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2015, Number S2

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Rev Mex Anest 2015; 38 (S2)

Definitions of and approach to critical bleeding

Carrillo-Esper R, Peña-Pérez CA

Language: Spanish
References: 11
Page: 374-379
PDF size: 225.18 Kb.


ABSTRACT

Massive bleeding is a life-threatening emergency in hospitalized patients and occurs across most specialties including surgery, medicine, obstetrics and neonatology. These patients are not infrequently admitted to intensive care or high dependency units, for continued care and close monitoring. Even if treated outside this setting, they are often managed with input from critical care physicians. Successful haemostatic control in these situations requires the delivery of effective resuscitation, specifically transfusion therapy, in conjunction with surgical or radiological interventions. We have, therefore, not yet reached our ultimate goal, which is an improved outcome for patients suffering from major bleeding. This requires a never-ending educational effort, the creation and implementation of institutional guidelines and algorithms, a regular assessment of adherence to these algorithms and the follow-up of the patients treated to allow the measurement of long-term outcomes. For specific questions to be answered, further clinical studies will need to be conducted. In this sense, the journey towards the optimal management of the bleeding patient has only just begun.


REFERENCES

  1. Stainsby D, MacLennan S, Hamilton PJ. Management of massive blood loss: a template guideline. Br J Anaesth. 2000;85:487-491.

  2. CRASH-2 collaborators, Roberts I, Shakur H et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377:1096-1101.

  3. Afshari A, Wikkelso A, Brok J, Moller AM, Wetterslev J. Thromboelastography (TEG) of thromboelastometry (ROTEM) to monitor heamotherapy versus usual care in patients with massive transfusion. Cochrane Database Syst Rev. 2011;(3):CD007871.

  4. de Lloyd L, Bovington R, Kaye A, et al. Standard haemostatic test following major obstetric haemorrhage. Int J Obstet Anesth. 20011;20:135-141.

  5. Solomon C, Collis RE, Collins PW. Haemostatic monitoring during postpartum haemorrhage and implications for management. Br J Anaesth. 2012;109:851-863.

  6. Saule I, Hawkins N. Transfusion practice in major obstetric haemorrhage: lessons from trauma. Int J Obstet Anesth. 2012;21:79-83.

  7. Novikova N, Hofmeyr GJ. Tranexamic acid for preventing postpartum haemorrhage. Cochrane Database Syst Rev. 2010;(7):CD007872.

  8. ISRCTN76912190. The WOMEN trial. London School of Tropical Medicine, London. http://www.thewomentrial.lshtm.ac.uk (accessed on March 21, 2012).

  9. NCT 00370877. Recombinant human activated factor VII as salvage therapy in women with severe postpartum hemorrhage. http://clinicaltrials.bov/ct2/show/NCT00370877 (accessed on April 03, 2012).

  10. Gluud LL, Klingenburg SL, Langholz E. Tranexamic acid for upper gastrointestinal bleeding. Cochrane Database Syst Rev. 2012;1:CD006640.

  11. Irita K, Inada E. Guidelines for management of critical bleeding in obstetrics. Masui. 2011;60:14-22.




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