Thromboelastography at the Point of Care in ICU: Research Update

摘要

The condition of a critically ill (CI) patient can significantly change on a daily basis, making serial assessment a crucial part of patient management. Cage-side diagnostics can be performed in addition to a daily physical examination to make this assessment more objective. With the increase in available choices this can become costly to the client. Thus, learning to maximize tests that are readily accessible and relatively inexpensive can make a large difference in your quality of care. One of themost difficult systems to predict and monitor is the hemostatic system. For years, we have been searching for a tool tha will predict if and when the patient will bleed or form a pathologic thrombus. In this author's opinion, the available information issometimes difficult to interpret as the "event" is already happening in the several of manuscripts at the time of the assay. As such, consumption has occurred and in the case of a thrombus, fibrinolysis may already be ongoing, thereby skewing commentaryand conclusions on its predictive power. That being said, whole blood thromboelastography (TEG) appears to be the best available tool to evaluate the hemostatic phenotype in a critically ill patient at a single point in time. However, there are some quandaries and obstacles to consider before making it a cage-side tool. This session will address 3 main concerns relative to TEG: 1) prediction of bleeding or pathologic thrombus formation, 2) analytical concerns with respect to activation, and 3) the impact of anemia on the TEG tracing.