Current opinion in anaesthesiology
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Coagulopathy represents one of the major challenges in the management of the severely injured patient. The present review will attempt to define the current 'optimal' transfusion strategies for the coagulopathic trauma patient and to assess potential weaknesses in the pertinent literature. ⋯ Coagulopathy has a significant impact on survival after major trauma. Most recent publications in the field are of retrospective design, and thus do not allow definitive recommendations for clinical practice. Well designed prospective trials and improved basic research studies are required to improve this important aspect of trauma care.
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Curr Opin Anaesthesiol · Apr 2009
ReviewMicrocirculatory effects of intravenous fluids in critical illness: plasma expansion beyond crystalloids and colloids.
Plasma expanders are reviewed to determine their ability to restore microvascular function as a means for extending the transfusion trigger and delaying the use of blood transfusions. This outcome is currently achievable because of the emergence of a new understanding of optimal tissue function that prioritizes maintenance of functional capillary density, which results from the normalization of blood viscosity via the increase in plasma viscosity with new viscogenic colloids. ⋯ Preclinical studies show that polyethylene glycol-conjugated albumin at concentrations in the range of 2-4% extends the transfusion trigger, providing the more extended and complete microvascular and systemic recovery from hemorrhagic shock, extreme hemodilution and endotoxemia, postponing the need of reestablish intrinsic blood oxygen-carrying capacity to hemoglobin concentrations lower than those associated with accepted transfusion triggers.
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Curr Opin Anaesthesiol · Apr 2009
ReviewMicrocirculation and mitochondria in sepsis: getting out of breath.
To present the recent findings obtained in clinical and experimental studies examining microcirculatory alterations in sepsis, their link to mitochondrial dysfunction, and current knowledge regarding the impact of these alterations on the outcome of septic patients. ⋯ Even though there is evidence that microcirculatory and mitochondrial dysfunction plays a role in the development of sepsis-induced organ failure, their interaction and respective contribution to the disease remains poorly understood. Future research is necessary to better define such relationships in order to identify therapeutic targets and refine treatment strategies.
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Curr Opin Anaesthesiol · Apr 2009
ReviewLink between coagulation abnormalities and microcirculatory dysfunction in critically ill patients.
The current review discusses the role of coagulation in microcirculatory abnormalities and whether anticoagulants may improve microvascular perfusion. ⋯ The activation of coagulation may play an indirect role in microvascular dysfunction, through interplay with endothelium and inflammation.
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Curr Opin Anaesthesiol · Apr 2009
ReviewThe role of thromboelastometry and recombinant factor VIIa in trauma.
Recombinant factor VIIa (rFVIIa) and thromboelastography have acquired increasing importance in patients with severe bleeding and coagulopathy. This article reviews the current opinions regarding their use, with the purpose of clarifying the ambiguities that exist in dealing with trauma patients. ⋯ Thromboelastometry may guide the medical staff when and to whom rFVIIa could be administered. Evidence also encourages the use of rFVIIa in traumatic brain injury. More research is required to prove decreases in mortality using both thromboelastography and rFVIIa in trauma, with a focus on clear end points and goal-directed therapy.