Pediatric trauma and resuscitation: optimizing care in an evolving landscape.

IF 2.3 3区 医学 Q2 ANESTHESIOLOGY
Carl L McMullen, David Levin, Asheen Rama
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引用次数: 0

Abstract

Purpose of review: Penetrating firearm-related injury has increased mortality rates in children in the USA. This article summarizes trends in pediatric injury patterns, the unique coagulation system of infants, and key components of hemostatic resuscitation in children.

Recent findings: Firearm-associated penetrating trauma increased mortality and led to higher rates of pediatric massive transfusions. Patients may be the victim of previous gun violence or live with an adult who purchased a firearm for the first time during the COVID-19 pandemic. Platelet dysfunction and hypocalcemia are important considerations that may lead to higher transfusion requirements if not addressed. Pediatric massive transfusion protocols have become more standardized, and the use of whole blood has increased. Low-titer group O whole blood has shown benefit to improve coagulopathy and shock-associated indices when compared with conventional component therapy.

Summary: Traumatic hemorrhage is potentially life-threatening in children and requires prompt hemostatic resuscitation. Massive transfusion protocols that target trauma-induced coagulopathy and account for the unique pediatric coagulation system are imperative. Ongoing and future research is important to standardize pediatric resuscitation practices.

儿科创伤和复苏:在不断变化的环境中优化护理。
综述目的:穿透性火器相关伤害增加了美国儿童的死亡率。本文总结了儿童损伤模式的趋势,婴儿独特的凝血系统,以及儿童止血复苏的关键组成部分。最近的研究发现:枪支相关的穿透性创伤增加了死亡率,并导致儿童大量输血的比例更高。患者可能是以前枪支暴力的受害者,或者与在COVID-19大流行期间首次购买枪支的成年人住在一起。血小板功能障碍和低钙血症是重要的考虑因素,如果不加以解决,可能导致更高的输血需求。儿科大规模输血方案已变得更加标准化,全血的使用也有所增加。与传统成分治疗相比,低滴度O组全血已显示出改善凝血功能和休克相关指标的益处。总结:儿童外伤性出血可能危及生命,需要及时止血复苏。针对创伤性凝血病的大规模输血方案和独特的儿科凝血系统是必要的。正在进行的和未来的研究对于规范儿科复苏实践非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.90
自引率
8.00%
发文量
207
审稿时长
12 months
期刊介绍: ​​​​​​​​Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in Anesthesiology features hand-picked review articles from our team of expert editors. With fifteen disciplines published across the year – including cardiovascular anesthesiology, neuroanesthesia and pain medicine – every issue also contains annotated references detailing the merits of the most important papers.
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