen, Hans Kirkegaard, Susanne Ilkjær, Anne Mette Hvas
BACKGROUND: Coagulation can be visualised using whole blood coagulation analyses such as thromboelastometry and platelet aggregation tests; however, the role of temperature in the analyses is ambiguous. The aim was to examine whether temperature influences the whole blood coagulation tests. METHODS: We included 40 patients treated with targeted temperature management (33 ± 1 °C) after out-of-hospital cardiac arrest. The blood samples were obtained on hypothermia and normothermia...
2016: Critical Care: the Official Journal of the Critical Care Forum
Christine M Leeper, Isam Nasr, Christine McKenna, Rachel P Berger, Barbara A Gaines
BACKGROUND: Victims of abusive head trauma have poor outcomes compared with other injured children. There is often a delay in diagnosis because these young patients are unable to communicate with health care providers. These critically injured patients would benefit from early identification and therapy. METHODS: We performed a retrospective review of our single hospital trauma registry from 2005 to 2014. All Level 1 pediatric (age 0-17 years) trauma patients who sustained abusive head trauma were included...
May 2016: Journal of Trauma and Acute Care Surgery
Ryan Perlman, Jeannie Callum, Claude Laflamme, Homer Tien, Barto Nascimento, Andrew Beckett, Asim Alam
Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming...
2016: Critical Care: the Official Journal of the Critical Care Forum
Arne Driessen, Matthias Fröhlich, Nadine Schäfer, Manuel Mutschler, Jerome M Defosse, Thomas Brockamp, Bertil Bouillon, Ewa K Stürmer, Rolf Lefering, Marc Maegele
BACKGROUND: Various studies have shown the deleterious effect of high volume resuscitation following severe trauma promoting coagulopathy by haemodilution, acidosis and hypothermia. As the optimal resuscitation strategy during prehospital trauma care is still discussed, we raised the question if the amount and kind of fluids administered changed over the recent years. Further, if less volume was administered, fewer patients should have arrived in coagulopathic depletion in the Emergency Department resulting in less blood product transfusions...
2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Oliver M Theusinger, Donat R Spahn
BACKGROUND: Orthopedic surgery, especially spine and spinal deformity surgery, may be associated with high perioperative blood loss. In order to reduce the risk of excessive blood loss and unnecessary blood transfusions, strategies such as Patient Blood Management including goal-directed coagulation management have been developed. RECENT FINDINGS: Adverse effects of allogeneic blood transfusions have been shown for most surgical fields including orthopedic surgery...
March 2016: Best Practice & Research. Clinical Anaesthesiology
Jeffrey J Cies, Wayne S Moore, Susan B Conley, Mindy J Dickerman, Christine Small, Dominick Carella, Paul Shea, Jason Parker, Arun Chopra
Pharmacokinetic parameters can be significantly altered for both extracorporeal life support (ECLS) and continuous renal replacement therapy (CRRT). This case report describes the pharmacokinetics of continuous-infusion meropenem in a patient on ECLS with concurrent CRRT. A 2.8-kg, 10-day-old, full-term neonate born via spontaneous vaginal delivery presented with hypothermia, lethargy, and a ~500-g weight loss from birth. She progressed to respiratory failure on hospital day 2 (HD 2) and developed sepsis, disseminated intravascular coagulation, and liver failure as a result of disseminated adenoviral infection...
January 2016: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
Angelo D'Alessandro, Hunter B Moore, Ernest E Moore, Matthew J Wither, Travis Nemkov, Alexander P Morton, Eduardo Gonzalez, Michael P Chapman, Miguel Fragoso, Anne Slaughter, Angela Sauaia, Christopher C Silliman, Kirk C Hansen, Anirban Banerjee
The use of aggressive crystalloid resuscitation to treat hypoxemia, hypovolemia, and nutrient deprivation promoted by massive blood loss may lead to the development of the blood vicious cycle of acidosis, hypothermia, and coagulopathy and, utterly, death. Metabolic acidosis is one of the many metabolic derangements triggered by severe trauma/hemorrhagic shock, also including enhanced proteolysis, lipid mobilization, as well as traumatic diabetes. Appreciation of the metabolic benefit of plasma first resuscitation is an important concept...
August 2016: Shock
G J Glas, M Levi, M J Schultz
Severe burn injury is associated with systemic coagulopathy. The changes in coagulation described in patients with severe burns resemble those found patients with sepsis or major trauma. Coagulopathy in patients with severe burns is characterized by procoagulant changes, and impaired fibrinolytic and natural anticoagulation systems. Both the timing of onset and the severity of hemostatic derangements are related to the severity of the burn. The exact pathophysiology and time course of coagulopathy are uncertain, but, at least in part, result from hemodilution and hypothermia...
May 2016: Journal of Thrombosis and Haemostasis: JTH
Satoshi Gando, Mineji Hayakawa
Trauma-induced coagulopathy is caused by multiple factors, such as anemia, hemodilution, hypothermia, acidosis, shock, and serious trauma itself, which affects patient outcomes due to critical bleeding requiring massive transfusion. Disseminated intravascular coagulation (DIC) with the fibrinolytic phenotype directly caused by trauma and/or traumatic shock has been considered to be the primary pathophysiology of trauma-induced coagulopathy. The key to controlling DIC is vigorous treatment of the underlying disorder, that is, trauma itself and hemorrhagic shock...
March 2016: Seminars in Thrombosis and Hemostasis
Christine Leeper, Isam Nasr, Christine McKenna, Rachel P Berger, Barbara A Gaines
BACKGROUND: Victims of abusive head trauma have poor outcomes compared to other injured children. There is often a delay in diagnosis as these young patients are unable to communicate with healthcare providers. These critically injured patients would benefit from early identification and therapy. METHODS: We performed a retrospective review of our single hospital trauma registry from 2005-2014. All level 1 pediatric (age 0-17) trauma patients who sustained abusive head trauma were included...
December 26, 2015: Journal of Trauma and Acute Care Surgery
E Guerado, A Medina, M I Mata, J M Galvan, M L Bertrand
PURPOSE: An update paper on massive bleeding after major trauma. A review of protocols to address massive bleeding, and its possible complications, including coagulation abnormalities, complications related to blood storage, immunosuppression and infection, lung injury associated with transfusion, and hypothermia is carried out. METHODS: Literature review and discussion with authors' experience. RESULTS: Massive bleeding is an acute life-threatening complication of major trauma, and consequently its prompt diagnosis and treatment is of overwhelming importance...
June 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Anne Katrine Wulff Nielsen, Anni Nørgaard Jeppesen, Hans Kirkegaard, Anne-Mette Hvas
AIM: Therapeutic hypothermia improves neurological outcome in patients resuscitated after out-of-hospital cardiac arrest. The aim was to investigate whether therapeutic hypothermia induced impaired coagulation. METHODS: Changes in coagulation were investigated in 22 out-of-hospital cardiac arrest patients treated with therapeutic hypothermia (33 ± 1 °C). Blood samples were obtained after 22 ± 2h of hypothermia and compared with normothermic samples drawn 48 h later...
January 2016: Resuscitation
Elisabeth Knöller, Tatjana Stenzel, Friederike Broeskamp, Rouven Hornung, Angelika Scheuerle, Oscar McCook, Ulrich Wachter, Josef A Vogt, José Matallo, Martin Wepler, Holger Gässler, Michael Gröger, Martin Matejovic, Enrico Calzia, Lorenz Lampl, Michael Georgieff, Peter Möller, Pierre Asfar, Peter Radermacher, Sebastian Hafner
OBJECTIVE: Hemorrhagic shock-induced tissue hypoxia induces hyperinflammation, ultimately causing multiple organ failure. Hyperoxia and hypothermia can attenuate tissue hypoxia due to increased oxygen supply and decreased demand, respectively. Therefore, we tested the hypothesis whether mild therapeutic hypothermia and hyperoxia would attenuate postshock hyperinflammation and thereby organ dysfunction. DESIGN: Prospective, controlled, randomized study. SETTING: University animal research laboratory...
May 2016: Critical Care Medicine
Katharina Rose Luise Schmitt, Katsiaryna Fedarava, Georgia Justus, Mathias Redlin, Wolfgang Böttcher, Eva Maria Delmo Walter, Roland Hetzer, Felix Berger, Oliver Miera
Minimizing the systemic inflammatory response caused by cardiopulmonary bypass is a major concern. It has been suggested that the perfusion temperature affects the inflammatory response. The aim of this prospective study was to compare the effects of moderate hypothermia (32°C) and normothermia (36°C) during cardiopulmonary bypass on markers of the inflammatory response and clinical outcomes (time on ventilator) after surgical closure of ventricular septal defects. During surgical closure of ventricular septal defects under cardiopulmonary bypass, 20 children (median age 4...
May 2016: Artificial Organs
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