Coagulopatía temprana en trauma: ¿Llegan los pacientes coagulopáticos a la sala de cirugía?

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Wilson Valencia, Johnnie Smith Husbands Luque" "autores" => array:2 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Wilson Valencia" ] 1 => array:2 [ "nombre" => "Johnnie Smith" "apellidos" => "Husbands Luque" ] ] ] ] ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0120334710840079?idApp=UINPBA00004N" "url" => "/01203347/0000003800000004/v2_201302061631/S0120334710840079/v2_201302061631/es/main.assets" ] "es" => array:15 [ "idiomaDefecto" => true "cabecera" => "ARTÍCULO DE REVISIÓN" "titulo" => "Coagulopatía temprana en trauma: ¿Llegan los pacientes coagulopáticos a la sala de cirugía?" "tieneTextoCompleto" => 0 "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "510" "paginaFinal" => "525" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Juan Carlos Jiménez B., Jairo de La Peña L., Rubén Teherán M., Andrés Orozco" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Juan Carlos" "apellidos" => "Jiménez B." "email" => array:1 [ 0 => "juanjim170@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "af0005" ] ] ] 1 => array:3 [ "nombre" => "Jairo de La" "apellidos" => "Peña L." "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "**" "identificador" => "af0010" ] ] ] 2 => array:3 [ "nombre" => "Rubén" "apellidos" => "Teherán M." "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "***" "identificador" => "af0015" ] ] ] 3 => array:3 [ "nombre" => "Andrés" "apellidos" => "Orozco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "****" "identificador" => "af0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "MD Especialista en Anestesiología, Universidad de Cartagena. Anestesiólogo Hospital Universitario del Caribe, Cartagena, Colombia" "etiqueta" => "*" "identificador" => "af0005" ] 1 => array:3 [ "entidad" => "Residente de I año Cirugía General, Universidad de Cartagena, Cartagena, Colombia" "etiqueta" => "**" "identificador" => "af0010" ] 2 => array:3 [ "entidad" => "MD. Anestesiólogo director UCI Hospital Universitario del Caribe, Cartagena, Colombia" "etiqueta" => "***" "identificador" => "af0015" ] 3 => array:3 [ "entidad" => "Médico de Planta, UCI Hospital Universitario del Caribe, Cartagena, Colombia" "etiqueta" => "****" "identificador" => "af0020" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:2 [ "titulo" => "Early Coagulopathy in Trauma" "subtitulo" => "Do Coagulopathic patients Reach the operating Room?" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2010-01-25" "fechaAceptado" => "2010-07-26" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras claves" "identificador" => "xpalclavsec17608" "palabras" => array:5 [ 0 => "Coagulopatía" 1 => "trauma" 2 => "hemorragia" 3 => "transfusión" 4 => "tromboelastografía (Fuente: DeCS, BIREME)" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec17607" "palabras" => array:5 [ 0 => "Coagulopathy" 1 => "trauma" 2 => "hemorrhage" 3 => "transfusion" 4 => "thromboelastography (Source: MeSH, BIREME)" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "RESUMEN" "resumen" => "IntroducciónDe la coagulopatía aguda en el trauma, resultan múltiples complicaciones como la necesidad de administración de hemoderivados, mayor incidencia de disfunción orgánica, aumento de estancia en unidad de cuidados intensivos y mayor mortalidad. Con el conocimiento actual de la fisiopatología del trauma y la vía celular de la coagulación es ahora posible mejorar el dignóstico y tratamiento de la coagulopatía inicial y conseguir mejores resultados en nuestros centros. MétodosEste artículo examina la fisiología básica de la coagulación, la etiología, el diagnóstico y el tratamiento de la coagulopatía temprana en trauma. La búsqueda se realizó con términos Mesh y no Mesh con conectores AND: Anesthesia-coagulophaty, postinjury and trauma thromboelastography, transfusion and trauma, shock- Mechanism and trauma review. ResultadosLa coagulopatía aguda o temprana en trauma está directamente asociada al estado de shock y se caracteriza por anticoagulación e hiperfibrinolisis sistémica; hay evidencia de la implicación de la proteína C en este proceso. Se ha establecido que seis mecanismos fisiopatológicos multifactoriales pueden perpetuar la coagulopatía en los pacientes traumatizados; éstos son: inflamación, acidosis, hipotermia, shock, trauma tisular y hemodilución. El diagnóstico se realiza con las diferentes pruebas (TP, TPT, plaquetas) ya conocidas desde hace mucho tiempo, pero con limitaciones que reducen su utilidad clínica. Ahora la tromboelastografía nos puede ayudar a guiar la transfusión, con el concepto actual de transfusión temprana de glóbulos rojos, plasma y plaquetas, utilizando la mejor proporción según la evidencia disponible. ConclusionesContamos, con algún conocimiento sobre la fisiopatología de la coagulopatía asociada con trauma pero son necesarias más investigaciones, en este campo. El diagnóstico rápido y una intervención directa inmediata son importantes para mejorar el desenlace de nuestros pacientes." ] "en" => array:2 [ "titulo" => "SUMMARY" "resumen" => "IntroductionAcute coagulopathy in trauma results in multiple complications such as the need for blood products, higher rates of organ dysfunction, longer stay in the ICU and higher mortality. With the current knowledge of the pathophysiology of trauma and of the cellular coagulation pathway it is now possible to improve diagnosis and treatment of the initial coagulopathy and achieve better outcomes in our trauma centers. MethodsThis paper looks into the basic physiology of coagulation, and the etiology, diagnosis and treatment of early coagulopathy in trauma. The search was done using Mesh and non-Mesh terms with AND connectors: Anesthesia-coagulopathy, postinjury and trauma thromboelastography, transfusion and trauma, shock-Mechanism and trauma review. ResultsAcute or early coagulopathy in trauma is directly associated with a state of shock and is characterized by anticoagulation and systemic hyperfibrinolysis; protein C is known to be implicated in this process. It has also been determined that six multi-factorial pathophysiological mechanisms may perpetuate coagulopathy in trauma patients, namely, inflammation, acidosis, hypothermia, shock, tissue trauma and hemodilution. Diagnosis is made using the different tests (PT, PPT, platelets) that have been in use for a long time; however, these tests have drawbacks that limit their clinical usefulness. Thromboelastography can now help guide early transfusion using the best proportion of red blood cells, plasma and platelets on the basis of the best available evidence. ConclusionsWe have some knowledge about the pathophysiology coagulopathy associated with trauma but more research in this field is needed. 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