Trauma

Whole Blood Resuscitation

Increasing interest is being reported in returning to whole blood rather than component transfusion in trauma. Much of the earlier experience comes from military studies, many of which are subject to selection or survivial biases and retrospective in nature. The overall evidence and rationale, as well as risk, is summarized in this review, with the usual scenario being a combination of whole blood with combination products. Further study is required to define what place whole blood transfusion may have in resuscitation.

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Traumatic Brain Injury and Hypothermia

A systematic review on therapeutic hypothermia finds the same results as known: “High-quality studies show no significant difference in mortality, poor outcomes, or new pneumonia. In addition, this review shows a place for fever control in the management of traumatic brain injury“. 

As in the post cardiac arrest scenario, 36° is just as good without the potential harmful effects of hypothermia, but fever or hyperthermia should be aggressively managed.

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Old or Fresh Blood?

Previous studies in critical care had allayed our concerns about standard issue blood, which did not affect any significant outcome compared with fresh red cells  link

A new study in a different setting provides evidence that large volume resuscitation with stored blood in a traumatic hemorrhage model in mice increases mortality from subsequent lung injury/pneumonia, compared to fresh blood. Free heme is postulated as the mechanism. Human studies and strategies to limit heme exposure should occur  link

 

Hypertonic Saline for TBI and Intracranial Hypertension

While both mannitol and hypertonic saline are used for intracranial hypertension, a trend to better control has emerged with continuous hypertonic saline infusion as opposed to bolus dosing in adult traumatic brain injuries.

Sodium in the range of 145-155 or serum osmolality of 320 is the aim using 23.4% NaCl with 6 hourly Na monitoring and caution rapidly raising Na if hyponatremia exists to avoid central pontine myelinolysis.

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