Institute of Anaesthesiology, University of Zurich and University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
Department of Trauma and Orthopaedic Surgery, Cologne-Merheim Medical Centre (CMMC), University of Witten/Herdecke, Ostmerheimer Strasse 200, D-51109, Cologne, Germany.
Crit Care. 2019 Mar 27;23(1):98. doi: 10.1186/s13054-019-2347-3.
Severe traumatic injury continues to present challenges to healthcare systems around the world, and post-traumatic bleeding remains a leading cause of potentially preventable death among injured patients. Now in its fifth edition, this document aims to provide guidance on the management of major bleeding and coagulopathy following traumatic injury and encourages adaptation of the guiding principles described here to individual institutional circumstances and resources.
The pan-European, multidisciplinary Task Force for Advanced Bleeding Care in Trauma was founded in 2004, and the current author group included representatives of six relevant European professional societies. The group applied a structured, evidence-based consensus approach to address scientific queries that served as the basis for each recommendation and supporting rationale. Expert opinion and current clinical practice were also considered, particularly in areas in which randomised clinical trials have not or cannot be performed. Existing recommendations were re-examined and revised based on scientific evidence that has emerged since the previous edition and observed shifts in clinical practice. New recommendations were formulated to reflect current clinical concerns and areas in which new research data have been generated.
Advances in our understanding of the pathophysiology of post-traumatic coagulopathy have supported improved management strategies, including evidence that early, individualised goal-directed treatment improves the outcome of severely injured patients. The overall organisation of the current guideline has been designed to reflect the clinical decision-making process along the patient pathway in an approximate temporal sequence. Recommendations are grouped behind the rationale for key decision points, which are patient- or problem-oriented rather than related to specific treatment modalities. While these recommendations provide guidance for the diagnosis and treatment of major bleeding and coagulopathy, emerging evidence supports the author group's belief that the greatest outcome improvement can be achieved through education and the establishment of and adherence to local clinical management algorithms.
A multidisciplinary approach and adherence to evidence-based guidance are key to improving patient outcomes. If incorporated into local practice, these clinical practice guidelines have the potential to ensure a uniform standard of care across Europe and beyond and better outcomes for the severely bleeding trauma patient.
严重创伤性损伤继续给全球医疗体系带来挑战，创伤后出血仍然是受伤患者中潜在可预防死亡的主要原因。本文为第五版，旨在为创伤后大出血和凝血病的管理提供指导，并鼓励根据机构情况和资源对本文中描述的指导原则进行调整。
2004 年成立了泛欧多学科创伤高级出血处理工作组，现任作者组包括六个相关欧洲专业学会的代表。该小组采用结构化的循证共识方法解决科学问题，这些问题是制定每条建议及其支持依据的基础。还考虑了专家意见和当前的临床实践，特别是在没有或无法进行随机临床试验的领域。根据上一版以来出现的科学证据和临床实践的变化，重新审查和修订了现有建议。制定新的建议，以反映当前的临床关注点和新的研究数据产生的领域。
对创伤后凝血病病理生理学的认识进展支持了改进的管理策略，包括早期个体化目标导向治疗改善严重受伤患者结局的证据。当前指南的总体组织旨在反映患者路径上的临床决策过程，大致按时间顺序排列。建议分组基于关键决策点的理由，这些决策点是面向患者或问题的，而不是与特定治疗方式相关。虽然这些建议为大出血和凝血病的诊断和治疗提供了指导，但新出现的证据支持作者组的信念，即通过教育和建立并坚持当地临床管理算法，可以实现最大的结果改善。
多学科方法和循证指导是改善患者结局的关键。如果纳入当地实践，这些临床实践指南有可能确保欧洲乃至全球的护理标准统一，并改善严重出血创伤患者的结局。
