To Tube or Not To Tube? A Critical Point in Emergency and Trauma

  • G. Berlot


The brief history of critical care medicine has been marked by some hotly debated issues, including the “crystalloid-colloid controversy”, the “stay and play vs. scoop and run” approach to severely injured patients, and the utility of obtaining above normal levels of cardiovascular and oxygenation variables. Basically, despite the relevance of the debated points and the high scientific ranks of the advocates of the different approaches, no study has been able to demonstrate conclusively that one given therapeutic behaviour is always the best option for all patients. In other words, an up-to-date reader of the scientific journals dealing with these issues can hardly draw a firm conclusion on the strategy to adopt in his daily clinical work. The very same considerations apply to the on-the-scene tracheal intubation (TI) of trauma patients, the role of which has been recently questioned by a number of studies mainly from the USA and Canada, in which a worse outcome was demonstrated in patients treated with on-the-scene TI. I find this particularly disturbing, because when I was young trainee I was taught (and I presently teach to my younger colleagues) that early TI can make the difference between life and death in trauma patients. On the side of life, needless to say.


Trauma Patient Tracheal Intubation Trauma Care Secondary Brain Injury Major Trauma Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Stocchetti N, Furian A, Volta F (1996) Hypoxaemia and arterial hypotension at the accident scene. J Trauma 40:764–767PubMedCrossRefGoogle Scholar
  2. 2.
    Ravussin P, Bracco D, Moeschler O (1999) Prevention and treatment of secondary brain injury. Curr Opin Crit Care 5:511–516Google Scholar
  3. 3.
    Gillahm M, Parr JA (2002) Resuscitation for major trauma. Curr Opin Crit Care 15:167–172Google Scholar
  4. 4.
    Gausce M, Lewis RJ, Stratton SJ et al (2000) Effect of out-of-hospital pediatric endotracheal intubation on survival and neurologic outcome. JAMA 283:783–790CrossRefGoogle Scholar
  5. 5.
    Eckstein M, Chan L, Schneir A et al (2000) Effect of prehospital advanced life support on outcomes of major trauma patients. J Trauma 48:643–648PubMedCrossRefGoogle Scholar
  6. 6.
    Lockey D, Davies G, Coats T (2001) An observational study of the survival of trauma patients who have pre-hospital tracheal intubation without anesthesia or muscle relaxants. Br Med J 323:1410Google Scholar
  7. 7.
    Di Bartolomeo S, Sanson G, Nardi G et al (2001) Effects of 2 patterns of prehopsital care on the outcome of patients with severe head injury. Ann Surg 136:1293–1300Google Scholar
  8. 8.
    Nardi G, Massarutti D, Muzzi R et al (1994) Impact of emergency medical helicopter service on mortality for trauma in north east Italy: a regional prospective audit. Eur J Emerg Med 1:69–77PubMedCrossRefGoogle Scholar
  9. 9.
    Winchell RJ, Hoyt DB (1997) Endoctracheal intubation on the scene improves survival in patients with severe head injury. Arch Surg 132:592–597PubMedCrossRefGoogle Scholar
  10. 10.
    Garner A, Rashford S, Lee A, Bartolacci R (1999) Addition of physicians to paramedics helicopter services decreases blunt trauma mortality. Aust N Z J Surg 69:697–701PubMedCrossRefGoogle Scholar
  11. 11.
    Dunham CM, Barraco RD, Clark DE et al (2003) Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma Inj Infect and Crit Care 55:162–179CrossRefGoogle Scholar
  12. 12.
    Stocchetti N, Pagliarini G, Gennari M et al (1994) Trauma care in Italy: evidence of in-hospital preventable deaths. J Trauma 36:401–405PubMedCrossRefGoogle Scholar
  13. 13.
    Biewener A, Aschenbrenner U, Rammelt S, Grass R, Zwipp H (2004) Impact of helicopter transport and hospital level on mortality of polytrauma patients. J Trauma Inj Infect and Crit Care 56:94–98CrossRefGoogle Scholar
  14. 14.
    Peleg K, Ahronson-Daniel L, Stein M et al (2004) Gunshot and explosion injuries-characteristics, outcomes and implications for care of terror-related injuries in Israel. Ann Surg 239:311–318PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Karch SB, Lewis T, Young S et al (1996) Field intubation of trauma patients: complications, indications and outcomes. Am J Emerg Med 14:617–619PubMedCrossRefGoogle Scholar
  16. 16.
    Sampalis JS, Tamin H, Denis R et al (1997) Ineffectiveness of on-site intravenous line: is prehopsital time the culprit? J Trauma Inj Infect and Crit Care 43:608–617CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • G. Berlot

There are no affiliations available

Personalised recommendations