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The Severe Trauma Patient in the ICU

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The Integrated Approach to Trauma Care

Part of the book series: Update in Intensive Care and Emergency Medicine ((UICM,volume 22))

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Abstract

Before admission of a trauma patient to the intensive care unit (ICU) hemodynamic and respiratory parameters should have been stabilized, diagnostic procedures carried out, and emergency surgery performed as required [1, 2]. During ICU stay three main points should be addressed: (a) close monitoring of vital organ functions, (b) prevention of late complications, and (c) treatment of disturbances in vital organ functions. This chapter discusses these points briefly.

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References

  1. Seibel R, LaDuca J, Hassett JM et al (1985) Blunt multiple trauma (ISS 36), femur traction and the pulmonary failure-septic state. Ann Surg 202:283–295

    Article  PubMed  CAS  Google Scholar 

  2. Johnson KD, Cadambi A, Seibert GB (1985) Incidence of adult respiratory distress syndrome in patients with multiple musculoskeletal injuries: effect of early operative stabilization of fractures. J Trauma 25:375–384

    Article  PubMed  CAS  Google Scholar 

  3. Border JR, Allgöwer M, Hansen ST, Ruedi TP (1990) Summary: postoperative care. In: Border JR (ed) Blunt multiple trauma. Dekker, New York, pp 759–764

    Google Scholar 

  4. Conn AKT, McCabe CJ, Warren RL (1991) Initial management of trauma patients. In: Vincent JL (ed) Update in intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 457–468

    Google Scholar 

  5. Kelly SB, McGuigan JA (1992) Thoracic trauma. Eur J Emerg 5:117–125

    Google Scholar 

  6. Glinz W (1990) Evaluation of thoracic injuries. In: Border JR (ed) Blunt multiple trauma. Dekker, New York, pp 391–408

    Google Scholar 

  7. Simmons E (1994) Bleeding and hemostasis. In: Bongard FS, Sue DY (eds) Current critical care diagnosis and treatment. Prentice-Hall, London, pp 199–213

    Google Scholar 

  8. Medical-Scientific Council CBO (1993) Transfusion of fresh frozen plasma (FFP) and other plasma components. Utrecht, the Netherlands, pp 5–7

    Google Scholar 

  9. Pepe PE, Hudson LD, Carrico CJ (1984) Early application of positive end-expiratory pressure in patients at risk for the adult respiratory-distress syndrome. N Engl J Med 311:281–286

    Article  PubMed  CAS  Google Scholar 

  10. Roumen RM, Hendriks T, Ven van der-Jongekrijg J et al (1993) Cytokine patterns in patients after major vascular surgery, hemorrhagic shock and severe blunt trauma. Relation with subsequent adult respiratory distress syndrome and multiple organ failure. Ann Surg 218:769–776

    Article  PubMed  CAS  Google Scholar 

  11. Nuytinck JKS, Goris RJA, Weerts JGE, Schillings PHM, Schuurmans Stekhoven JH (1986) Acute generalized microvascular injury by activated complement and hypoxia; the basis of the adult respiratory distress syndrome and multiple organ failure? Br J Exp Pathol 67:537–548

    PubMed  CAS  Google Scholar 

  12. Heideman M (1978) Complement activation and hematologic, hemodynamic and respiratory reaction early after soft tissue injury. J Trauma 18:697–700

    Article  Google Scholar 

  13. Deitch EA (1992) Multiple organ failure. Pathophysiology and potential future therapy. Ann Surg 216:117–134

    Article  PubMed  CAS  Google Scholar 

  14. Debets JMH, Kampmeijer R, van der Linden MPMH, Buurman WA, van der Linden CJ (1989) Plasma tumor necrosis factor and mortality in critically ill septic patients. Crit Care Med 17:489–494

    Article  PubMed  CAS  Google Scholar 

  15. van Deuren M, Ven van der-Jongekrijg J, Demacker PNM et al (1994) Differential expression of proinflammatory cytokines and their inhibitors during the course of meningococcal infections. J Infect Dis 169:157–161

    Article  PubMed  Google Scholar 

  16. Nuytinck JKS, Offermans XJMW, Kubat K et al (1988) Whole-body inflammation in trauma patients: an autopsy study. Arch Surg 123:1519–1524

    Article  PubMed  CAS  Google Scholar 

  17. Goris RJA, Gimbrere JSF, van Niekerk JL et al (1982) Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 22:895–903

    Article  PubMed  CAS  Google Scholar 

  18. Meek RN, Vivoda EE, Pirani S (1986) Comparison of mortality of patients with multiple injuries according to type of fracture treatment: a retrospective age- and injury-matched series. Injury 17:2–4

    Article  PubMed  CAS  Google Scholar 

  19. Bone LB, Johnson ND, Weigelt J, Scheinberg R (1989) Early versus delayed stabilization of femoral fractures. A prospective randomized study. J Bone Joint Surg 71A:336–340

    Google Scholar 

  20. Phillips TF, Contreras DM (1990) Timing of operative treatment of fractures in patients who have multiple injuries. J Bone Joint Surg 72A:784–788

    Google Scholar 

  21. Stoutenbeek CP, van Saene HKF, Miranda DR, Zandstra DF (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 10:185–192

    Article  PubMed  CAS  Google Scholar 

  22. Ledingham IM, Alcock SR, Eastaway AT, McDonald JC, McKay IC, Ramsay G (1988) Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 1:785–790

    Article  PubMed  CAS  Google Scholar 

  23. Hammond JMJ, Potgieter PD, Saunders GL (1994) Selective decontamination of the digestive tract in multiple trauma patients: is there a role? Results of a prospective double-blind randomized trial. Crit Care Med 22:33–39

    PubMed  CAS  Google Scholar 

  24. Vandenbroucke-Grauls CMJE, Vandenbroucke JP (1991) Effect of selective decontamination of the digestive tract on respiratory tract infections and mortality in the intensive care unit. Lancet 338:859–862

    Article  PubMed  CAS  Google Scholar 

  25. Selective Decontamination of the Digestive Tract Trialists’ Collaborative Group (1993) Meta-analysis of randomised controlled trials of selective decontamination of the digestive tract. Br Med J 307:525–532

    Article  Google Scholar 

  26. Verhoef J, Verhage EAE, Visser MR (1993) A decade of experience with selective decontamination of the digestive tract as prophylaxis for infections in patients in the intensive care unit: what have we learned? Clin Infect Dis 17:1047–1054

    Article  PubMed  CAS  Google Scholar 

  27. van Dalen R (1991) Selective decontamination in ICU patients: benefits and doubts. In: Vincent JL (ed) Update in intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 379–386

    Google Scholar 

  28. Kudsk KA, Stone JM, Carpenter G, Sheldon GF (1983) Enterai and parenteral feeding influences mortality after hemoglobin E.coli peritonitis in normal rats. J Trauma 23:605–609

    Article  PubMed  CAS  Google Scholar 

  29. Moore FA, Moore EE, Jones TN et al (1989) Total enterai nutrition versus total parenteral nutrition following major torso trauma: reduced septic morbidity. J Trauma 29:916–923

    Article  PubMed  CAS  Google Scholar 

  30. Dellinger EP (1991) Antibiotic prophylaxis in trauma: penetrating abdominal injuries and open fractures. Rev Infect Dis 13:S847–S857

    Article  PubMed  Google Scholar 

  31. van Dalen R (1992) Strategies for antibiotic prophylaxis in trauma patients. Eur J Emerg 5:158–165

    Google Scholar 

  32. Sheikh MA (1981) Respiratory changes after fractures and surgical skeletal injury. Injury 13:489–494

    Article  Google Scholar 

  33. Miller JD (1993) Head injury. J Neurol Neurosurg Psychiatry 56:440–447

    Article  PubMed  CAS  Google Scholar 

  34. Maas AIR (1993) Pathophysiology, monitoring and treatment of severe head injury. In: Vincent JL (ed) Yearbook of intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 564–578

    Google Scholar 

  35. Muizelaar JP, Marmarou A, Ward JD et al (1991) Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomised clinical trial. J Neurosurg 75:731–739

    Article  PubMed  CAS  Google Scholar 

  36. Pickard JD, Czosnyka M (1993) Management of raised intracranial pressure. J Neurol Neurosurg Psychiatry 56:845–858

    Article  PubMed  CAS  Google Scholar 

  37. Braakman R, Schouten HJA, van Blauw-Dishoeck BM, Minderhout JM (1983) Megadose steroids in severe head injury: results of a prospective double blind clinical trial. J Neurosurg 58:326–330

    Article  PubMed  CAS  Google Scholar 

  38. Dearden NM, Gibson JS, McDowall DG, Gibson RM, Cameron MM (1986) Effect of high dose dexamethasone on outcome from severe head injury. J Neurosurg 64:81–88

    Article  PubMed  CAS  Google Scholar 

  39. European Study Group on Nimodipine in Severe Head Injury (1994) A multicenter trial of the efficacy of nimodipine on the outcome of severe head injury. J Neurosurg 80:797–804

    Article  Google Scholar 

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© 1995 Springer-Verlag Berlin Heidelberg

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van Dalen, R. (1995). The Severe Trauma Patient in the ICU. In: Goris, R.J.A., Trentz, O. (eds) The Integrated Approach to Trauma Care. Update in Intensive Care and Emergency Medicine, vol 22. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-79272-4_23

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  • DOI: https://doi.org/10.1007/978-3-642-79272-4_23

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-79274-8

  • Online ISBN: 978-3-642-79272-4

  • eBook Packages: Springer Book Archive

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