Impactul prognostic al tulburărilor echilibrului fluido-coagulant la „marii arși“

Abstract

Introduction. The „major burns“ are critically ill patients with extended burn injuries, over 20% of the total body surface, IInd or IIIrd degree or with special location as face, neck, upper respiratory airways, or lesions that are associated with other traumatic injuries (1). One of the early systemic changes after the burn injury is the coagulation disorder, which influences the outcome. The posttraumatic coagulopathy is influenced primarily by the surface extension and degree of the burn lesion (2), but there are also systemic factors that are induced by the traumatic lesions and amplify the coagulopathy: the systemic inflammatory response, the tissue hypoperfusion, the acidosis (4). Other important factors, which may change the evolution of the major burnt, are: the initial excessive fluid resuscitation, the age, the gender, the comorbidities of the patient (5). Materials and methods. The authors conducted an analysis of the coagulation disorders in a case series of burned patients hospitalized in 2015, in the Intensive Care Unit of the Clinical Emergency Hospital of Bucharest. The prospective observational study included 11 patients hospitalized simultaneously. The study was approved by the internal ethical committee and the consent was obtained for the processing of clinical and laboratory anonymous data. It were analysed the demographic data, the severity of the burn lesions, injury severity score (ISS), the haemostatic pattern through the assessment of the complete blood count, classical coagulation tests, rotational thromelastometry (ROTEM). Results. Patients̒ median age was of 36.00±7.89 years, with variation between 21-45 years old. Men to women ratio was of 7:4. The estimated body surface was between 20-70%, with a mean value of 42.5%±12.03% (it was counted only the burns with degree 2 and 3). At the admission, the ISS score was variated between 17-61 points (of 75 points maximum (10)), with a mean value of 45 ±15.18 points. The lot was devided into two groups, with or without the presence of the posttraumatic coagulopathy criteria, on lab tests or ROTEM, despite blood replacement therapy. There were analysed the parameters which define the posttraumatic coagulopathy and their impact on the blood replacement therapy and mortality. Conclusions. The etiology of the coagulation disorder at the „major bunt“ is multifactorial, but regardless of the predominant cause, it worsens the patients̒ outcome, increases the need for transfusions and mortality. The optimization of the diagnostic methods for the coagulopathy can offer important data regarding the incidence and the severity, with the possibility for faster and targeted theraputic intervention to the patient̒s need.