Hypothermia is one of the most important factors affecting intraoperative hemorrhage, causing the development of hypocoagulation. Intraoperative hypothermia develops spontaneously as a result of trauma, surgical intervention and anesthesia as a result of a violation of the conformity of heat production to heat loss and suppression of the compensatory thermoregulatory response. Intensive care for polytrauma should be aimed at the "triad of death": hypothermia, acidosis and coagulopathy are the main links in the pathogenesis of polytrauma. Temperature is one of the most important factors determining the coagulation cascade, and since temperature-sensitive plasma esterase reactions, like the functional activity of platelets, are inhibited by hypothermia, it is not surprising that coagulopathy is the final part of the lethal triad. It should be emphasized that this occurs in conditions of blood loss, i.e. the initial loss of coagulation factors and the additional development of dilutional coagulopathy associated with the implementation of infusion therapy to correct hypovolemia causing a pooling of coagulation factors initially at a low level. The purpose of this study was to check the risk of developing trauma-induced coagulopathy depending on the level of postoperative body temperature in patients with polytrauma when using active or passive intraoperative warming. Material and methods. Twenty patients with polytrauma who underwent urgent surgical interventions were examined. Patients were divided into 2 groups: Group I (n = 10) patients were actively heated by the “WarmAir 135” (CSZ) convection heating system with the use of blankets for warming in the operating room – the "FilteredFlo-248" model; Group II – control group (n = 10) patients did not use convection warming. Patients of study groups underwent abdominal, thoracic and neurosurgical surgeries, urological interventions for traumatic injury of pelvic organs, interventions for musculoskeletal injuries. The duration of the intraoperative period was 92 to 225 minutes. All patients were monitored with a core temperature (Tco) using a thermometer for measuring rectal Tco "SureTemp Plus" (WelchAllyn). The body core temperature was measured at the following stages of the intraoperative period: initially and at the end of the operation. The volume of blood loss was determined intraoperatively. In patients of both groups, the pH and INR were determined in the postoperative period at the time of admission to the ICU. Initially at the time of admission to the hospital, all patients were evaluated according to the clinical scale of trauma-induced coagulopathy (TICCS - Trauma Induced Coagulopathy Clinical Score). More than 10 scores collected in patients on the TICCS scale correlate well with laboratory markers for the development of traumatic coagulopathy. Results and discussion. Initially, the risk of developing trauma-induced coagulopathy according to the TICCS scale did not differ significantly between the groups, more than 10 points were recorded in 50% of patients in both study groups (p>0.05). A study of the pH value at the time of admission from the operating room to the ICU revealed a trend towards a decrease in this parameter in the of patients in Group II (7,309±0,08) compared to patients of Group I (7,326±0,03) (p>0.05). A significantly lower INR value was found in the group of patients with convection warming (1.28±0.19) compared with the passive warming group (1.56±0.08) (p <0.05). Conclusion. Intraoperative use of the convection system for warming patients, allows reducing by 40% the risk of trauma-induced coagulopathy in patients with polytrauma.
Full text: PDF (Rus) 262K