Hemodynamic Monitoring in Trauma
Trauma remains the leading cause of preventable death in young adults . Several recent reports in the UK have highlighted possible inadequacies in the provision of all aspects of traumacare-initial clinical assessment and resuscitation, definitive radiological investigation and surgery and provision of intensive care [2, 3]. Management of trauma victims from the cardiorespiratory point of view has until recently been dominated by the concept of an “ebb phase” of metabolic rate and oxygen consumption (VO2) which was said to last for the first 48 hrs after injury . The therapeutic implication of this concept was never directly stated but was tacitly accepted by many clinicians to mean that in the early post-traumatic period normal values of cardiac output (CO) would suffice. This lead to the restoration of blood pressure and urine output as the goals of resuscitation. In fact the importance of achieving an adequate urine output before surgery in wounded soldiers was demonstrated by Ladd in the Korean conflict (see below) . Even this simple message was unheard of by the majority of physicians not practising in trauma centres. The “ebb phase” concept has recently been questioned . The human data on which it was based is unconvincing. The classic, much quoted series, was of only 7 patients with trivial injuries. These were studied after elective orthopaedic procedures. There is strong circumstantial evidence in the literature that an “ebb phase” does not exist - possibly the reverse.
KeywordsCatheter Depression Urea Lactate Creatinine
Unable to display preview. Download preview PDF.
- 6.Little R (1987) Thermoregulation and metabolic rate in injury. In: Vincent JL (ed) Update in intensive care and emergency medicine, vol 3. Springer, Berlin Heidelberg New York Tokyo, pp 16–25Google Scholar
- 11.Rady MY, Edwards JD, Nightingale P, Mortimer AJ (1989) Cardiorespiratory patterns in survivors and non-survivors following blunt chest trauma. Br J Hosp Med 42: 142Google Scholar
- 12.Bruns FJ, Fraley DS, Haigh J, Marquez JM, Martin DJ, Matuschak GM, Snyder JY (1987) Control of organ blood flow. Oxygen transport in the critically ill. J Crit Care 2: 87–124Google Scholar
- 13.Dahn MS, Lange P, Lobdell CCRNK, Hans B, Jacobs LA, Mitchell RA (1987) Splanchnic and total body oxygen consumption differences in septic and injured patients. Surgery, pp 69–80Google Scholar
- 15.Aikawa N (1989) Rationale and guidelines of fluid resuscitation in extensive burns. In: Vincent JL (ed) Update in intensive care and emergency medicine, vol 8. Springer, Berlin Heidelberg New York Tokyo, pp 395–400Google Scholar
- 19.Rady MY, Brough W, Edwards JD, Nightingale P, Mortimer AJ (1989) A prospective study of blunt chest trauma requiring admission to the intensive care unit. Br J Hosp Med 42: 147Google Scholar
- 20.Goris RJA (1987) Can ARDS and MOF be prevented? In: Vincent JL (ed) Update in intensive care and emergency medicine, vol 3. Springer, Berlin Heidelberg New York Tokyo, pp 155–162Google Scholar