<?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>0120-3347</journal-id>
<journal-title><![CDATA[Colombian Journal of Anestesiology]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. colomb. anestesiol.]]></abbrev-journal-title>
<issn>0120-3347</issn>
<publisher>
<publisher-name><![CDATA[SCARE-Sociedad Colombiana de Anestesiología y Reanimación]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0120-33472022000400301</article-id>
<article-id pub-id-type="doi">10.5554/22562087.e1038</article-id>
<title-group>
<article-title xml:lang="en"><![CDATA[Advancing in the understanding of coagulopathy during hemorrhagic shock: From the triad to the deadly pentad]]></article-title>
<article-title xml:lang="es"><![CDATA[Avanzando en el entendimiento de la coagulopatía durante el choque hemorrágico: de la tríada a la pentada mortal]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Quintana-Díaz]]></surname>
<given-names><![CDATA[Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Garay-Fernández]]></surname>
<given-names><![CDATA[Manuel]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ariza]]></surname>
<given-names><![CDATA[Fredy]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Autónoma de Madrid Intensive Medicine Service Hospital Universitario La Paz]]></institution>
<addr-line><![CDATA[Madrid ]]></addr-line>
<country>Spain</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad El Bosque Pulmonology and Intensive Care ]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Santa Clara Pulmonology and Intensive Care Internal Medicine]]></institution>
<addr-line><![CDATA[Bogotá ]]></addr-line>
<country>Colombia</country>
</aff>
<aff id="Af4">
<institution><![CDATA[,Universidad del Valle  ]]></institution>
<addr-line><![CDATA[Cali ]]></addr-line>
<country>Colombia</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2022</year>
</pub-date>
<volume>50</volume>
<numero>4</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S0120-33472022000400301&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S0120-33472022000400301&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S0120-33472022000400301&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract The deadly triad concept represented a dogma in the definition of poor outcomes and death associated with major bleeding in trauma. This model of end-stage disease was then rapidly transferred to other major bleeding scenarios. However, and notwithstanding the fact that it represented a severe scenario, the original triad fails to establish a sequence, which would be relevant when defining the objectives during the initial treatment of severe bleeding. Likewise, this model admits only one scenario where all the conditions shall co-exist, knowing that each one of them contributes with a different risk burden. Based on a structured review, we propose a pentad model that includes a natural pattern of events occurring with hypoxemia as the main trigger for the development of hypocalcemia, hyperglycemia, acidosis and hypothermia, as surrogates of multi-organ impairment. This severity model of major bleeding considers coagulopathy as a result of the failure to restore the initial components of damage.]]></p></abstract>
<abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen El concepto de la tríada mortal significó un dogma en la definición de malos desenlaces y muerte asociados al sangrado mayor en trauma. Este modelo de afectación terminal fue luego rápidamente trasladado a otros escenarios de sangrado mayor. Sin embargo y a pesar de significar un escenario de gravedad, la tríada original falla en adjudicar una secuencialidad, lo cual sería importante a la hora de definir los objetivos durante el tratamiento inicial de la hemorragia grave. De igual forma, solo admite un único escenario en donde deben coexistir todas las condiciones, cuando se sabe que cada una atribuye una carga diferencial de riesgo. A partir de una revisión estructurada proponemos un modelo de pentada que incluye un patrón natural de eventos que se implantan sobre la hipoxemia como principal detonante para el desarrollo de hipocalcemia, hiperglucemia, acidosis e hipotermia como representantes del deterioro en múltiples sistemas. Este modelo de gravedad del sangrado mayor culmina con la coagulopatía como resultante de la falla en la resolución de los demás componentes previos.]]></p></abstract>
<kwd-group>
<kwd lng="en"><![CDATA[Coagulation disorders]]></kwd>
<kwd lng="en"><![CDATA[Hemorrhage]]></kwd>
<kwd lng="en"><![CDATA[Acidosis]]></kwd>
<kwd lng="en"><![CDATA[Hypothermia]]></kwd>
<kwd lng="en"><![CDATA[Calcium]]></kwd>
<kwd lng="en"><![CDATA[Hyperglycemia]]></kwd>
<kwd lng="en"><![CDATA[Anesthesiology]]></kwd>
<kwd lng="es"><![CDATA[Trastornos de la coagulación]]></kwd>
<kwd lng="es"><![CDATA[Hemorragia]]></kwd>
<kwd lng="es"><![CDATA[Acidosis]]></kwd>
<kwd lng="es"><![CDATA[Hipotermia]]></kwd>
<kwd lng="es"><![CDATA[Calcio]]></kwd>
<kwd lng="es"><![CDATA[Hiperglucemia]]></kwd>
<kwd lng="es"><![CDATA[Anestesiología]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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