18/10/2019
Coagulopathies
📷 Don't correct coagulopathies in critical illness unless there is a specific reason (e.g., bleeding or an upcoming invasive procedure).
📷 Massive Transfusion in the ICU
With the realization that transfusion of blood products can cause harm, the historical tendency to "physiologically" correct hemoglobin and coagulation factors toward normal has been supplanted by a more cautious, restrictive approach, in general.
For patients with major bleeding after trauma ("massive transfusion," >10 units pRBC / 24 hours):
How much fresh frozen plasma should be transfused for each unit of packed red cells?
No one knows. A large randomized trial, PROPPR showed no difference between varying ratios.
Retrospective series of military and civilian casualties suggested a 1:1 ratio of FFP to pRBC improved survival, and have led to adoption of these ratios (1:1 or 1:2 FFP to RBC) both in massive and non-massive transfusion.
In one study, patients receiving such a "high FFP" strategy for non-massive transfusions (
