Current Approaches to the Treatment of Traumatic Shock (Review)

Abstract

The clinical manifestation of shock is characterized by systemic circulatory disturbances andblood flow, hypoxic and metabolic disorders. The leading role in the pathogenesis of traumatic shock (the subtype of a hypovolemic shock), is assigned to the severity of the damaging effect, the time interval sufficient for the development of a pathophysiological response, mismatch between body tissue perfusion and the metabolic requirements, and impaired aerobic oxidation in tissues. The use of a comprehensive multicomponent intensive care strategy matching the pathophysiological changes is a difficult challenge for a critical care physician.The aim of the review is to demonstrate the specific features and sequence of events occurring in the body during the development of traumatic shock, the pattern of manifestations of clinical signs, and potential use of intensive therapy methods tailored to the pathophysiological responses in traumatic shock.Material. The information search was carried out in the PubMed and RSCI databases, among which 80 sources were finally selected, representing current therapeutic approaches, the results of scientific research and clinical guidelines related to the scope of this review.Results. The main stages of traumatic shock pathogenesis were reviewed. The basic patterns of cardiovascular and respiratory failure development were analyzed, the criteria of their severity were evaluated, and the complexity of the selection of intensive therapy was shown.Conclusion. Respiratory support, stabilization of cardiac and circulatory parameters and optimization of oxygen status are the most important components of treatment of patients with traumatic shock. Current methods of respiratory failure control allow to estimate promptly the severity of respiratory dysfunction, reveal the cause and correct existing disorders in an individualized way taking into account the better availability of mechanical ventilation. Replacement of circulating blood volume is aimed both at achieving hemodynamic effect and restoring the concentration of sources of oxygen carriers and plasma pro- and anticoagulant factors. The earliest and most comprehensive intensive therapy can improve the prognosis and outcome in patients with traumatic shock.

Perioperative management of patients with hemostatic system disorders. Methodological recommendations of the All-Russian public organization “Federation of Anesthesiologists and Reanimatologists” and the National Association of Specialists in Thrombosis, Clinical Hemostasiology and Hemorheology

“…желой травме [42]; для контроля применения концентрата фибриногена в кардиохирургии (оценка эффекта препарата, основанная на целевом значении MА ТЭГ может снизить кровопотерю и потребность в трансфузии после АКШ) [40]; для оценки фибринолиза при трансплантации печени и определения показаний к применению транексамовой кислоты (такая методика позволяет снизить использование СЗП и частоту тромбоэмболических осложнений [43]); для решения вопроса о возможности выполнения эпидуральной анестезии после массивной трансфузии [44]; для выявления пациентов с риском тромбоэмболических осложнений; для оценки гемостатических свойств тромбоцитов ex vivo и в тромбоцитных концентратах. Трансфузионный алгоритм, включающий ТЭГ-мониторинг коагуляции, эффективно снижает кровопотерю и переливание аллогенных препаратов крови, повышает безопасность и экономическую эффективность гемостатической терапии в кардиохирургии, абдоминальной хирургии, при тяжелой травме и кровотечении [40][41][42][43][44][45][46][47], не увеличивая при этом риск неблагоприятных исходов. Baksaas-Aasen et al [48] [78].…”

The effect of a tyrosyl-D-alanyl-glycyl-phenylalanyl-leucyl-arginine diacetate (Dalargin) on oxidative stress in patients with severe combined trauma: a prospective clinical study

“…Нарушение проницаемости эндотелия с вовлечением его в воспалительный ответ, в свою очередь, способствует развитию полиорганной недо статочности и таких осложнений, как острый респираторный дистресс-синдром, острая почечная недостаточность, сердечно-сосудистая недо статочность, церебральная недо статочность и др. [35,36].…”