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1.
Transfus Clin Biol ; 26(1): 18-26, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29936040

RESUMO

OBJECTIVES: The European trauma guidelines were developed to assist clinicians in the early phase of trauma management to diagnose and treat coagulopathy and bleeding. This study aimed to determine compliance with these European trauma guidelines in a French referral trauma centre. METHODS: Medical charts of trauma patients with an injury severity score≥16 admitted between January 2013 and December 2014 were reviewed. Compliance with 21 recommendations in the first 24-hours of patient management was assessed. RESULTS: There were 145 patients with median ISS of 34 [IQR 25-41]. A good level of compliance (i.e. applied in≥80% of patients) was identified for nine recommendations, inconsistent compliance (i.e. applied in 50 to 79% of patients) for six recommendations, including fibrinogen levels at hospital admission and achievement of a target mean arterial blood pressure (MAP)>80mmHg in patients with major bleeding and TBI (55.5%), and poor compliance (i.e. applied in<50% of patients) for another six recommendations. Poorly applied recommendations included early measurement of lactate or base deficit (32%), early administration of tranexamic acid (18%), and achievement of normocapnia in patients with TBI undergoing invasive ventilation (3%). CONCLUSIONS: In a referral trauma centre, nine of the 21 evaluable recommendations in the European trauma guidelines were applied in≥80% of patients. Early diagnosis and treatment of trauma-related coagulopathy was identified as an area for significant practice improvement. In patients with TBI, efforts should be made to achieve the targeted MAP and to maintain normocapnia.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Testes de Coagulação Sanguínea/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adulto , Transtornos da Coagulação Sanguínea/terapia , Feminino , França , Hemodinâmica , Hemorragia/diagnóstico , Hemorragia/etiologia , Hemorragia/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Ressuscitação/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/complicações
4.
Clin Pharmacol Ther ; 88(2): 183-90, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20631694

RESUMO

Low doses of hydrocortisone (HC) and fludrocortisone (FC) administered together improve the prognosis after septic shock; however, there continues to be disagreement about the utility of FC for this indication. The biological and hemodynamic effects of HC (50 mg intravenously) and FC (50 microg orally) were assessed in 12 healthy male volunteers with saline-induced hypoaldosteronism in a placebo-controlled, randomized, double-blind, crossover study performed according to a 2 x 2 factorial design. HC and FC significantly decreased urinary sodium and potassium levels (from -58% at 4 h to -28% at 10 h and from -35% at 8 h to -24% at 12 h, respectively) with additive effects. At 4 h after administration, HC significantly increased cardiac output (+14%), decreased systemic vascular resistances (-14%), and slightly increased heart rate (+4 beats/min), whereas FC had no hemodynamic effect. At doses used in septic shock, HC induced greater mineralocorticoid effect than FC did. HC also induced transient systemic hemodynamic effects, whereas FC did not. New studies are required to better define the optimal dose of FC in septic shock.


Assuntos
Anti-Inflamatórios/farmacologia , Fludrocortisona/farmacologia , Hidrocortisona/farmacologia , Hipoaldosteronismo/sangue , Adulto , Aldosterona/sangue , Glicemia/metabolismo , Estudos Cross-Over , Método Duplo-Cego , Hemodinâmica/efeitos dos fármacos , Humanos , Hipoaldosteronismo/induzido quimicamente , Masculino , Renina/sangue , Sódio , Urodinâmica/efeitos dos fármacos , Equilíbrio Hidroeletrolítico/efeitos dos fármacos , Adulto Jovem
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