Management of bleeding in major burn surgery
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Management of bleeding in major burn surgery. / Welling, Harald; Ostrowski, Sisse Rye; Stensballe, Jakob; Vestergaard, Martin Risom; Partoft, Søren; White, Jonathan; Johansson, Pär Ingemar.
In: Burns, Vol. 45, No. 4, 2019, p. 755-762.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - Management of bleeding in major burn surgery
AU - Welling, Harald
AU - Ostrowski, Sisse Rye
AU - Stensballe, Jakob
AU - Vestergaard, Martin Risom
AU - Partoft, Søren
AU - White, Jonathan
AU - Johansson, Pär Ingemar
PY - 2019
Y1 - 2019
N2 - Major burn surgery is often associated with excessive bleeding and massive transfusion, and the development of a coagulopathy during major burn surgery is associated with increased morbidity and mortality. The aim of this study was to review the literature on intraoperative haemostatic resuscitation of burn patients during necrectomy to reveal strategies applied for haemostatic monitoring and resuscitation. We searched PubMed, EMBASE, and CENTRAL for studies published in the period 2006–2017 concerning bleeding issues related to burn surgery i.e. coagulopathy, transfusion requirements and clinical outcomes. In a broad search, a total of 1375 papers were identified. 124 of these fulfilled the inclusion criteria, and six of these were included for review. The literature confirmed that transfusion requirements increases with burn injury severity and that haemostatic monitoring by TEG® (thrombelastography) or ROTEM® (rotational thromboelastometry) significantly decreased intraoperative transfusions and was useful in predicting and goal-directing haemostatic therapy during excision surgery. Resuscitation of bleeding during major burn surgery in many instances was neither standardized nor haemostatic. We suggest that resuscitation should aim for normal haemostasis during the bleeding phase through close haemostatic monitoring and resuscitation. Randomised controlled trials are highly warranted to confirm the benefit of this concept.
AB - Major burn surgery is often associated with excessive bleeding and massive transfusion, and the development of a coagulopathy during major burn surgery is associated with increased morbidity and mortality. The aim of this study was to review the literature on intraoperative haemostatic resuscitation of burn patients during necrectomy to reveal strategies applied for haemostatic monitoring and resuscitation. We searched PubMed, EMBASE, and CENTRAL for studies published in the period 2006–2017 concerning bleeding issues related to burn surgery i.e. coagulopathy, transfusion requirements and clinical outcomes. In a broad search, a total of 1375 papers were identified. 124 of these fulfilled the inclusion criteria, and six of these were included for review. The literature confirmed that transfusion requirements increases with burn injury severity and that haemostatic monitoring by TEG® (thrombelastography) or ROTEM® (rotational thromboelastometry) significantly decreased intraoperative transfusions and was useful in predicting and goal-directing haemostatic therapy during excision surgery. Resuscitation of bleeding during major burn surgery in many instances was neither standardized nor haemostatic. We suggest that resuscitation should aim for normal haemostasis during the bleeding phase through close haemostatic monitoring and resuscitation. Randomised controlled trials are highly warranted to confirm the benefit of this concept.
KW - Bleeding
KW - Haemostatic
KW - Resuscitation
KW - ROTEM
KW - Surgery
KW - TEG
U2 - 10.1016/j.burns.2018.08.024
DO - 10.1016/j.burns.2018.08.024
M3 - Review
C2 - 30292526
AN - SCOPUS:85054125269
VL - 45
SP - 755
EP - 762
JO - Burns
JF - Burns
SN - 0305-4179
IS - 4
ER -
ID: 230249023