By Tisherman, Samuel A.;
Stein, Deborah M.
Objectives: To
describe the current state of the art regarding management of the critically
ill trauma patient with an emphasis on initial management in the ICU.
Data Sources and Study Selection: A PubMed literature review was performed for
relevant articles in English related to the management of adult humans with
severe trauma. Specific topics included airway management, hemorrhagic shock,
resuscitation, and specific injuries to the chest, abdomen, brain, and spinal
cord.
Data Extraction and Data Synthesis: The basic principles of initial management of the
critically ill trauma patients include rapid identification and management of
life-threatening injuries with the goal of restoring tissue oxygenation and
controlling hemorrhage as rapidly as possible. The initial assessment of the
patient is often truncated for procedures to manage life-threatening injuries.
Major, open surgical procedures have often been replaced by nonoperative or
less-invasive approaches, even for critically ill patients. Consequently, much
of the early management has been shifted to the ICU, where the goal is to
continue resuscitation to restore homeostasis while completing the initial
assessment of the patient and watching closely for failure of nonoperative
management, complications of procedures, and missed injuries.
Conclusions: The
initial management of critically ill trauma patients is complex. Multiple, sometimes
competing, priorities need to be considered. Close collaboration between the
intensivist and the surgical teams is critical for optimizing patient outcomes.
