Timothy Craig Hardcastle1,2, David J J Muckart3,4, Ronald V Maier5. 1. Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4091, South Africa. Hardcastle@ukzn.ac.za. 2. Department of Surgery, University of KwaZulu-Natal, Durban, South Africa. Hardcastle@ukzn.ac.za. 3. Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4091, South Africa. 4. Department of Surgery, University of KwaZulu-Natal, Durban, South Africa. 5. Department of Surgery, Harborview Medical Center, University of Washington, Surgery Clinic, 410 9th Ave, 7th Floor, Seattle, WA, 98104, USA.
Abstract
INTRODUCTION: Ventilation of major trauma patients is often needed in both the acute (emergency department and early ICU phase) and subsequent phases of trauma care for those who need ICU admission. What is unclear is whether ICU ventilation strategies should be directly extrapolated to the acute phase of treatment. METHODS: This paper reviews the ARDS.net study, highlights recent developments in ventilation strategies, and provides practical ventilation guidance to the trauma surgeon for acute phase (in the ED or ICU) and the subsequent phase of ICU care. RESULTS: The acute phase of care in the ED and the ICU is different from the subsequent phases of ICU care as the lung is more recruitable and there are other aspects of resuscitation from metabolic acidosis and traumatic brain injury, which require a different ventilation strategy to the traditional ARDS.net approach. DISCUSSION AND CONCLUSION: The acute phase is different from the subsequent phase of care and there appears to be some inappropriate extrapolation of ICU practice to the acute phase. Application of the proposed ventilation strategies should ensure an optimal outcome. It is important to treat patients as individuals during assessment and treatment.
INTRODUCTION: Ventilation of major traumapatients is often needed in both the acute (emergency department and early ICU phase) and subsequent phases of trauma care for those who need ICU admission. What is unclear is whether ICU ventilation strategies should be directly extrapolated to the acute phase of treatment. METHODS: This paper reviews the ARDS.net study, highlights recent developments in ventilation strategies, and provides practical ventilation guidance to the trauma surgeon for acute phase (in the ED or ICU) and the subsequent phase of ICU care. RESULTS: The acute phase of care in the ED and the ICU is different from the subsequent phases of ICU care as the lung is more recruitable and there are other aspects of resuscitation from metabolic acidosis and traumatic brain injury, which require a different ventilation strategy to the traditional ARDS.net approach. DISCUSSION AND CONCLUSION: The acute phase is different from the subsequent phase of care and there appears to be some inappropriate extrapolation of ICU practice to the acute phase. Application of the proposed ventilation strategies should ensure an optimal outcome. It is important to treat patients as individuals during assessment and treatment.
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