American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

V39N6: Transfusion and Shock

Costantini TW, Min E, Box K, et al. Dose adjusting enoxaparin is necessary to achieve adequate venous thromboembolism prophylaxis in trauma patients. J Trauma Acute Care Surg. 2013;74(1):128-133; discussion 134-135.

Several articles have described a residual risk for venous thromboembolism in injured patients despite administration of preventive anticoagulants at recommended dosages. One approach to this problem is upward adjustment of anticoagulant dosing using blood levels of anti-Xa as a guide. This article describes experience with this approach.

De Backer D, Biston P, Devriendt J, et al. Comparison of dopamine and norepinephrine in the treatment of shock. N Engl J Med. 2010;362(9):779-789. Free full-text

This article provides data supporting the superiority of norepinephrine over dopamine for the management of hypotension due to sepsis or cardiogenic shock.

De Backer D, Donadello K, Sakr Y, et al. Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med. 2013;41(3):791-799.

De Backer and colleagues present evidence for microvascular obstruction as one hemodynamic abnormality in septic patients.

Delaney AP, Dan A, McCaffrey J, et al. The role of albumin as a resuscitation fluid for patients with sepsis: a systematic review and meta-analysis. Crit Care Med. 2011;39(2):386-391.

This article describes evidence in the literature for the benefit of albumin therapy in selected patients with sepsis and septic shock.

Harr JN, Moore EE, Johnson J, et al. Antiplatelet therapy is associated with decreased transfusion-associated risk of lung dysfunction, multiple organ failure, and mortality in trauma patients. Crit Care Med. 2013;41(2):399-404.

This article provides evidence for platelet function abnormalities in patients with TRALI. Antiplatelet therapy was protective.

Holcomb JB, Minei KM, Scerbo ML, et al. Admission rapid thrombelastography can replace conventional coagulation tests in the emergency department: experience with 1974 consecutive trauma patients. Ann Surg. 2012;256(3):476-486.

This article describes the use of rapid thromboelastography for the identification of trauma-related coagulopathy and for guidance of therapy of coagulopathy.

Kashuk JL, Moore EE, Sawyer M, et al. Postinjury coagulopathy management: goal directed resuscitation via POC thrombelastography. Ann Surg. 2010;251(4):604-614.

Kashuk and coauthors present a description of the use of thromboelastography as a guide to therapy for trauma-related coagulopathy.

Lagu T, Rothberg MB, Shieh MS, et al. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med. 2012;40(3):754-761.

This article presents a national overview of the health burden of sepsis.

Minei JP, Cuschieri J, Sperry J, et al. The changing pattern and implications of multiple organ failure after blunt injury with hemorrhagic shock. Crit Care Med. 2012;40(4):1129-1135. Free full-text

The pattern of emergence and the course of multiple organ failure have changed as diagnostic criteria and therapeutic approaches have changed. This report documents the differences in MOF in current practice compared with earlier understandings.

Moore LJ, McKinley BA, Turner KL, et al. The epidemiology of sepsis in general surgery patients. J Trauma. 2011;70(3):672-680.

Moore and coauthors describe the clinical features of sepsis in surgical patients. Most septic surgical patients have a focus of infection in the abdomen.

Morrison CA, Carrick MM, Norman MA, et al. Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial. J Trauma. 2011;70(3):652-663.

Hypotensive (target systolic pressure of 50 mmHg) might assist in operative efforts at hemostasis. This report documents the safety of this approach.

Napolitano LM, Cohen MJ, Cotton BA, et al. Tranexamic acid in trauma: How should we use it? J Trauma Acute Care Surg. 2013;74(6):1575-1586.

This is a useful review of the evidence on the use of tranexamic acid as a means of improving coagulation in injured patients. Evidence-based recommendations are included.

Ranieri VM, Thompson BT, Barie PS, et al. Drotrecogin alfa (activated) in adults with septic shock. N Engl J Med. 2012;366(22):2055-2064. Free full-text

This article confirms the lack of benefit of recombinant-activated protein C in septic patients.

Tchorz KM, Chandra MS, Markert RJ, et al. Comparison of hemodynamic measurements from invasive and noninvasive monitoring during early resuscitation. J Trauma Acute Care Surg. 2012;72(4):852-860.

Tchorz and coauthors provide a useful comparison of invasive and noninvasive monitoring during resuscitation of injured patients. Of interest is that transthoracic ultrasound demonstrated cardiac valvular regurgitation in many patients.