title: [Massive transfusion and trauma patient management: pathophysiological approach to treatment].
abstract: Bleeding that requires massive blood transfusion is one of the main causes of cardiac arrest and death in the operating room. Its mortality varies widely between 15 and 54%, and it is strongly related to multiple factors such as acidosis, hypothermia and hypocoagulation. We undertook this study to describe the mechanisms that perpetuate bleeding during massive hemorrhage and the particular issues under the different clinical conditions of controlled and uncontrolled tissue damage. Laboratory tests for coagulation status diagnosis as well as treatment guidelines for usage of different fluid replacement solutions and hemoderivatives are described. A well-established response plan is needed by the surgical team and the blood bank in order to quickly facilitate blood products to the patient. Measures to avoid hypothermia and availability of rapid infusion systems are also necessary.
authors.affiliation: Cátedra de Anestesiología, Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay.
authors.forename: Graciela
authors.initials: G
authors.lastname: Zunini-Fernandez
authors.forename: Karina
authors.initials: K
authors.lastname: Rando-Huluk
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Martínez-Pelayo
authors.forename: Ara Lizeth
authors.initials: AL
authors.lastname: Castillo-Trevizo
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001780:Blood Coagulation Tests; D016063:Blood Loss, Surgical; D001798:Blood Proteins / Q000032:analysis; D001803:Blood Transfusion / Q000295:instrumentation; D003102:Colloids / Q000627:therapeutic use; D000077324:Crystalloid Solutions; D019468:Disease Management; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D017558:Elective Surgical Procedures; D004630:Emergencies; D005440:Fluid Therapy; D006470:Hemorrhage / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D007035:Hypothermia / Q000150:complications; D007552:Isotonic Solutions / Q000009:adverse effects / Q000627:therapeutic use; D010952:Plasma Substitutes / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D014148:Tranexamic Acid / Q000627:therapeutic use; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology
chemical_list: D000933:Antifibrinolytic Agents; D001798:Blood Proteins; D003102:Colloids; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D010952:Plasma Substitutes; D014148:Tranexamic Acid