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A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients.

Perlman R, Callum J, Laflamme C, Tien H, Nascimento B, Beckett A, Alam A - Crit Care (2016)

Bottom Line: Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming.Future research in hypothermia management should concentrate on applying this treatment algorithm and should evaluate its influence on patient outcomes.This treatment strategy may help to reduce blood loss and improve morbidity and mortality in this population of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Rm M3-200, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.

ABSTRACT
Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming. Selected passive and active warming techniques can be applied in damage control resuscitation. While treatment guidelines exist for acidosis and bleeding, there is no evidence-based approach to managing hypothermia in trauma patients. We synthesized a goal-directed algorithm for warming the severely injured patient that can be directly incorporated into current Advanced Trauma Life Support guidelines. This involves the early use of warming blankets and removal of wet clothing in the prehospital phase followed by aggressive rewarming on arrival at the hospital if the patient's injuries require damage control therapy. Future research in hypothermia management should concentrate on applying this treatment algorithm and should evaluate its influence on patient outcomes. This treatment strategy may help to reduce blood loss and improve morbidity and mortality in this population of patients.

No MeSH data available.


Related in: MedlinePlus

An algorithm for early goal-directed therapy for hypothermia in trauma. ATLS Advanced Trauma Life Support, CT computed tomography, PRN “pro re nata” (when necessary)
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Fig1: An algorithm for early goal-directed therapy for hypothermia in trauma. ATLS Advanced Trauma Life Support, CT computed tomography, PRN “pro re nata” (when necessary)

Mentions: A potential strategy for early goal-directed therapy of hypothermia amongst trauma patients is detailed in Fig. 1. No randomized outcome data are available to provide a systematic review. Instead, we have described all available evidence and provided expert opinion to create a pragmatic treatment strategy that can be implemented in most major trauma centers. We intend to evaluate the efficacy of this protocol in an upcoming prospective trial based in Toronto, ON, Canada. This treatment protocol is divided into three sequential stages of resuscitation: prehospital, hospital, and observation phases.Fig. 1


A recommended early goal-directed management guideline for the prevention of hypothermia-related transfusion, morbidity, and mortality in severely injured trauma patients.

Perlman R, Callum J, Laflamme C, Tien H, Nascimento B, Beckett A, Alam A - Crit Care (2016)

An algorithm for early goal-directed therapy for hypothermia in trauma. ATLS Advanced Trauma Life Support, CT computed tomography, PRN “pro re nata” (when necessary)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837515&req=5

Fig1: An algorithm for early goal-directed therapy for hypothermia in trauma. ATLS Advanced Trauma Life Support, CT computed tomography, PRN “pro re nata” (when necessary)
Mentions: A potential strategy for early goal-directed therapy of hypothermia amongst trauma patients is detailed in Fig. 1. No randomized outcome data are available to provide a systematic review. Instead, we have described all available evidence and provided expert opinion to create a pragmatic treatment strategy that can be implemented in most major trauma centers. We intend to evaluate the efficacy of this protocol in an upcoming prospective trial based in Toronto, ON, Canada. This treatment protocol is divided into three sequential stages of resuscitation: prehospital, hospital, and observation phases.Fig. 1

Bottom Line: Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming.Future research in hypothermia management should concentrate on applying this treatment algorithm and should evaluate its influence on patient outcomes.This treatment strategy may help to reduce blood loss and improve morbidity and mortality in this population of patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesia, Rm M3-200, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.

ABSTRACT
Hypothermia is present in up to two-thirds of patients with severe injury, although it is often disregarded during the initial resuscitation. Studies have revealed that hypothermia is associated with mortality in a large percentage of trauma cases when the patient's temperature is below 32 °C. Risk factors include the severity of injury, wet clothing, low transport unit temperature, use of anesthesia, and prolonged surgery. Fortunately, associated coagulation disorders have been shown to completely resolve with aggressive warming. Selected passive and active warming techniques can be applied in damage control resuscitation. While treatment guidelines exist for acidosis and bleeding, there is no evidence-based approach to managing hypothermia in trauma patients. We synthesized a goal-directed algorithm for warming the severely injured patient that can be directly incorporated into current Advanced Trauma Life Support guidelines. This involves the early use of warming blankets and removal of wet clothing in the prehospital phase followed by aggressive rewarming on arrival at the hospital if the patient's injuries require damage control therapy. Future research in hypothermia management should concentrate on applying this treatment algorithm and should evaluate its influence on patient outcomes. This treatment strategy may help to reduce blood loss and improve morbidity and mortality in this population of patients.

No MeSH data available.


Related in: MedlinePlus