Impact of Graded Hypothermia on Coagulation and Fibrinolysis

Staikou, Chryssoula; Paraskeva, Anteia; Δράκος, Ηλίας; Anastassopoulou, Ioanna; Papaioannou, Eleni; Donta, Ismini; Kontos, Michael C.

doi:10.1016/j.jss.2009.07.037

Cited by 25 publications

(17 citation statements)

References 34 publications

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“…Administration of intravenous fluids can also lead to hemodilution, because the fluids do not contain clotting factors or erythrocytes, and to hypothermia, if unwarmed, because of the increased infusion rate (>4 mL/kg per minute). 32 Current evidence 42 suggests that moderate hypotension for less than 30 minutes can be tolerated by trauma patients without progression to end-organ failure. These patients respond better to a possible delay in surgical management of the hemorrhage in a definitive care facility than do patients with greater hypotension.…”

Section: Discussionmentioning

confidence: 99%

“…Hypothermia gradually derails the hemostatic system by increasing the tendency for fibrinolysis. 32 This increase marks the limit of a patient's ability to cope with the physiological consequences of injury. The already established acidosis, coagulopathy, and hypothermia may be aggravated by resuscitation with crystalloid fluids.…”

Section: The Triad Of Death and Damage Control Surgerymentioning

confidence: 99%

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Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Gourgiotis

Gemenetzis

Kocher

et al. 2013

Critical Care Nurse

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T rauma remains the leading cause of mortality among persons 1 to 44 years old in the United States 1 and accounts for almost 9% of total mortality worldwide. 2 In 2008 a total of 663000 injury-related deaths occurred in Europe (6.9% of total deaths). 2 Uncontrolled bleeding and exsanguination are the leading cause of preventable death after trauma 3 and require early detection of potential bleeding sources and prompt action to minimize blood loss, restore tissue perfusion, and achieve a stable hemodynamic status. Permissive Hypotension in CNE Continuing Nursing EducationCover Severity of hemorrhage and rate of bleeding are fundamental factors in the outcomes of trauma. Intravenous administration of fluid is the basic treatment to maintain blood pressure until bleeding is controlled. The main guideline, used almost worldwide, Advanced Trauma Life Support, established by the American College of Surgeons in 1976, calls for aggressive administration of intravenous fluids, primarily crystalloid solutions. Several other guidelines, such as Prehospital Trauma Life Support, Trauma Evaluation and Management, and Advanced Trauma Operative Management, are applied according to a patient's current condition. However, the ideal strategy remains unclear. With permissive hypotension, also known as hypotensive resuscitation, fluid administration is less aggressive. The available models of permissive hypotension are based on hypotheses in hypovolemic physiology and restricted clinical trials in animals. Before these models can be used in patients, randomized, controlled clinical trials are necessary. (Critical Care Nurse. 2013;33[6]:18-25)

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Section: Discussionmentioning

confidence: 99%

Section: The Triad Of Death and Damage Control Surgerymentioning

confidence: 99%

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Gourgiotis

Gemenetzis

Kocher

et al. 2013

Critical Care Nurse

View full text Add to dashboard Cite

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“…It has also been reported that the use of DHCA is associated with longer duration of surgery, adverse postoperative neurologic outcomes due to derangements in cellular metabolism [3] and coagulation disorders promoting haemorrhage [4]. We also hypothesize that DHCA is associated with increased postoperative wake up time, mechanical ventilation time and longer use of postoperative inotropic support.…”

Section: Introductionmentioning

confidence: 60%

Antegrade Brain Perfusion for Pulmonary Thromboendarterectomy

Morin

Hirsch²,

Tharmalingam³

2011

WJCS

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Objective: The gold standard procedure for pulmonary thromboendarterectomy is median sternotomy, cardiopulmonary bypass, profound hypothermia (18˚C) and circulatory arrest. We propose a modified technique to improve the quality of care in this patient population, based on an intervention previously used in aortic surgery. Method: In our modified technique, we cannulated the right axillary artery to allow antegrade brain perfusion while on circulatory arrest. In this retrospective study, we have reviewed the data relating to the first 7 patients on whom we performed the modified technique and have made comparison with a group of 7 case-matched individuals who underwent the standard technique (control group). Results: The modified technique allowed for use of moderate hypothermia (25˚C -28˚C). Patients in both groups woke up without neurologic complications. A trend towards, but non-significant reduction in duration of surgery from 303 (±42) to 279 (±44), duration of postoperative inotropic support from 2.7 ± 3.4 days to 1.7 ± 2.0 days, as well as postoperative mechanical ventilation time from 4.87 (±3.7) to 2 (±2.7) days were seen in the control and modified groups respectively. All patients in the modified group woke up on post-operative day 0, whereas most patients in the control group awoke on postoperative day 1. No significant differences were noted in the reduction in preoperative to postoperative systolic pulmonary artery pressure, post-operative length of stay in the intensive care unit and length of stay in the hospital among the two groups. Conclusions: The antegrade brain perfusion via the right axillary artery allows for good brain protection, while maintaining a bloodless field in the arterial pulmonary tree. All our patients awoke without any neurologic deficits. In the future, by using an even milder level of cooling, we may be able to significantly reduce the duration of surgery and improve the recovery of our patients.

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“…The use of irrigation with warmed water for epistaxis and minor vessel hemostasis in endoscopic sinus surgery has been reported [2-4]. There is no literature looking at warm soaks on cutaneous versus mucosal surfaces.It has been hypothesized that hypothermia inhibits enzymatic reactions of the coagulation cascade and might impair platelet reactivity [5].Hypothermia from general anesthesia has been associated with coagulopathy [6]. By increasing the body temperature, this coagulopathy might be nullified and actually reversed.…”

mentioning

confidence: 99%

“…It has been hypothesized that hypothermia inhibits enzymatic reactions of the coagulation cascade and might impair platelet reactivity [5].…”

mentioning

confidence: 99%

Room Temperature Saline-soaked Gauze Assists in Hemostasis Between Mohs Layers

Sutton¹,

Orengo²

2017

ACD

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leeding between Mohs layers is distressing to the patient and potentially time-consuming for the physician. Electrosurgery is utilized for hemostasis in most Mohs cases. Obtaining complete hemostasis between Mohs layers can be difficult as anticoagulant use by patients is often encountered. We present a simple and cost-effective method to assist in obtaining hemostasis between Mohs layers. Advantages of this method include quick hemostasis that doesn't require significant electrodesiccation; therefore, saves time for the physician between Mohs layers, less destruction of tissue that may be critical for the reconstruction, and perhaps decreases exposure to smoke from electrosurgery.We have found the use of gauze soaked with room temperature sterile saline and then applied to the wound bed under a pressure bandage can assist in hemostasis. We use room temperature saline which is most commonly around 20-25°C. We presume the success of this method is due to the saline being cooler than body temperature; therefore, precipitating local vasoconstriction. The saline-weighted gauze might also provide additional pressure. This technique is particularly useful for eyelid lesions where minimizing electrosurgery to improve outcome is critical.Other locations that seem to benefit from this technique are scalp and nose defects. Although we have found success with this method repeatedly, the literature is divergent regarding the temperature of saline to assist in hemostasis.Perhaps contrary to intuition, warm saline opposed to cool or room temperature saline has been associated with reduced bleeding [1]. A recent study in oral surgery compared dressings soaked in room temperature saline compared to saline dressings warmed to 42°C. Significantly reduced bleeding was reported in this split-mouth study with the warmed saline dressings. These findings are aligned with results previously reported in endoscopic sinus surgery and treatment of epistaxis. The use of irrigation with warmed water for epistaxis and minor vessel hemostasis in endoscopic sinus surgery has been reported [2-4]. There is no literature looking at warm soaks on cutaneous versus mucosal surfaces.It has been hypothesized that hypothermia inhibits enzymatic reactions of the coagulation cascade and might impair platelet reactivity [5].Hypothermia from general anesthesia has been associated with coagulopathy [6]. By increasing the body temperature, this coagulopathy might be nullified and actually reversed. In addition, other mechanisms of action proposed include interstitial edema precipitating compression on blood vessels [7]. Vasodilation of the vessels is also thought to decrease intraluminal pressure that would slow blood flow. Under this theory, the role of vasoconstriction due to hypothermia contributing to hemostasis has yet to be determined and would play a secondary role.The use of cold saline has been supported in various literature. A randomized, control trial during total knee arthroplasty that compared irrigating with cold (4°C) saline with 0.5% epinephr...

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Impact of Graded Hypothermia on Coagulation and Fibrinolysis

Cited by 25 publications

References 34 publications

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

Antegrade Brain Perfusion for Pulmonary Thromboendarterectomy

Room Temperature Saline-soaked Gauze Assists in Hemostasis Between Mohs Layers

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