Sloos Pieter H, Maas M Adrie W, Hollmann Markus W, Juffermans Nicole P, Kleinveld Derek J B
Department of Intensive Care Medicine, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.
Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands.
Intensive Care Med Exp. 2022 Jan 7;10(1):1. doi: 10.1186/s40635-021-00428-1.
Trauma-induced coagulopathy (TIC) is a life-threatening condition associated with high morbidity and mortality. TIC can present with different coagulation defects. In this study, the aim was to determine the effect of shock duration on TIC characteristics. We hypothesized that longer duration of shock leads to a more hypocoagulable rotational thromboelastometry (ROTEM) profile compared to a shorter duration of shock.
Male B57BL/6J(c) mice (n = 5-10 per group) were sedated and mechanically ventilated. Trauma was induced by bilateral lower limb fractures and crush injuries to the liver and small intestine. Shock was induced by blood withdrawals until a mean arterial pressure of 25-30 mmHg was achieved. Groups reflected trauma and shock for 30 min (TS30) and trauma and shock for 90 min (TS90). Control groups included ventilation only (V90) and trauma only (T90).
Mice in the TS90 group had significantly increased base deficit compared to the V90 group. Mortality was 10% in the TS30 group and 30% in the TS90 group. ROTEM profile was more hypocoagulable, as shown by significantly lower maximum clot firmness (MCF) in the TS30 group (43.5 [37.5-46.8] mm) compared to the TS90 group (52.0 [47.0-53.0] mm, p = 0.04). ROTEM clotting time and parameters of clot build-up did not significantly differ between groups.
TIC characteristics change with shock duration. Contrary to the hypothesis, a shorter duration of shock was associated with decreased maximum clotting amplitudes compared to a longer duration of shock. The effect of shock duration on TIC should be further assessed in trauma patients.
创伤性凝血病（TIC）是一种危及生命的疾病，与高发病率和死亡率相关。TIC可表现出不同的凝血缺陷。在本研究中，目的是确定休克持续时间对TIC特征的影响。我们假设，与较短的休克持续时间相比，较长的休克持续时间会导致旋转血栓弹力图（ROTEM）检测结果显示血液凝固性更低。
对雄性B57BL/6J（c）小鼠（每组n = 5 - 10只）进行镇静并机械通气。通过双侧下肢骨折以及肝脏和小肠挤压伤诱导创伤。通过抽血诱导休克，直至平均动脉压达到25 - 30 mmHg。分组包括创伤和休克30分钟（TS30）组以及创伤和休克90分钟（TS90）组。对照组包括仅通气组（V90）和仅创伤组（T90）。
与V90组相比，TS90组小鼠碱缺失显著增加。TS30组死亡率为10%，TS90组为30%。ROTEM检测结果显示血液凝固性更低，与TS90组（52.0 [47.0 - 53.0] mm，p = 0.04）相比，TS30组最大血凝块硬度（MCF）显著更低（43.5 [37.5 - 46.8] mm）。各组之间ROTEM凝血时间和血凝块形成参数无显著差异。
TIC特征随休克持续时间而变化。与假设相反，与较长的休克持续时间相比，较短的休克持续时间与最大凝血幅度降低有关。休克持续时间对TIC的影响应在创伤患者中进一步评估。
