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Hypothermia AND coagulation

Penny S Reynolds, Bernard J Fisher, Jacquelyn McCarter, Christopher Sweeney, Erika J Martin, Paul Middleton, Matthew Ellenberg, Evan Fowler, Donald F Brophy, Alpha A Fowler, Bruce D Spiess, Ramesh Natarajan
BACKGROUND: Coagulopathy and inflammation induced by hemorrhagic shock and traumatic injury are associated with increased mortality and morbidity. Vitamin C (VitC) is an antioxidant with potential protective effects on the pro-inflammatory and pro-coagulant pathways. We hypothesized that high-dose VitC administered as a supplement to fluid resuscitation would attenuate inflammation, coagulation dysfunction, and end-organ tissue damage in a swine model of polytrauma and hemorrhage. METHODS: Male Sinclair swine (n = 24; mean body weight 27 kg) were anesthetized, intubated, mechanically ventilated, and instrumented for physiological monitoring...
March 12, 2018: Journal of Trauma and Acute Care Surgery
Anna Clebone
PURPOSE OF REVIEW: Trauma is the most common cause of pediatric mortality. Much of the research that led to life-saving interventions in adults, however, has not been replicated in the pediatric population. Children have important physiologic and anatomic differences from adults, which impact hemostasis and transfusion. Hemorrhage is a leading cause of death in trauma, and children have important differences in their coagulation profiles. Transfusion strategies, including the massive transfusion protocol and use of antifibrinolytics, are still controversial...
April 2018: Current Opinion in Anaesthesiology
Mahek Shah, Kaushal Parikh, Brijesh Patel, Manyoo Agarwal, Lohit Garg, Sahil Agrawal, Shilpkumar Arora, Nilay Patel, Nainesh Patel, William H Frishman
OBJECTIVES: The study aimed to assess the impact of therapeutic hypothermia (TH) on bleeding and in-hospital mortality among patients with coagulation disorders (CD). BACKGROUND: TH affects coagulation factors and platelets putting patients at risk for bleeding and worse outcomes. Effect of TH among patients with CD remains understudied. METHODS: Between 2009 and 2014, a total of 6,469 cases of TH were identified using the National Inpatient Sample out of which 1,036 (16...
January 3, 2018: Resuscitation
Tomasz Derkowski, Sylweriusz Kosiński, Paweł Podsiadło, Tomasz Sanak, Kinga Sałapa, Arkadiusz Wejnarski, Robert Gałązkowski, Tomasz Darocha
Polish Medical Air Rescue is tasked to deal with the most serious incidents associated with life threatening situations, in multiple circumstances. As a consequence, medical personnel have to meet high standards of education and show a continuous theoretical and practical development of the skills which are necessary during medical treatment. Thanks to the introduction of ECMO treatment for accidental hypothermia patients, new clinical and operational possibilities have arisen, so more patients can be saved with a very good neurological outcome...
2017: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Jonathan H Chow, Khang Lee, Ezeldeen Abuelkasem, Obi R Udekwu, Kenichi A Tanaka
Coagulation management, and transfusion practice in liver transplantation (LT) have been evolving in the recent years due to better understanding of coagulation abnormalities in end-stage liver disease, and clinical management of LT patients. Avoidance of allogeneic blood components is feasible in some patients, but multi-modal coagulation therapies may be necessary in others who develop complex coagulopathy due to hemorrhage, hemodilution, hypothermia, and acid-base disturbances. Transfusions of plasma and cryoprecipitate remain to be the mainstay therapy for procoagulant factor replacement during LT...
November 1, 2017: Seminars in Cardiothoracic and Vascular Anesthesia
B Malgras, B Prunet, X Lesaffre, G Boddaert, S Travers, P-J Cungi, E Hornez, O Barbier, H Lefort, S Beaume, M Bignand, J Cotte, P Esnault, J-L Daban, J Bordes, E Meaudre, J-P Tourtier, S Gaujoux, S Bonnet
The concept of damage control (DC) is based on a sequential therapeutic strategy that favors physiological restoration over anatomical repair in patients presenting acutely with hemorrhagic trauma. Initially described as damage control surgery (DCS) for war-wounded patients with abdominal penetrating hemorrhagic trauma, this concept is articulated in three steps: surgical control of lesions (hemostasis, sealing of intestinal spillage), physiological restoration, then surgery for definitive repair. This concept was quickly adapted for intensive care management under the name damage control resuscitation (DCR), which refers to the modalities of hospital resuscitation carried out in patients suffering from traumatic hemorrhagic shock within the context of DCS...
December 2017: Journal of Visceral Surgery
H Erhan Güven
Massive hemorrhage causes instant and early deaths because of hypovolemia. However, even if the victim makes it to the hospital, hypothermia, metabolic acidosis, and coagulation impairments caused by bleeding pose a great risk for survival. Many topical hemostatic agents are developed for neck, armpit, or groin injuries that are not amenable to tourniquet application and for extremity wounds to be used in conjunction with tourniquets. This paper focuses on those hemostatics that differ based on the action mechanism and are suitable for pre-hospital setting and summarizes the latest recommendations regarding their usage...
September 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Jill M Cholette, David Faraoni, Susan M Goobie, Victor Ferraris, Nabil Hassan
Efforts to reduce blood product transfusions and adopt blood conservation strategies for infants and children undergoing cardiac surgical procedures are ongoing. Children typically receive red blood cell and coagulant blood products perioperatively for many reasons, including developmental alterations of their hemostatic system, and hemodilution and hypothermia with cardiopulmonary bypass that incites inflammation and coagulopathy and requires systemic anticoagulation. The complexity of their surgical procedures, complex cardiopulmonary interactions, and risk for inadequate oxygen delivery and postoperative bleeding further contribute to blood product utilization in this vulnerable population...
October 5, 2017: Anesthesia and Analgesia
Robert G Hahn
Guidelines for infusion fluid therapy rarely take into account that adverse effects occur in a dose-dependent fashion. Adverse effects of crystalloid fluids are related to their preferential distribution to the interstitium of the subcutis, the gut, and the lungs. The gastrointestinal recovery time is prolonged by 2 days when more than 2 litres is administered. Infusion of 6-7 litres during open abdominal surgery results in poor wound healing, pulmonary oedema, and pneumonia. There is also a risk of fatal postoperative pulmonary oedema that might develop several days after the surgery...
2017: Anaesthesiology Intensive Therapy
Douglas R Thompson, David Zurakowski, Charles M Haberkern, Paul A Stricker, Petra M Meier, Carolyn Bannister, Hubert Benzon, Wendy Binstock, Adrian Bosenberg, Alyssa Brzenski, Stefan Budac, Veronica Busso, Samantha Capehart, Franklin Chiao, Franklyn Cladis, Michael Collins, Jordan Cusick, Rachel Dabek, Nicholas Dalesio, Ricardo Falcon, Allison Fernandez, Patrick Fernandez, John Fiadjoe, Meera Gangadharan, Katherine Gentry, Chris Glover, Susan Goobie, Heike Gries, Allison Griffin, Cornelius Botha Groenewald, John Hajduk, Rebecca Hall, Jennifer Hansen, Mali Hetmaniuk, Vincent Hsieh, Henry Huang, Pablo Ingelmo, Iskra Ivanova, Ranu Jain, Jeffrey Koh, Courtney Kowalczyk-Derderian, Jane Kugler, Kristen Labovsky, José Luis Martinez, Razaz Mujallid, Bridget Muldowney, Kim-Phuong Nguyen, Thanh Nguyen, Olutoyin Olutuye, Codruta Soneru, Timothy Petersen, Kim Poteet-Schwartz, Srijaya Reddy, Russell Reid, Karene Ricketts, Daniel Rubens, Rochelle Skitt, Lisa Sohn, Susan Staudt, Wai Sung, Tariq Syed, Peter Szmuk, Brad Taicher, Lisa Tetreault, Rheana Watts, Karen Wong, Vanessa Young, Lillian Zamora
BACKGROUND: The North American Pediatric Craniofacial Collaborative Group (PCCG) established the Pediatric Craniofacial Surgery Perioperative Registry to evaluate outcomes in infants and children undergoing craniosynostosis repair. The goal of this multicenter study was to utilize this registry to assess differences in blood utilization, intensive care unit (ICU) utilization, duration of hospitalization, and perioperative complications between endoscopic-assisted (ESC) and open repair in infants with craniosynostosis...
March 2018: Anesthesia and Analgesia
Andreas Lund Hattesen, Henrik Karsten Berg, Lars Folkersen, Anne-Mette Hvas
This article summarizes the current knowledge of drowning-induced hyperfibrinolytic disseminated intravascular coagulation. Drowning induces respiratory failure with ensuing cardiac arrest, hypoxaemia and ischaemia. A coagulopathy is induced by ischaemia, acidosis and hypothermia, and clinically the patient develops uncontrolled bleeding due to hyperfibrinolysis. A rapid diagnostic approach is required to recognize this hyperfibrinolytic state, since initiation of treatment with antifibrinolytics and fibrinogen concentrate may bring this life-threatening condition to cessation...
August 28, 2017: Ugeskrift for Laeger
Karim Asehnoune, Zsolt Balogh, Giuseppe Citerio, Andre Cap, Timothy Billiar, Nino Stocchetti, Mitchell J Cohen, Paolo Pelosi, Nicola Curry, Christine Gaarder, Russell Gruen, John Holcomb, Beverley J Hunt, Nicole P Juffermans, Mark Maegele, Mark Midwinter, Frederick A Moore, Michael O'Dwyer, Jean-François Pittet, Herbert Schöchl, Martin Schreiber, Philip C Spinella, Simon Stanworth, Robert Winfield, Karim Brohi
In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice...
September 2017: Intensive Care Medicine
Aleksander Trąbka-Zawicki, Marek Tomala, Aleksander Zeliaś, Elżbieta Paszek, Wojciech Zajdel, Ewa Stępień, Krzysztof Żmudka
BACKGROUND: The use of mild therapeutic hypothermia (MTH) in patients after out-of-hospital cardiac arrest (OHCA) who are undergoing primary percutaneous coronary intervention (pPCI) can protect patients from thromboembolic complications. The aim of the study was to evaluate the adaptive mechanisms of the coagulation system in MTH-treated comatose OHCA survivors. METHODS: Twenty one comatose OHCA survivors with acute coronary syndrome undergoing immediate pPCI were treated with MTH...
July 11, 2017: Cardiology Journal
Félix Ezequiel Fernández Suárez, David Fernández Del Valle, Adrián González Alvarez, Blanca Pérez-Lozano
The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20...
May 2017: Journal of Thoracic Disease
Bensong Han, Feng Xue, Cunyi Fan, Xiumei Mo
OBJECTIVES: This study aims to investigate the small intestinal submucosal (SIS) surface after heparinization with the hypothermia plasma technique, to improve the blood compatibility of SIS, and to explore the possibility of construction of small-caliber vascular grafts with modified SIS scaffolds in vivo. METHODS: SIS films prepared from jejunums of pigs were processed for surface treatment at different time periods with the argon plasma initiation technique under vacuum, and were then immediately immersed in 4% (m/v) heparin sodium solution for 24-h heparinization...
2017: Bio-medical Materials and Engineering
Elif Akpınar, Mehmet Sabri Gürbüz, Gülfidan Bitirgen, Mehmet Özerk Okutan
Postoperative visual loss is an extremely rare complication of nonocular surgery. The most common causes are ischemic optic neuropathy, central retinal artery occlusion, and cerebral ischemia. Acute visual loss after spinal surgery is even rarer. The most important risk factors are long-lasting operations, massive bleedings, fluid overload, hypotension, hypothermia, coagulation disorders, direct trauma, embolism, long-term external ocular pressure, and anemia. Here, we present a case of a 54-year-old male who developed acute visual loss in his left eye after a lumbar instrumentation surgery and was diagnosed with retinal artery occlusion...
April 2017: Journal of Neurosciences in Rural Practice
Peter Stachon, Johannes Kalbhenn, Stephan Walterspacher, Christoph Bode, Dawid Staudacher
Introduction Drowning with submersion over 10 minutes is associated with a high mortality. Here, we present a case, in which a good neurological outcome was achieved after interdisciplinary, intensive care therapy despite submersion of 20 minutes followed by 16 hours of hypoxia. History A 19 year old man drowned in fresh-water. After 20 minutes submersion he was localized and salvaged from 8 meters depth and primarily resuscitated successfully after 10 minutes. Within the next hour, there condition worsened by respiratory deterioration due to a massive capillary leak syndrome in addition to a disseminated intravascular coagulation...
April 2017: Deutsche Medizinische Wochenschrift
Megha U Sharma, Pragati Ganjoo, Daljit Singh, Monica S Tandon, Jyotsna Agarwal, Durga P Sharma, Anita Jagetia
BACKGROUND: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. METHODS: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications...
January 2017: Asian Journal of Neurosurgery
H Trimmel, G Herzer, H Schöchl, W G Voelckel
Traumatic brain injury (TBI) and hemorrhagic shock due to uncontrolled bleeding are the major causes of death after severe trauma. Mortality rates are threefold higher in patients suffering from multiple injuries and additionally TBI. Factors known to impair outcome after TBI, namely hypotension, hypoxia, hypercapnia, acidosis, coagulopathy and hypothermia are aggravated by the extent and severity of extracerebral injuries. The mainstays of TBI intensive care may be, at least temporarily, contradictory to the trauma care concept for multiple trauma patients...
September 2017: Der Unfallchirurg
Patrick Odonkor, Archana Srinivas, Erik Strauss, Brittney Williams, Michael Mazzeffi, Kenichi A Tanaka
Perioperative management of cardiovascular surgical procedures requiring cardiopulmonary bypass (CPB) in patients with hemophilia A poses a clinical challenge in coagulation management. Use of CPB requires the administration of an anticoagulant, usually unfractionated heparin, and also causes dilutional coagulopathy, platelet dysfunction or platelet consumption coagulopathy. Hypothermia and activation of the inflammatory cascade also affect coagulation. The effects of CPB on circulating levels of factor VIII have not been clearly defined...
December 2017: Seminars in Cardiothoracic and Vascular Anesthesia
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