Mil Lite 9 0 R2 FULL Version 43 ~REPACK~ 💻
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to assess the patient’s risk for developing bleeding, the trauma-injury severity score (triss), the revised trauma score (rts), the injury severity score (iss), the acute physiology and chronic health evaluation (apache) ii score and the glasgow coma scale (gcs) have been calculated [ 671, 672 ]. these clinical scores are only surrogate markers for haemorrhagic risk, and the decision to transfuse should be based on the evaluation of these scores as well as on the assessment of the patient’s haemodynamic stability [ 673 ]. furthermore, the level of anticoagulation, the need for further clinical procedures and other clinical situations should be considered as determinants of bleeding risk [ 674 ].
the choice of transfusion strategy is an important aspect of haemorrhage management in the critically ill patient. in addition to improving oxygen delivery, red blood cell transfusion can improve microcirculatory perfusion and perfusion distribution, restoring or preventing ischaemia in the absence of ongoing severe haemorrhage [ 675 ]. an intact coagulation system is also vital in preventing disseminated intravascular coagulation (dic) in cases of massive blood loss. however, in patients without clinically evident disseminated intravascular coagulation, targeting mean arterial blood pressure <60mmhg can increase bleeding risk, although it may reduce the risk of hypovolaemic shock [ 676 ].
key outcomes measure the effectiveness of treatment strategies, e.g. organ function, survival, treatment-related side effects, and cost. in the presence of bleeding, survival is the most important outcome, as loss of life is directly related to the rate of bleeding. the effect of bleeding management on the rate of death and the number of patients who fail to respond are not reliable. other important outcomes include the ability of a protocol to achieve a target haemoglobin concentration, and to prevent transfusion-related adverse events, such as post-traumatic acute lung injury [ 677 ].
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