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Damage Control Anesthesia

  • Shihab Sugeir
  • Itamar Grunstein
  • Joshua M. Tobin
Chapter

Abstract

The role of the anesthesiologist in damage control trauma care is that of resuscitation consultant. Damage control anesthesia must occur in concert with damage control resuscitation and surgery to optimize the physiology of the shocked patient, while ensuring adequate surgical conditions for the operative team. Damage control anesthesia encompasses a variety of procedural skills, from the induction of anesthesia to advanced airway management techniques and to the full spectrum of vascular access options. Beyond providing only procedural assistance in the resuscitation, the anesthesiologist offers the unique perspective of a physician who spends each day monitoring and correcting deranged physiology in the operating room.

Participation in the initial phases of trauma care ensures seamless transition from the trauma bay to the operating room and into the intensive care unit. A consideration for resuscitation end points and their impact on multiple organ systems is vital to the successful conduct of damage control anesthesia. The following chapter will review the anesthesiologist’s role in the induction of anesthesia, airway management, and hemodynamic monitoring of the trauma patient, as well as resuscitation end points, neurotrauma concerns, renal protection issues, and pulmonary management.

Keywords

Trauma anesthesiology Damage control resuscitation Airway management Awake intubation Cricothyroidotomy Base deficit Lung protective ventilation 

References

  1. 1.
    Bruder EA, Ball IM, Ridi S, Pickett W, Hohl C. Single induction dose of etomidate versus other induction agents for endotracheal intubation in critically ill patients. Cochrane Database Syst Rev. 2015;1:CD010225.PubMedGoogle Scholar
  2. 2.
    Coursin DB, Fish JT, Joffe AM. Etomidate-trusted alternative or time to trust alternatives? Crit Care Med. 2013;41(3):917–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Jabre P, Combes X, Lapostolle F, Dhaouadi M, Ricard-Hibon A, Vivien B, Bertrand L, Beltramini A, Gamand P, Albizzati S, et al. Etomidate vs ketamine for rapid sequence intubation in acutely ill patients: a multicentre randomized controlled trial. The KETASED trial. Lancet. 2009;374:293–300.CrossRefPubMedGoogle Scholar
  4. 4.
    Ray DC, McKeown DW. Effect of induction agent on vasopressor and steroid use, and outcome in patients with septic shock. Crit Care. 2007;11(3):1–8.CrossRefGoogle Scholar
  5. 5.
    Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59:165–75. e1CrossRefGoogle Scholar
  6. 6.
    Miguel-Montanes R, Hajage D, Messika J, Bertrand F, Gaudry S, Rafat C, Labbe V, Dufour N, Jean-Baptiste S, Bedet A, Dreyfuss D, Richard JD. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43:574–83.CrossRefPubMedGoogle Scholar
  7. 7.
    Stephens CT, Kahntroff S, Dutton RP. The success of emergency endotracheal intubation in trauma patients: a 10-year experience at a major adult trauma referral center. Anesth Analg. 2009;109:866–72.CrossRefPubMedGoogle Scholar
  8. 8.
    Sollid SJ, Lossius HM, Soreide E. Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service. Scand J Trauma Resusc Emerg Med. 2010;18:30.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Shatney CH, Brunner RD, Nguyen TQ. The safety of orotracheal intubation in patients with unstable cervical spine fracture or high spinal cord injury. Am J Surg. 1995;170:676–9; discussion 9–80.CrossRefPubMedGoogle Scholar
  10. 10.
    Turner CR, Block J, Shanks A, Morris M, Lodhia KR, Gujar SK. Motion of a cadaver model of cervical injury during endotracheal intubation with a Bullard laryngoscope or a Macintosh blade with and without in-line stabilization. J Trauma. 2009;67:61–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Gerling MC, Davis DP, Hamilton RS, et al. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med. 2000;36:293–300.CrossRefPubMedGoogle Scholar
  12. 12.
    Griesdale DE, Liu D, McKinney J, Choi PT. Glidescope((R)) video-laryngoscopy versus direct laryngoscopy for endotracheal intubation: a systematic review and meta-analysis. Can J Anaesth. 2012;59(1):41–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Yeatts DJ, Dutton RP, Hu PF, et al. Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. J Trauma Acute Care Surg. 2013;75:212–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Nouruzi-Sedeh P, Schumann M, Groeben H. Laryngoscopy via Macintosh blade versus GlideScope: success rate and time for endotracheal intubation in untrained medical personnel. Anesthesiology. 2009;110:32–7.CrossRefPubMedGoogle Scholar
  15. 15.
    Aziz MF, Healy D, Kheterpal S, Fu RF, Dillman D, Brambrink AM. Routine clinical practice effectiveness of the Glidescope in difficult airway management: an analysis of 2,004 Glidescope intubations, complications, and failures from two institutions. Anesthesiology. 2011;114:34–41.CrossRefPubMedGoogle Scholar
  16. 16.
    Hulme J, Perkins GD. Critically injured patients, inaccessible airways, and laryngeal mask airways. Emerg Med J. 2005;22:742–4.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Baker PA, Webber JB. Failure to ventilate with supraglottic airways after drowning. Anaesth Intensive Care. 2011;39:675–7.PubMedGoogle Scholar
  18. 18.
    Bindra T, Nihalani SK, Bhadoria P, Wadhawan S. Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting. J Anaesthesiol Clin Pharmacol. 2011;27:544–6.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Tobin JM. Usage and efficacy of airway adjuncts in an emergency intubation kit. Emerg Med Australas. 2011;23:514–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Schalk R, Meininger D, Ruesseler M, et al. Emergency airway management in trauma patients using laryngeal tube suction. Prehosp Emerg Care. 2011;15:347–50.CrossRefPubMedGoogle Scholar
  21. 21.
    Gahan K, Studnek JR, Vandeventer S. King LT-D use by urban basic life support first responders as the primary airway device for out-of-hospital cardiac arrest. Resuscitation. 2011;82:1525–8.CrossRefPubMedGoogle Scholar
  22. 22.
    Law JA, Morris IR, Brousseau PA, de la Ronde S, Milne AD. The incidence, success rate, and complications of awake tracheal intubation in 1,554 patients over 12 years: an historical cohort study. Can J Anaesth. 2015;62:736–44.CrossRefPubMedGoogle Scholar
  23. 23.
    Joseph TT, Gal JS, DeMaria S Jr, Lin HM, Levine AI, Hyman JB. A retrospective study of success, failure, and time needed to perform awake intubation. Anesthesiology. 2016;125:105–14.CrossRefPubMedGoogle Scholar
  24. 24.
    Adams BD, Cuniowski PA, Muck A, De Lorenzo RA. Registry of emergency airways arriving at combat hospitals. J Trauma. 2008;64:1548–54.CrossRefPubMedGoogle Scholar
  25. 25.
    Mabry RL. An analysis of battlefield cricothyrotomy in Iraq and Afghanistan. J Spec Oper Med. 2012;12:17–23.PubMedGoogle Scholar
  26. 26.
    Lehman LW, Saeed M, Talmor D, Mark R, Malhotra A. Methods of blood pressure measurement in the ICU. Crit Care Med. 2013;41:34–40.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Pytte M, Dybwik K, Sexton J, Straume B, Nielsen EW. Oscillometric brachial mean artery pressures are higher than intra-radial mean artery pressures in intensive care unit patients receiving norepinephrine. Acta Anaesthesiol Scand. 2006;50:718–21.CrossRefPubMedGoogle Scholar
  28. 28.
    Berkenstadt H, Margalit N, Hadani M, et al. Stroke volume variation as a predictor of fluid responsiveness in patients undergoing brain surgery. Anesth Analg. 2001;92:984–9.CrossRefPubMedGoogle Scholar
  29. 29.
    Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma. 1988;28:1464–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Davis JW, Parks SN, Kaups KL, Gladen HE, O’Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996;41:769–74.CrossRefPubMedGoogle Scholar
  31. 31.
    Connelly CR, Schreiber MA. Endpoints in resuscitation. Curr Opin Crit Care. 2015;21:512–9.CrossRefPubMedGoogle Scholar
  32. 32.
    Mutschler M, Nienaber U, Brockamp T, et al. Renaissance of base deficit for the initial assessment of trauma patients: a base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU(R). Crit Care. 2013;17:R42.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Einav S, Bromiker R, Weiniger CF, Matot I. Mathematical modeling for prediction of survival from resuscitation based on computerized continuous capnography: proof of concept. Acad Emerg Med. 2011;18:468–75.CrossRefPubMedGoogle Scholar
  34. 34.
    Tyburski JG, Collinge JD, Wilson RF, Carlin AM, Albaran RG, Steffes CP. End-tidal CO2-derived values during emergency trauma surgery correlated with outcome: a prospective study. J Trauma. 2002;53:738–43.CrossRefPubMedGoogle Scholar
  35. 35.
    Ho KM, Leonard AD. Concentration-dependent effect of hypocalcaemia on mortality of patients with critical bleeding requiring massive transfusion: a cohort study. Anaesth Intensive Care. 2011;39:46–54.PubMedGoogle Scholar
  36. 36.
    Vivien B, Langeron O, Morell E, et al. Early hypocalcemia in severe trauma. Crit Care Med. 2005;33:1946–52.CrossRefPubMedGoogle Scholar
  37. 37.
    Magnotti LJ, Bradburn EH, Webb DL, et al. Admission ionized calcium levels predict the need for multiple transfusions: a prospective study of 591 critically ill trauma patients. J Trauma. 2011;70:391–5; discussion 5–7.CrossRefPubMedGoogle Scholar
  38. 38.
    Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Clin Neurosurg. 2013;60:82–91.CrossRefGoogle Scholar
  39. 39.
    Carney N, Totten AM, O’Reilly C, Ullman JS, GWJ H, Bell MJ, Bratton SL, Chesnut R, Harris OA, Kissoon N, Rubiano AM, Shutter L, Tasker RC, Vavilala MS, Wilberger J, Wright DW, Ghajar J. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15.PubMedGoogle Scholar
  40. 40.
    Gomes E, Antunes R, Dias C, Araujo R, Costa-Pereira A. Acute kidney injury in severe trauma assessed by RIFLE criteria: a common feature without implications on mortality? Scand J Trauma Resusc Emerg Med. 2010;18:1.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute dialysis quality initiative workgroup. Acute renal failure—definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) group. Crit Care. 2004;B(4):R204–12.CrossRefGoogle Scholar
  42. 42.
    Liaño F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int. 1998;53:S16–24.Google Scholar
  43. 43.
    Cosentino F, Chaff C, Piedmonte M. Risk factors influencing survival in ICU acute renal failure. Nephrol Dial Transplant. 1994;9:179–82.PubMedGoogle Scholar
  44. 44.
    Huen SC, Parikh CR. Predicting acute kidney injury after cardiac surgery: a systematic review. Ann Thorac Surg. 2012;93(1):337–47.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Brown C, Rhee P, Chan L, Evans K, Demetriades D, Velmahos D. Preventing renal failure in patients with rhabdomyolysis: do bicarbonate and mannitol make a difference? J Trauma Inj Infect Crit Care. 2004;56(6):1191–6.CrossRefGoogle Scholar
  46. 46.
    Ho KM, Power BM. Benefits and risks of furosemide in acute kidney injury. Anesthesia. 2010;65(3):283–93.CrossRefGoogle Scholar
  47. 47.
    Comparison of two fluid-management strategies and acute lung injury. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) clinical trials network. N Engl J Med. 2006;354:2564–75.CrossRefGoogle Scholar
  48. 48.
    Murphy EL, Kwaan N, Looney MR, et al. Risk factors and outcomes in transfusion-associated circulatory overload. Am J Med. 2013;126:357.e29–38.CrossRefGoogle Scholar
  49. 49.
    The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med. 2000;342:1301–8.Google Scholar
  50. 50.
    Papazian L, Forel JM, Gacouin A, et al. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010;363:1107–16.CrossRefPubMedGoogle Scholar
  51. 51.
    Serpa Neto A, Cardoso SO, Manetta JA, et al. Association between use of lung-protective ventilation with lower tidal volumes and clinical outcomes among patients without acute respiratory distress syndrome: a meta-analysis. JAMA. 2012;308:1651–9.CrossRefPubMedGoogle Scholar
  52. 52.
    Serpa Neto A, Hemmes SN, Barbas CS, et al. Protective versus conventional ventilation for surgery: a systematic review and individual patient data meta-analysis. Anesthesiology. 2015;123:66–78.CrossRefPubMedGoogle Scholar
  53. 53.
    Guldner A, Kiss T, Serpa Neto A, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015;123:692–713.CrossRefPubMedGoogle Scholar
  54. 54.
    Arlt M, Philipp A, Voelkel S, et al. Extracorporeal membrane oxygenation in severe trauma patients with bleeding shock. Resuscitation. 2010;81:804–9.CrossRefPubMedGoogle Scholar
  55. 55.
    McElroy LM, Macapagal KR, Collins KM, Abecassis MM, Holl JL, Ladner DP, Gordon EJ. Clinician perceptions of operating room to intensive care unit handoffs and implications for patient safety: a qualitative study. Am J Surg. 2015;210(4):629–35.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Salzwedel C, Mai V, Punke MA, Kluge S, Reuter DA. The effect of a checklist on the quality of patient handover from the operating room to the intensive care unit: a randomized controlled trial. J Crit Care. 2016;32:170–4.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Shihab Sugeir
    • 1
  • Itamar Grunstein
    • 1
  • Joshua M. Tobin
    • 1
  1. 1.Division of Trauma AnesthesiologyKeck School of Medicine at USCLos AngelesUSA

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