Evidence-based guidelines for bleeding in trauma patients where do we go from here.docVIP

Available online /content/11/2/128 Commentary Evidence-based guidelines for bleeding in trauma patients: where do we go from here? Joseph P Minei Department of Surgery, UT Southwestern Medical Center and Parkland Memorial Hospital, Dallas, Texas, USA Correspondence: Joseph P Minei, joseph.minei@ Published: 27 April 2007 Critical Care 2007, 11:128 (doi:10.1186/cc5737) This article is online at /content/11/2/128 ? 2007 BioMed Central Ltd See related research by Spahn et al., /content/11/1/R17 Abstract need to be placed in context, particularly in terms of the dynamic continuum of patient management over time. For example, the recommendation that red cell transfusion be based on a conservative transfusion trigger (hemoglobin 7 to 9 g/dl) is based on solid evidence. However, that evidence applies only to the stabilized (postoperative) patient who is no longer bleeding massively. Within this context it would be unwise to await laboratory data to decide whether to transfuse an acutely bleeding patient. Under such dynamic circumstances, the decision must be based on clinical factors such as vital signs, response to resuscitation, volume of ongoing bleeding, and the success of surgical attempts to control bleeding. Likewise, transfusion of thawed plasma under those circumstances should not await the results of an international normalized ratio (INR, for prothrombin time), but rather the decision should be based on clinical factors. Once bleeding is controlled and the patient is stabilized, such strict laboratory-guided transfusion practices can be followed. The development of evidence-based guidelines has gained popularity as a strategy to reduce variation in practice and to orient clinical care around documentable best practices. Based on available data, the new European guidelines for the management of bleeding in the trauma