Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Introduction
- Pharmacokinetics
- Pharmacodynamics
- Drug Interactions
- Therapeutic Drug Monitoring
- Summary
- Introduction
- Pharmacological Principles of Monitoring
- Pharmacological Characteristics of Antibiotics
- Therapeutic Drug Monitoring for Specific Drugs
- Special Circumstances
- Antibiotic Stewardship
- Acknowledgements
- Introduction
- Blood Groups and Cross-Matching
- Safe Transfusion
- Adverse Effects of Transfusion
- Patient Blood Management
- Effective Transfusion in Surgery and Critical Care
- Major Haemorrhage
- Management of Patients Who Do not Accept Transfusion
- Introduction
- Conventional Coagulation Tests
- Point-of-Care Tests
- Fluids
- Inotropes, Vasopressors and Inodilators
- Vasodilators
- Anti-hypertensives
- Introduction
- Aims and Indications for Mechanical Circulatory Support
- Types of Mechanical Circulatory Support
- Implementation and Monitoring of Mechanical Circulatory Support
- Summary and Conclusion
- Initiating Mechanical Ventilation
- Maintenance of Ventilation
- Modes of Ventilation
- Ventilation Considerations
- Special Considerations
- Weaning from Ventilation
- Introduction
- Indications
- Principles and Techniques of RRT
- Nomenclatures for Continuous RRT
- Modalities of RRT
- Timing of RRT Initiation
- Vascular Access
- Dose of RRT
- Fluid Balance and Management
- Anticoagulation
- CRRT Prescription and Monitoring
- Complications of CRRT
- Weaning from RRT
- Conclusion
- Introduction
- How to Provide Nutritional Support
- Refeeding Syndrome
- Protocols
- Summary
- Introduction
- Intracranial Pressure
- Brain Tissue Oxygen Tension
- Jugular Bulb Oximetry
- Cerebral Microdialysis
- Transcranial Doppler Ultrasound
- Continuous Electroencephalography
- 4.1 Principles of Safe Prescription of Drugs and Therapeutics (Including Pharmacokinetics, Pharmacodynamics and Drug Monitoring)
- 4.2 Antibiotic Management and Monitoring
- 4.3 Administration of Blood and Blood Products in Intensive Care
- 4.4 Monitoring Coagulation, Including Thromboelastography
- 4.5 Fluids, Inotropes and Vasopressors, Vasodilators and Anti-hypertensives
- 4.6 Principles of Mechanical Circulatory Support in the Acute Setting
- 4.7 Mechanical Ventilation: Initiation, Maintenance and Weaning
- 4.8 Renal Replacement Therapy in Critical Care
- 4.9 Nutritional Assessment and Support in Intensive Care (Enteral and Parenteral Nutrition)
- 4.10 Neuromonitoring and Cerebral Protection
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
4.4 - Monitoring Coagulation, Including Thromboelastography
from Section 4 - Therapeutic Interventions and Organ Support
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Introduction
- Pharmacokinetics
- Pharmacodynamics
- Drug Interactions
- Therapeutic Drug Monitoring
- Summary
- Introduction
- Pharmacological Principles of Monitoring
- Pharmacological Characteristics of Antibiotics
- Therapeutic Drug Monitoring for Specific Drugs
- Special Circumstances
- Antibiotic Stewardship
- Acknowledgements
- Introduction
- Blood Groups and Cross-Matching
- Safe Transfusion
- Adverse Effects of Transfusion
- Patient Blood Management
- Effective Transfusion in Surgery and Critical Care
- Major Haemorrhage
- Management of Patients Who Do not Accept Transfusion
- Introduction
- Conventional Coagulation Tests
- Point-of-Care Tests
- Fluids
- Inotropes, Vasopressors and Inodilators
- Vasodilators
- Anti-hypertensives
- Introduction
- Aims and Indications for Mechanical Circulatory Support
- Types of Mechanical Circulatory Support
- Implementation and Monitoring of Mechanical Circulatory Support
- Summary and Conclusion
- Initiating Mechanical Ventilation
- Maintenance of Ventilation
- Modes of Ventilation
- Ventilation Considerations
- Special Considerations
- Weaning from Ventilation
- Introduction
- Indications
- Principles and Techniques of RRT
- Nomenclatures for Continuous RRT
- Modalities of RRT
- Timing of RRT Initiation
- Vascular Access
- Dose of RRT
- Fluid Balance and Management
- Anticoagulation
- CRRT Prescription and Monitoring
- Complications of CRRT
- Weaning from RRT
- Conclusion
- Introduction
- How to Provide Nutritional Support
- Refeeding Syndrome
- Protocols
- Summary
- Introduction
- Intracranial Pressure
- Brain Tissue Oxygen Tension
- Jugular Bulb Oximetry
- Cerebral Microdialysis
- Transcranial Doppler Ultrasound
- Continuous Electroencephalography
- 4.1 Principles of Safe Prescription of Drugs and Therapeutics (Including Pharmacokinetics, Pharmacodynamics and Drug Monitoring)
- 4.2 Antibiotic Management and Monitoring
- 4.3 Administration of Blood and Blood Products in Intensive Care
- 4.4 Monitoring Coagulation, Including Thromboelastography
- 4.5 Fluids, Inotropes and Vasopressors, Vasodilators and Anti-hypertensives
- 4.6 Principles of Mechanical Circulatory Support in the Acute Setting
- 4.7 Mechanical Ventilation: Initiation, Maintenance and Weaning
- 4.8 Renal Replacement Therapy in Critical Care
- 4.9 Nutritional Assessment and Support in Intensive Care (Enteral and Parenteral Nutrition)
- 4.10 Neuromonitoring and Cerebral Protection
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Coagulopathy is common in the ICU and abnormal results should be interpreted in the context of the patient’s clinical condition.
2. Conventional coagulation tests monitor the intrinsic and extrinsic pathways of coagulation and are the mainstay of haemostatic monitoring.
3. Full blood count and conventional coagulation tests have a turnaround time that renders them unhelpful in acute bleeding scenarios.
4. Point-of-care viscoelastic tests, such as thromboelastography (TEG®) and rotational thromboelastrometry (ROTEM®), can provide a rapid overview of coagulation from clot formation to lysis, demonstrating both hypo- and pro-coagulant states.
5. Algorithms based upon viscoelastic tests in bleeding patients have demonstrated a reduction in blood transfusion requirements.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 473 - 476Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Haas, T, Fries, D, Tanaka, KA, et al. Usefulness of standard plasma coagulation tests in the management of perioperative coagulopathic bleeding: is there any evidence? Br J Anaesth 2015;114:217–24.Google Scholar
Kozek-Langenecker, SA, Ahmed, AB, Afshari, A, et al. Management of severe perioperative bleeding. Eur J Anaesthesiol 2017;34:332–95.CrossRefGoogle ScholarPubMed
Lancé, MD. A general review of major global coagulation assays: thromboelastography, thrombin generation test and clot waveform analysis. Thromb J 2015;13:2607.CrossRefGoogle ScholarPubMed
Levi, M, Hunt, BJ. A critical appraisal of point-of-care coagulation testing in critically ill patients. J Thromb Haemost 2015;13:1960–7.CrossRefGoogle ScholarPubMed
Mallett, SV, Armstrong, M. Point-of-care monitoring of haemostasis. Anaesthesia 2014;70(Suppl 4):73–7, e25–6.Google Scholar