Thromboelastometry profile in critically ill patients: A single-center, retrospective, observational study.

BACKGROUND: Transfusion therapy is associated with increased morbidity, mortality and costs. Conventional coagulation tests (CCT) are weak bleeding predictors, poorly reflecting coagulation in vivo. Thromboelastometry (ROTEM) provides early identification of coagulation disorders and can guide transfusion therapy by goals, reducing blood components transfusion. OBJECTIVE: The aim of this study is to describe coagulation profile of critically ill patients using ROTEM and evaluate the association between CCT and thromboelastometry. METHODS: This is a retrospective, observational study conducted in medical-surgical intensive care unit (ICU). Adult patients (≥18 years) admitted to ICU between November 2012 and December 2014, in whom ROTEM analyses were performed for bleeding management were included in this study. The first ROTEM and CCT after ICU admission were recorded simultaneously. Additionally, we collected data on blood components transfusion and hemostatic agents immediately after laboratory tests results. RESULTS: The study included 531 patients. Most ROTEM tests showed normal coagulation profile [INTEM (54.8%), EXTEM (54.1%) and FIBTEM (53.3%)] with divergent results in relation to CCT: low platelet count (51.8% in INTEM and 55.9% in EXTEM); prolonged aPTT (69.9% in INTEM and 63.7% in EXTEM) and higher INR (23.8% in INTEM and 27.4% in EXTEM). However 16,7% of patients with normocoagulability in ROTEM received platelet concentrates and 10% fresh frozen plasma. CONCLUSION: The predominant ROTEM profile observed in this sample of critically ill patients was normal. In contrast, CCT suggested coagulopathy leading to a possibly unnecessary allogenic blood component transfusion. ROTEM test may avoid inappropriate allogeneic blood products transfusion in these patients.

Análise das causas de óbitos de crianças queimadas no Hospital Infantil Joana de Gusmão, no período de 1991 a 2008 / Analysis of the causes of death of children hospitalized for burn injuries at Hospital Infantil Joana de Gusmão, in the period of 1991 to 2008

Introdução: As investigações epidemiológicas em queimaduras têm possibilitado a compreensão dos fatores de risco e o desenvolvimento de estratégias preventivas. Embora os dados estatísticos brasileiros sejam escassos, é de extrema importância o seu conhecimento para determinar medidas preventivas, avaliar novos tratamentos e identificar fatores de risco. Objetivo: Analisar o perfil epidemiológico, características clínicas e causas de óbito de crianças internadas por queimaduras no Hospital Infantil Joana de Gusmão, entre janeiro de 1991 e dezembro de 2008. Método: Foi realizado um estudo retrospectivo, descritivo, com base nos prontuários de 24 crianças, e analisado o perfil epidemiológico em relação a sexo, idade, agente agressor, profundidade da queimadura, superfície corporal queimada, cirurgias, suporte nutricional e ventilatório, terapia intensiva, intervalo livre, tempo de internação e sobrevida, culturas de pele e causa do óbito. Resultados: Dentre os óbitos, 40% ocorreram em pré-escolares. O álcool foi responsável por 44% das queimaduras. O intervalo livre foi maior que 8 horas em 52% dos casos. A maioria dos pacientes apresentava uma SCQ > 60% (68%) e profundidade de espessura total (80%). O debridamento foi realizado em 55% dos pacientes. As crianças necessitaram de suporte nutricional (76%), assistência ventilatória (56%) e internação na UTI (84%). As causas de óbitos foram: choque séptico (52%), DMOS primária (32%), hemorragia digestiva (8%), lesão respiratória (4%) e choque elétrico (4%). A taxa de mortalidade foi de 1,60%. Conclusões: O perfil epidemiológico dos pacientes que vão a óbito é de um menino pré-escolar, que se queimou na cozinha de casa, com fogo resultante da combustão de álcool e chegou ao HIJG em mais de 8 horas.

Objective: To analyze the epidemiological profile, clinical characteristics and causes of death of children hospitalized for burn injuries at Hospital Infantil Joana de Gusmao, in the period of January of 1991 to December of 2008. Methods: A retrospective study was carried out based on the clinical records of 24 children, on the following variables: sex, age, agent, depth of burn, total body surface area, skin grafting and debridements, nutritional support, breathing care, stay in Intensive Care Unit, blood transfusion, free time, hospitalization and survival period, skin cultures and cause of death. Results: From the total number of deaths, 44% of the cases were of children attending pre-school. Alcohol was responsible for 52% of burns. Free time was more than 8 hours in 50% of cases. The majority of patients presented TBSA > 60% (68%) and full thickness burn (80%). Debridement was done in 55% of cases. Children needed nutritional support (76%), breathing care (56%), stay in ICU (84%). The causes of death were: septic shock (52%), primary MODS (32%), gastrointestinal bleeding (8%), respiratory injury (4%) and electric shock (4%). The death rate was 1.60%. Conclusions: The epidemiologic profile is of a boy attending pre-school, whose burn occurred in the kitchen of his house, with fire resulting from alcohol combustion, arriving at HIJG within more than 8 hours.