ABSTRACT
Objective Coagulation disorder is an independent risk factor of death in trauma patients. This study aimed to investigate the prognostic value of thromboelastography (TEG) for patients with trauma-induced coagulopathy.Methods This retrospective study included 124 cases of trauma-induced coagulopathy treated in our Department of Critical Care Medicine from September 2015 to July 2018. We collected the clinical data and laboratory Results of the patients within 2 hours after admission, divided the patients into a survival group (n=108) and death group (n=16) according to their 90-day prognosis after trauma, and compared the TEG parameters between the two groups. Using logistic regression analysis and ROC curves, we identified the optimal prognostic factors and compared the platelet (PLT) count and mortality rate among those with different cut-off values.Results In comparison with the survival group, the death group showed a significant increase in the clot formation time (CFT) (3.2 \[2.2-4.8\] vs 5.2 \[5.0-9.8\] min, P45.65 mm (86 \[46-114\] vs 116 \[84-171\]×109/L, P<0.05), and mortality was remarkably higher in the former than in the latter group (31.8% vs 1.2%, P<0.05).Conclusion Among the TEG parameters, MA / maximal clot strength is a valuable indicator for the prognosis of trauma-induced coagulopathy, and MA<45.65 mm indicates early PLT dysfunction and poor prognosis.
ABSTRACT
Traumatic Brain Injury (TBI) is a complex disease with a high social burden because of its high mortality and high rate of sequelae. Outcome after TBI is related to early management, including anesthetic management. In this article we review up to date concepts for anesthetic management of TBI patients; from pre-anesthetic evaluation to different aspects of surgical management: induction of anesthesia, airway control, mechanical ventilation, intravenous fluid management, maintenance of anesthesia during neurological and nonneurological surgery, and the treatment of brain edema, coagulopathy, electrolyte balance and temperature. We think the treatment must be directed to goals in order to offer the patient the best conditions for recovery and to avoid secondary brain injury.
El Trauma Cráneo Encefálico (TCE) es una enfermedad compleja, con gran repercusión social por su alta mortalidad y alta tasa de secuelas. El desenlace que tenga nuestro enfermo está relacionado con el manejo temprano que reciba, incluido el manejo anestésico. En este escrito se revisan los conceptos actuales de manejo anestésico de enfermos con TCE, desde su evaluación preanestésica hasta los diferentes aspectos del manejo quirúrgico: inducción de anestesia, control de la vía aérea, ventilación mecánica, manejo de líquidos intravenosos, mantenimiento anestésico en cirugía neurológica y no neurológica, manejo del edema cerebral, de la coagulopatía, de los electrolitos y de la temperatura. Nuestro enfoque se basa en el manejo orientado a metas de manera que ofrezcamos al paciente las mejores condiciones de recuperación y evitemos la lesión secundaria.