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https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#1
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28199784/allosensitization-following-bone-graft
#2
Eoin D O'Sullivan, Richard K Battle, Sharon Zahra, John F Keating, Lorna P Marson, David M Turner
It is recognised that patients may become sensitized to donor-specific HLA antigens as a result of previous antigenic exposures, classically through previous transplantation, pregnancy or blood transfusion. We present an unusual case of a patient who unexpectedly developed a range of anti-HLA antibodies following orthopaedic surgery where a bone graft was deployed intraoperatively. We describe the case of a 52-year-old male awaiting a renal transplantation, undergoing elective orthopaedic surgery requiring a small volume bone graft...
February 15, 2017: American Journal of Transplantation
https://www.readbyqxmd.com/read/28198023/patient-outcomes-and-amotosalen-uva-treated-platelet-utilization-in-massively-transfused-patients
#3
W Nussbaumer, M Amato, H Schennach, M Astl, C Y Chen, J-S Lin, L Corash, R J Benjamin
BACKGROUND: Amotosalen/UVA-treated platelet concentrates (PCs) have demonstrated efficacy for treating and preventing bleeding in clinical trials and in routine use; however, most studies were performed in haematology/oncology patients. We investigated efficacy during massive transfusion (MT) in general hospitalized patients. METHODS: Universal amotosalen/UVA treatment (INTERCEPT Blood System) of platelets was introduced at a large Austrian medical centre. We performed a retrospective cohort analysis comparing component use, in-hospital mortality and length of stay after MT that included platelet transfusion, for two periods (21 months each) before and after implementation...
February 15, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28193445/endovascular-management-for-peripheral-arterial-trauma-the-new-norm
#4
Anand Ganapathy, Ahmed F Khouqeer, S Robb Todd, Joseph L Mills, Ramyar Gilani
BACKGROUND: Endovascular therapy is well studied in atraumatic conditions; and there appears to be a growing interest in its application to traumatic injuries. The objective of this study is to compare open and endovascular techniques in the management of peripheral arterial trauma. METHODS: This is a retrospective review of patients admitted to a Level I Trauma Center sustaining injuries to the subclavian, axillary, superficial femoral, and popliteal arteries. Demographics, surgical interventions, complications, and clinical outcomes were evaluated in patients requiring open or endovascular repair between 2009 and 2015...
February 4, 2017: Injury
https://www.readbyqxmd.com/read/28193297/pre-hospital-transfusion-of-packed-red-blood-cells-in-147-patients-from-a-uk-helicopter-emergency-medical-service
#5
Richard M Lyon, Eleanor de Sausmarez, Emily McWhirter, Gary Wareham, Magnus Nelson, Ashley Matthies, Anthony Hudson, Leigh Curtis, Malcolm Q Russell
BACKGROUND: Early transfusion of packed red blood cells (PRBC) has been associated with improved survival in patients with haemorrhagic shock. This study aims to describe the characteristics of patients receiving pre-hospital blood transfusion and evaluate their subsequent need for in-hospital transfusion and surgery. METHODS: The decision to administer a pre-hospital PRBC transfusion was based on clinical judgment. All patients transfused pre-hospital PRBC between February 2013 and December 2014 were included...
February 14, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28190583/fibrinogen-is-an-independent-predictor-of-mortality-in-major-trauma-patients-a-five-year-statewide-cohort-study
#6
Zoe K McQuilten, Erica M Wood, Michael Bailey, Peter A Cameron, David J Cooper
INTRODUCTION: Fibrinogen may be reduced following traumatic injury due to loss from haemorrhage, increased consumption and reduced synthesis. In the absence of clinical trials, guidelines for fibrinogen replacement are based on expert opinion and vary internationally. We aimed to determine prevalence and predictors of low fibrinogen on admission in major trauma patients and investigate association of fibrinogen levels with patient outcomes. PATIENTS AND METHODS: Data on all major trauma patients (January 2007-July 2011) identified through a prospective statewide trauma registry in Victoria, Australia were linked with laboratory and transfusion data...
November 21, 2016: Injury
https://www.readbyqxmd.com/read/28188036/outcomes-of-an-accelerated-care-pathway-for-pediatric-blunt-solid-organ-injuries-in-a-public-healthcare-system
#7
Oluwatomilayo Daodu, Mary Brindle, Carlos R Alvarez-Allende, Lisette Lockyer, Bryce Weber, Steven R Lopushinsky
PURPOSE: An accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed. METHODS: Data were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest...
January 29, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28181262/descriptive-characteristics-and-in-hospital-mortality-of-critically-bleeding-patients-requiring-massive-transfusion-results-from-the-australian-and-new-zealand-massive-transfusion-registry
#8
R Ruseckaite, Z K McQuilten, J C Oldroyd, T H Richter, P A Cameron, J P Isbister, E M Wood
BACKGROUND AND OBJECTIVES: Critically bleeding patients requiring massive transfusion (MT) are clinically challenging, and limited data exist to support management decisions. This study describes patient characteristics, transfusion support and clinical outcomes from the Australian and New Zealand (NZ) Massive Transfusion Registry (ANZ-MTR). MATERIALS AND METHODS: Retrospective, cohort study of all adult patients receiving MT (≥5 units red blood cells [RBC] in 4 h) at participating ANZ-MTR hospitals, 2011-2015...
February 8, 2017: Vox Sanguinis
https://www.readbyqxmd.com/read/28168326/damage-control-laparotomy-for-abdominal-trauma-in-children
#9
Stephanie F Polites, Elizabeth B Habermann, Amy E Glasgow, Martin D Zielinski
BACKGROUND: Damage control laparotomy (DCL) is not well studied in the pediatric trauma population. The purpose of this study was to develop a surrogate definition of DCL compatible with national and administrative data sources so that the rate and outcomes of DCL in pediatric trauma patients could be determined. METHODS: Using the 2010-2014 National Trauma Data Bank, children ≤18 with an abdominal AIS ≥ 3 who underwent a laparotomy within 3 h of arrival were identified (n = 2989)...
February 6, 2017: Pediatric Surgery International
https://www.readbyqxmd.com/read/28166173/is-this-autograft-worth-it-the-blood-loss-and-transfusion-rates-associated-with-ria-bone-graft-harvest
#10
Lucas S Marchand, David L Rothberg, Erik N Kubiak, Thomas F Higgins
OBJECTIVES: To investigate the blood loss and transfusion rate associated with the use of reamer irrigator aspirator (RIA). DESIGN: Retrospective review. SETTING: Academic Level-I trauma hospital. PATIENTS: One hundred eight patients requiring bone graft harvest for surgical reconstruction of non-union or failed arthrodesis. INTERVENTION: Bone graft harvest preformed via RIA or iliac crest bone graft (ICBG)...
January 30, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28161564/management-of-vascular-trauma-during-the-paris-terrorist-attack-of-november-13-2015
#11
Philippe Tresson, Joseph Touma, Julien Gaudric, Quentin Pellenc, Marielle Le Roux, Charles Pierret, Hicham Kobeiter, Pierre Julia, Olivier Goeau-Brissonniere, Pascal Desgranges, Fabien Koskas, Yves Castier
OBJECTIVES: On November 13, 2015, Paris and Saint-Denis were the targets of terrorist attacks. The hospitals of the Public Hospitals of Paris Organization (AP-HP) and the Percy Armed Forces Instruction Hospitals were mobilized to face the mass casualty situation. The objective of this study was to analyze the management of the victims presenting with a non-thoracic vascular trauma (NTVT). MATERIAL AND METHODS: All the data relating to the victims of NTVT who required a specific vascular open or endovascular treatment were analyzed retrospectively...
February 1, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28151829/haemotherapy-algorithm-for-the-management-of-trauma-induced-coagulopathy-an-australian-perspective
#12
James Winearls, Biswadev Mitra, Michael C Reade
PURPOSE OF REVIEW: Recent advances in the understanding of the pathophysiological processes associated with traumatic haemorrhage and trauma-induced coagulopathy have resulted in improved outcomes for seriously injured trauma patients. However, a significant number of trauma patients still die from haemorrhage. This article reviews the various transfusion strategies utilized in the management of traumatic haemorrhage and describes the major haemorrhage protocol (MHP) strategy employed by an Australian trauma centre...
February 1, 2017: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/28149824/early-high-ratio-platelet-transfusion-in-trauma-resuscitation-and-its-outcomes
#13
Ruben Peralta, Adarsh Vijay, Ayman El-Menyar, Rafael Consunji, Ibrahim Afifi, Ismail Mahmood, Mohammed Asim, Rifat Latifi, Hassan Al-Thani
INTRODUCTION: The optimal ratio of platelets (PLTs) to packed red blood cell (PRBC) in trauma patients requiring massive transfusion protocol (MTP) is still controversial. This report aims to describe the effect of attaining a high PLT:PRBC ratio (≥1:1.5) within 4 h postinjury on the outcomes of trauma patients receiving MTP. METHODS: Over a 24-month period, records of all adult patients with traumatic injury who received MTP were retrospectively reviewed. Data were analyzed with respect to PLT:PRBC ratio ([high-MTP ≥1:1...
October 2016: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/28148274/severity-dependent-differences-in-early-management-of-thoracic-trauma-in-severely-injured-patients%C3%A2-analysis-based-on-the-traumaregister-dgu%C3%A2
#14
J Bayer, R Lefering, S Reinhardt, J Kühle, N P Südkamp, T Hammer
BACKGROUND: Major trauma is associated with chest injuries in nearly 50% of multiple injuries. Thoracic trauma is a relevant source of comorbidity throughout the period of multiply-injured patient care and may require swift and well-thought-out interventions in order to avert a deleterious outcome. In this epidemiological study we seek to characterize groups of different thoracic trauma severity in severely injured patients and identify related differences in prehospital and early clinical management...
February 2, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28144603/early-prediction-of-ongoing-hemorrhage-in-severe-trauma-presentation-of-the-existing-scoring-systems
#15
Martin L Tonglet
Early prediction of ongoing hemorrhage may reduce mortality via the earlier delivery of blood products, adequate orientation of the patient in a dedicated highly specialized and trained infrastructure, and by earlier correction of acute traumatic coagulopathy. We identified 14 scores or algorithms developed for the prediction of ongoing hemorrhage and the need for massive transfusion in severe trauma patients.
December 2016: Archives of Trauma Research
https://www.readbyqxmd.com/read/28137537/randomized-controlled-trial-evaluating-the-efficacy-of-peritoneal-resuscitation-in-the-management-of-trauma-patients-undergoing-damage-control-surgery
#16
Jason W Smith, Paul J Matheson, Glen A Franklin, Brian G Harbrecht, J David Richardson, R Neal Garrison
BACKGROUND: Peritoneal resuscitation (PR) represents a unique modality of treatment for severely injured trauma patients requiring damage control surgery (DCS). These data represent the outcome of a single institution RCT into the efficacy of PR as a management option in these patients. STUDY DESIGN: From 2011-2015, 103 patients were enrolled in a prospective RCT evaluating the utility of PR in the treatment of patients undergoing DCS compared to conventional resuscitation (CR) alone...
January 27, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28131117/identification-and-management-of-obstetric-hemorrhage
#17
REVIEW
Emily J Baird
Obstetric hemorrhage remains the leading cause of maternal death and severe morbidity worldwide. Although uterine atony is the most common cause of peripartum bleeding, abnormal placentation, coagulation disorders, and genital tract trauma contribute to adverse maternal outcomes. Given the inability to reliably predict patients at high risk for obstetric hemorrhage, all parturients should be considered susceptible, and extreme vigilance must be exercised in the assessment of blood loss and hemodynamic stability during the peripartum period...
March 2017: Anesthesiology Clinics
https://www.readbyqxmd.com/read/28122682/fibrinogen-level-on-admission-is-a-predictor-for-massive-transfusion-in-patients-with-severe-blunt-trauma-analyses-of-a-retrospective-multicentre-observational-study
#18
Yoshihiko Nakamura, Hiroyasu Ishikura, Shigeki Kushimoto, Fumiaki Kiyomi, Hiroshi Kato, Junichi Sasaki, Hiroshi Ogura, Tetsuya Matsuoka, Toshifumi Uejima, Naoto Morimura, Mineji Hayakawa, Akiyoshi Hagiwara, Munekazu Takeda, Naoyuki Kaneko, Daizoh Saitoh, Daisuke Kudo, Kunihiko Maekawa, Takashi Kanemura, Takayuki Shibusawa, Yasushi Hagihara, Shintaro Furugori, Atsushi Shiraishi, Kiyoshi Murata, Gou Mayama, Arino Yaguchi, Shiei Kim, Osamu Takasu, Kazutaka Nishiyama
INTRODUCTION: In the early phase of trauma, fibrinogen (Fbg) plays an important role in clot formation. However, to the best of our knowledge, few studies have analysed methods of predicting the need for massive transfusion (MT) based on Fbg levels using multiple logistic regression. Therefore, the present study aimed to evaluate whether Fbg levels on admission can be used to predict the need for MT in patients with trauma. METHODS: We conducted a retrospective multicentre observational study...
January 16, 2017: Injury
https://www.readbyqxmd.com/read/28109111/-efficacy-of-high-versus-low-plasma-red-blood-cell-ratio-resuscitation-in-patients-with-severe-trauma-requiring-massive-blood-transfusion-a-meta-analysis
#19
Fang Yu, Tao Zhong, Gang Wu
OBJECTIVE: To evaluate the efficacy of high (≥1:2) and low (<1:2) plasma: red blood cell (RBC) ratio resuscitation in patients with severe trauma requiring massive blood transfusion. METHODS: The databases including the Cochrane Library, Pubmed, Web of Science, and EMBASE were systemically searched for relevant studies published between January, 2009 and April, 2016. The selection of studies, assessment of methodological quality and data extraction were performed by two researchers independently according to the inclusion and exclusion criteria...
January 20, 2017: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/28099382/failure-of-nonoperative-management-of-pediatric-blunt-liver-and-spleen-injuries-a-prospective-atomac-study
#20
Maria E Linnaus, Crystal S Langlais, Nilda M Garcia, Adam C Alder, James W Eubanks, R Todd Maxson, Robert W Letton, Todd A Ponsky, Shawn D St Peter, Charles Leys, Amina Bhatia, Daniel J Ostlie, David W Tuggle, Karla A Lawson, Alexander R Raines, David M Notrica
BACKGROUND: Nonoperative management (NOM) is standard of care for most pediatric blunt liver and spleen injuries (BLSI); only 5% of patients fail NOM in retrospective reports. No prospective studies examine failure of NOM of BLSI in children. The aim of this study was to determine the frequency and clinical characteristics of failure of NOM in pediatric BLSI patients. METHODS: A prospective observational study was conducted on patients ≤18 years presenting to any of ten level 1 pediatric trauma centers April 2013 and January 2016 with BLSI on computed tomography...
January 17, 2017: Journal of Trauma and Acute Care Surgery
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