Massive transfusion ...Facts..and new facts

Definitions vary… They include:

10 unit transfusion in 24 h

transfusion of an entire blood volume in 24 h

replacement of 50% blood volume over 3 h

1 adult bag of platelets is equivalent to 4 units PRBCs for the purposes of maintaining the 1:1 ratio.

Note that the 1:1:1 concept is mainly supported by the fact that it makes sense pathophysiologically and by retrospective and observational studies. It has not been conclusively proven in the way that a large double-blind randomised controlled trial would. Indeed, there are concerns that at least some of the perceived benefit of hemostatic resuscitation and the ’1:1:1′ ratio is due to survivor bias .

Tranexamic acid an antifibrinolytic that works by competitively inhibiting the activation of plasminogen to plasmin plasmin is responsible for the degradation of fibrin. Given that tranexamic acid is cheap, one of the few interventions with proven mortality benefit (NNT = 67) and few adverse effects I think clinicians should strongly consider this using this agent in major trauma patients.

Tranexamic acid is given as 1g IV loading dose followed by 1g over 8 hours. It should be given with 3 hours of major trauma.

Tranexamic acid should be given early, within 3 hours of the time of injury.

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Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

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