T), coagulation factor concentrates, and hemostatic drugs, according to the individual needs of each patient. We searched National Library of Medicine, MEDLINE for publications relevant to management of critical ill bleeding patients in different settings in the ICU. Bibliographies of included articles were also searched to identify additional relevant studies. English-language systematic reviews, meta-analyses, randomized trials, observational studies, and case reports were reviewed. Data related to study methodology, patient population, bleeding management strategy, and clinical outcomes were qualitatively evaluated. According to systematic reviews and meta-analyses, EGDHT guided by viscoelastic testing (VET) has been associated with a reduction in transfusion utilization, improved morbidity and outcome in patients with active bleeding. Furthermore, literature data showed an increased risk of severe adverse events and poor clinical outcomes with inappropriate prophylactic uses of blood components to correct altered conventional coagulation tests (CCTs). Finally, prospective, randomized, controlled trials point to the role of goal-directed fibrinogen substitution to reduce bleeding and the amount of red blood cell (RBC) transfusion with the potential to decrease mortality. In conclusion, severe acute bleeding management in the ICU is still a major challenge for intensive care physicians. The organized and sequential approach to the bleeding patient, guided by POCT allows for rapid and effective bleeding control, through the rational use of blood components and hemostatic drugs, since VET can identify specific coagulation disorders in real time, guiding hemostatic therapy with coagulation factor concentrates and hemostatic drugs with individual goals....

中文翻译：

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重症监护病房严重急性出血的早期目标导向止血治疗：叙述性回顾

T)、凝血因子浓缩物和止血药物，根据每个患者的个体需要。我们检索了国家医学图书馆 MEDLINE，查找与 ICU 不同环境下危重出血患者的管理相关的出版物。还检索了纳入文章的参考书目，以确定其他相关研究。审查了英语系统评价、荟萃分析、随机试验、观察性研究和病例报告。对研究方法、患者群体、出血管理策略和临床结果相关的数据进行了定性评估。根据系统评价和荟萃分析，粘弹性测试 (VET) 指导下的 EGDHT 与活动性出血患者的输血利用减少、发病率和预后改善相关。此外，文献数据显示，不恰当地预防性使用血液成分来纠正改变的常规凝血测试（CCT）会增加严重不良事件和不良临床结果的风险。最后，前瞻性、随机、对照试验指出了目标导向的纤维蛋白原替代在减少出血和红细胞 (RBC) 输注量方面的作用，并有可能降低死亡率。总之，ICU严重急性出血的处理仍然是重症监护医生面临的重大挑战。在 POCT 指导下，对出血患者进行有组织、有序的处理，通过合理使用血液成分和止血药物，可以快速有效地控制出血，因为 VET 可以实时识别特定的凝血障碍，指导凝血因子浓缩物的止血治疗以及具有个人目标的止血药物......