Unit of Anesthesia and Critical Care, Hôpital Beaujon, DMU PARABOL, APHP Nord - Université de Paris, Paris, France.
Inserm, U1216, Grenoble Institute of Neurosciences, CHU Grenoble Alpes, Grenoble Alpes University, Grenoble, France -
Minerva Anestesiol. 2022 Mar;88(3):184-191. doi: 10.23736/S0375-9393.21.15914-0. Epub 2021 Oct 12.
A considerable amount of literature has nurtured the idea that massive transfusion is an independent trauma disease and therapeutic tool. In this opinion paper, the authors expose the evolution and challenge the classic paradigm and historic definition of massive transfusion. Based on current evidence the elements of an evolving strategy in transfusion management and bleeding control are exposed to use of tranexamic acid, combination and ratios of blood products, use of fluids and viscoelastic testing, etc. The synergy of these elements provides the basis to develop updated strategies and perspectives for transfusion management after trauma and to consider a classic definition of massive transfusion as outdated or the need for massive transfusion as failure. An alternative concept, time critical transfusion may be better placed to take into account modern transfusion management after trauma.
大量文献已经形成这样的观点，即大量输血是一种独立的创伤性疾病和治疗手段。在这篇观点文章中，作者揭示了其演变过程，并对大量输血的经典范例和历史定义提出了挑战。基于目前的证据，暴露了输血管理和出血控制中不断发展策略的要素，包括使用氨甲环酸、血液制品的组合和比例、液体的使用以及粘弹性检测等。这些要素的协同作用为制定创伤后输血管理的更新策略和观点提供了基础，并考虑将大量输血的经典定义视为过时或需要大量输血作为失败的标准。替代概念，即时间关键输血，可能更适合考虑现代创伤后输血管理。
