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Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Traditional transfusion practices are changing. | Holcomb Critical Care 2010 14 162 http ccforum.eom content 14 3 162 CRITICAL CARE COMMENTARY L__ Traditional transfusion practices are changing John B Holcomb See related research by Schochl etal. http ccforum.eom content 14 2 R55 Abstract Schochl and co-authors have described a 5-year retrospective study that outlines a novel important and controversial transfusion concept in seriously injured trauma patients. Traditionally clinicians have been taught to use a serial approach resuscitating hypovolemic trauma patients with a form of crystalloid or colloid followed by red blood cells RBCs then fresh frozen plasma FFP and lastly platelets. The data supporting this widely accepted approach are remarkably weak. Conversely Schochl and colleagues in an innovative retrospective study describe the use of fibrinogen concentrate plasma complex concentrate RBCs FFP and platelets driven by a thromboelastometry-based algorithm. Finally it appears that transfusion therapy is becoming driven by physiology. The data presented by Schochl and colleagues will be seen as intriguing important innovative and controversial 1 . This paper builds on work by Dr Detmer Fries published in a swine injury model in 2006 2 3 . However as with all retrospective studies caution must be exercised before widespread adoption. The usual concerns apply as there is no control group the data supporting the thromboelastometry goal-directed algorithm are not presented and the risks of using and combining fibrinogen concentrates and plasma complex concentrates PCCs in trauma patients are unknown. Preclinical and clinical evidence to answer these questions is lacking and should be investigated. With regards to the study by Schochl and colleagues I am concerned with the comparison of mortality rates in the small numbers of seriously injured patients collected over 5 years to that predicted by the trauma injury severity score TRISS and by the revised injury severity Correspondence .
