<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-0390</journal-id>
<journal-title><![CDATA[Revista Médica del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Méd. Urug.]]></abbrev-journal-title>
<issn>1688-0390</issn>
<publisher>
<publisher-name><![CDATA[Sindicato Médico del Uruguay]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-03902023000201401</article-id>
<article-id pub-id-type="doi">1688-0390-rmu-39-2-e401</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Puesta al día sobre transfusión masiva]]></article-title>
<article-title xml:lang="en"><![CDATA[Massive transfusion update]]></article-title>
<article-title xml:lang="pt"><![CDATA[Atualização sobre transfusão maciça]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Berro]]></surname>
<given-names><![CDATA[Maximiliano]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de la República Facultad de Medicina. ]]></institution>
<addr-line><![CDATA[Montevideo ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>00</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>00</month>
<year>2023</year>
</pub-date>
<volume>39</volume>
<numero>2</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-03902023000201401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-03902023000201401&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-03902023000201401&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: La transfusión masiva plantea desafíos clínicos, organizacionales y logísticos para el personal de la salud en general y los servicios de Medicina Transfusional en particular. No existe una definición universalmente aceptada de transfusión masiva, las definiciones más comúnmente utilizadas se basan en el número de unidades de sangre administradas dentro de un cierto período de tiempo. La mayoría de los eventos de transfusión masiva ocurren en el contexto de hemorragias graves en pacientes quirúrgicos, politraumatizados, con hemorragia gastrointestinal u obstétrica. La reanimación de control de daños y los protocolos de transfusión masiva son las estrategias más utilizadas actualmente para el tratamiento inicial, seguidas de un tratamiento personalizado, dirigido por objetivos, mediante la monitorización de la coagulación en tiempo real mediante estudios viscoelásticos. Existen una serie de controversias alrededor del tratamiento óptimo, incluyendo el uso de sangre total, la relación de hemocomponentes a utilizar, el uso de concentrados de factores de la coagulación, y la indicación óptima del ácido tranexámico. El estudio de los productos ideales para el tratamiento de los pacientes con sangrado masivo se ha convertido en un área de gran interés de la investigación científica. El contexto clínico en el que ocurrió el evento hemorrágico, el número de hemocomponentes transfundidos, la edad del paciente y las comorbilidades son los predictores más importantes de la sobrevida a corto y largo plazo. Esta revisión narrativa explora el estado actual del conocimiento sobre la transfusión masiva, así como los avances que podemos esperar en el futuro cercano.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract: Massive transfusion poses clinical, organizational and logistic challenges for the health staff in general, and the Transfusion Medicine Services in particular. There is no universally accepted definition for massive transfusion, the most widely used being based on the number of blood units administered in a certain period of time. Most massive transfusion events occur in the context of severe hemorrhage on surgical or multiple-trauma patients or patients with gastrointestinal or obstetric bleeding. Today, damage control resuscitation and massive transfusion protocols are the most common strategies for initial treatment, followed by personalized therapy, goal-directed, my means of monitoring coagulation in real time with viscoelastic studies. There are disputes as to the best surgical treatment, including using whole blood, the relation of blood components to be used, the use of coagulation factor concentrates and the optimal indication of tranexamic acid. The study of ideal products to treat patients with massive hemorrhage has become an area of great interest for scientific research. The clinical context of the hemorrhagic event, the number of blood components transfused, patient's age and comorbilities are the most important predictors for survival in the short and long term. This narrative review explores the current state of affairs on knowledge about massive transfusion, as well as progress to be expected in the near future.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: A transfusão maciça apresenta desafios clínicos, organizacionais e logísticos para o pessoal de saúde em geral e para os serviços de Medicina Transfusional em particular. Não existe uma definição universalmente aceita de transfusão maciça; as definições mais comumente usadas são baseadas no número de unidades de sangue administradas em um determinado período de tempo. A maioria dos eventos de transfusão maciça ocorre no contexto de sangramento maior em pacientes cirúrgicos, politraumatizados, com sangramento gastrointestinal ou obstétrico. Atualmente, a ressuscitação para controle de danos e os protocolos de transfusão maciça são as estratégias mais usadas para o tratamento inicial, seguidos por tratamento personalizado e orientado por objetivos usando monitoramento de coagulação em tempo real usando testes viscoelásticos. Há uma série de controvérsias em torno do tratamento ideal, incluindo o uso de sangue total, a proporção de componentes sanguíneos a serem usados, o uso de concentrados de fator de coagulação e a indicação ideal de ácido tranexâmico. O estudo dos produtos ideais para o tratamento de pacientes com sangramento maciço tornou-se uma área de grande interesse na pesquisa científica. O contexto clínico em que ocorreu o evento hemorrágico, o número de hemocomponentes transfundidos, a idade do paciente e as comorbidades são os preditores mais importantes de sobrevida a curto e longo prazo. Esta revisão narrativa explora o estado atual do conhecimento sobre transfusão maciça, bem como os avanços que podemos esperar no futuro próximo.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Hemorragia]]></kwd>
<kwd lng="es"><![CDATA[Transfusión sanguínea]]></kwd>
<kwd lng="es"><![CDATA[Transfusión masiva]]></kwd>
<kwd lng="es"><![CDATA[Protocolo de transfusión masiva]]></kwd>
<kwd lng="es"><![CDATA[Resucitación]]></kwd>
<kwd lng="es"><![CDATA[Hemostasis]]></kwd>
<kwd lng="es"><![CDATA[Sangre total]]></kwd>
<kwd lng="es"><![CDATA[Hemoderivados]]></kwd>
<kwd lng="es"><![CDATA[Protocolos clínicos]]></kwd>
<kwd lng="es"><![CDATA[Reanimación de control de daños]]></kwd>
<kwd lng="en"><![CDATA[Massive transfusion]]></kwd>
<kwd lng="en"><![CDATA[Massive hemorrhage]]></kwd>
<kwd lng="en"><![CDATA[Massive transfusion protocol]]></kwd>
<kwd lng="en"><![CDATA[Damage control resuscitation]]></kwd>
<kwd lng="en"><![CDATA[Hemostatic resuscitation]]></kwd>
<kwd lng="en"><![CDATA[Whole blood]]></kwd>
<kwd lng="en"><![CDATA[Blood components]]></kwd>
<kwd lng="en"><![CDATA[Blood products]]></kwd>
<kwd lng="pt"><![CDATA[Hemorragia]]></kwd>
<kwd lng="pt"><![CDATA[Transfusão de sangue]]></kwd>
<kwd lng="pt"><![CDATA[Transfusão maciça]]></kwd>
<kwd lng="pt"><![CDATA[Protocolo de transfusão maciça]]></kwd>
<kwd lng="pt"><![CDATA[Resuscitação]]></kwd>
<kwd lng="pt"><![CDATA[Hemostasia]]></kwd>
<kwd lng="pt"><![CDATA[Sangue total]]></kwd>
<kwd lng="pt"><![CDATA[Hemoderivados]]></kwd>
<kwd lng="pt"><![CDATA[Protocolos clínicos]]></kwd>
<kwd lng="pt"><![CDATA[Ressuscitação de controle de danos]]></kwd>
</kwd-group>
</article-meta>
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