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Contemporary management of major haemorrhage in critical care

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A Correction to this article was published on 29 January 2024

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Abstract

Haemorrhagic shock is frequent in critical care settings and responsible for a high mortality rate due to multiple organ dysfunction and coagulopathy. The management of critically ill patients with bleeding and shock is complex, and treatment of these patients must be rapid and definitive. The administration of large volumes of blood components leads to major physiological alterations which must be mitigated during and after bleeding. Early recognition of bleeding and coagulopathy, understanding the underlying pathophysiology related to specific disease states, and the development of individualised management protocols are important for optimal outcomes. This review describes the contemporary understanding of the pathophysiology of various types of coagulopathic bleeding; the diagnosis and management of critically ill bleeding patients, including major haemorrhage protocols and post-transfusion management; and finally highlights recent areas of opportunity to better understand optimal management strategies for managing bleeding in the intensive care unit (ICU).

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Correspondence to Julie Helms.

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CLM has nothing to disclose. KB has received grants from Werfen GmbH Ltd. NC has received study grants from national agencies: DSTL, Welcome Trust, MRC, and Investigator led grants from commercial companies: CSL Behring, SOBI. She has received honoraria for lectures from the Limbic and support for attending meetings from LFB, CSL Behring and SOBI. NC participates on an Advisory Board from Octapharma. NPJ has nothing to disclose. LMM has received honoraria for lectures from Octapharma, Ferrer Hospital (Haemonetics) and Werfen. She has received support for attending meetings and/or travel from ESAIC and Croatian Society of Anesthesiology. MDN has received grants from National Institutes of Health, National Institute of General Medical Services, Haemonetics, Alexion and Instrumentation Laboratories, honoraria for lectures from Haemonetics and Takeda, payment for expert testimony from Romanucci Blandon Law and Matis Baum O’Connor, support for attending meetings and/or travel from Takeda; participates on a Data Safety Monitoring Board or Advisory Board from NHLBI CONNECTS Steering Committee; is the Chief Medical Officer, Haima Therapeutics, and has Patents planned, issued or pending (US Patent 11,408.844; US Patent 9.072,760). BS has received book royalties from Elsevier, consulting fees from Chilled Platelets Study and supporting fees for attending meetings from Biomedical Excellence for Safer Transfusion. APJV has nothing to disclose. JH has received honoraria for lectures from Asahi Kasei, Diagnostica Stago, Pfizer PFE and Sanofi Aventis France.

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This study has been authorised by ethical committee (Comité de Protection des Personnes Nord Ouest IV 2018-A03446-49).

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Maier, C.L., Brohi, K., Curry, N. et al. Contemporary management of major haemorrhage in critical care. Intensive Care Med 50, 319–331 (2024). https://doi.org/10.1007/s00134-023-07303-5

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