Traditional transfusion practices are changing 英文参考文献.docVIP

Holcomb Critical Care 2010,14:162 /content/14/3/162 COMMENTARY Traditional transfusion practices are changing John B Holcomb* See related research by Schochl et al., /content/14/2/R55 classi? cation (RISC) score. It is very easy for such small Abstract data sets to su? er signi? cant statistical problems when 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 ?brinogen 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. attempting to match injuries and initial physiology. It would have been preferable to at least construct a before and after design. Several questions are apparent: when the thromboelastometry was repeated, did the test results change (improve?) after transfusion of the proscribed agent? What was the timing of the ? brinogen and PCC concentrates in relation to red blood cells (RBCs)? How often was the ? brinogen or PCC given before the RBCs? How did mortality change over time, as the authors became more comfortable with their alternative resusci- tation strategy? Despite these and many more questions, I sincerely congratulate the authors on forging ahead and intro ducing a novel resuscitation approa e issues inherent in this retrospective study (and in every one of the recently published retrospective transfusion studi