Common PACU problems in trauma patients

  • W. Lingnau
Part of the Topics in Anaesthesia and Critical Care book series (TIACC)


Prehospital resuscitation and transportation to an emergency room for further diagnostic assessment and aggressive stabilisation of vital organ functions are cornerstones of the initial management of injured patients. The anaesthetist aims at circulatory stability and sufficient respiratory function. Surgical intervention to stop haemorrhage and to fix long bone fractures are at the top of the priority list for subsequent treatment in the operation room. Trauma patients are then referred to a Postanaesthesia Care Unit (PACU) or an Intensive Care Unit (ICU) depending on the severity of injury and the expected duration of impaired organ function. Tissue injury, hypoxaemia and haemorrhagic shock initiate pathophysiologic, immunologic and metabolic changes that lead to secondary complications. Wudel et al. [1] studied trauma patients after mass transfusion of more than 20 units and found 28% dying within the first 24 h and another 20% dying later from multiple organ failure. Patients who are specifically prone to complications are defined by advanced age, pretraumatic health condition, shock and the severity of injuries.


Continuous Positive Airway Pressure Trauma Patient Functional Residual Capacity Adult Respiratory Distress Syndrome Closing Capacity 
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.
    Wudel JH, Morris JA Jr, Yates K, Wilson A, Bass SM (1991) Massive transfusion: outcome in blunt trauma patients. J Trauma 31:1–7.PubMedCrossRefGoogle Scholar
  2. 2.
    Brewer LA, Burbank B, Samson PC et al (1946) The wet lung in war casualties. Ann Surg 123:343–347.CrossRefGoogle Scholar
  3. 3.
    Graf CJ, Rossi NP (1978) Catecholamine response to intracranial hypertension. J Neurosurg 49:862–868.PubMedCrossRefGoogle Scholar
  4. 4.
    Moss J, Lisbon A, Levine JF (1975) The effects of increased intracranial pressure on respiratory functions. In: Lundberg N, Ponten U, Brock M (eds) Intracranial pressure II. Springer-Verlag, Berlin Heidelberg New York, p 315.CrossRefGoogle Scholar
  5. 5.
    Wagner RB, Jamieson PM (1989) Pulmonary contusion. Evaluation and classification by computed tomography. Surg Clin North Am 69:31–40.PubMedGoogle Scholar
  6. 6.
    Pepe PE, Potkin RT, Reus DH, Hudson LD, Carrico CJ (1982) Clinical predictors of the adult respiratory distress syndrome. Am J Surg 144:124–130.PubMedCrossRefGoogle Scholar
  7. 7.
    Hamilton WK (1961) Atelectasis, pneumothorax, and aspiration as postoperative complications. Anesthesiology 22:708–713.PubMedCrossRefGoogle Scholar
  8. 8.
    Don HF, Wahba WM, Craig DB (1972) Airway closure, gas trapping, and the functional residual capacity during anesthesia. Anesthesiology 36:533–539.PubMedCrossRefGoogle Scholar
  9. 9.
    Cooperman LH, Price HR (1970) Pulmonary edema in the operative and postoperative period: review of 40 cases. Ann Surg 172:883–891.PubMedCrossRefGoogle Scholar
  10. 10.
    Morton KS, Kendall MJ (1965) Fat embolism: its production and source of fat. Can J Surg 8:214.PubMedGoogle Scholar
  11. 11.
    Peltiere LF (1956) Fat embolism III. The toxic properties of neutral fat and free fatty acids. Surgery 40:665.Google Scholar
  12. 12.
    Lequire VS, Shapiro JL, Lequire CB et al (1959) A study of the pathogenesis of fat embolism based on human necropsy material and animal experiments. Am J Pathol 35:999.PubMedGoogle Scholar
  13. 13.
    Moylan JA, Birnbaum M, Katz A, Everson MA (1976) Fat emboli syndrome. J Trauma 16:341–347.PubMedCrossRefGoogle Scholar
  14. 14.
    Weissman C, Damask MC, Yang J (1984) Noncardiogenic pulmonary edema following laryngeal obstruction. Anesthesiology 60:163–165.PubMedCrossRefGoogle Scholar
  15. 15.
    Jackson FN, Rowland V, Corssen G (1980) Laryngospasm induced pulmonary edema. Chest 78:819–821.PubMedCrossRefGoogle Scholar
  16. 16.
    Crandall ED, Staub NE, Goldberg HS, Effros RM (1983) Recent development in pulmonary edema. Ann Intern Med 99:808–822.PubMedGoogle Scholar
  17. 17.
    Shapiro JM, Mihm FG, Trudell JR, Stevens JH, Feeley TW (1987) Leukotriene D4 increases extravascular lung water in the dog. Circ Shock 21:121–128.PubMedGoogle Scholar
  18. 18.
    Goris RJ, Gimbrere JS, van Niekerk JL, Schoots FJ, Booy LH (1982) Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient. J Trauma 22:895–903.PubMedCrossRefGoogle Scholar
  19. 19.
    Bernard GR, Luce JM, Sprung CL, Rinaldo JE, Tate RM, Sibbald WJ, Kariman K, Higgins S, Bradley R, Metz CA et al (1987) High-dose corticosteroids in patients with the adult respiratory distress syndrome. N Engl J Med 317:1565–1570.PubMedCrossRefGoogle Scholar
  20. 20.
    Hines R, Barash PG, Watrous G, O’Connor T (1992) Complications occurring in the postanaesthesia care unit: a survey. Anesth Analg 74:503–509.PubMedCrossRefGoogle Scholar
  21. 21.
    Van Oss CJ, Absolom DR, Moore LL, Park BH, Humbert JR (1980) Effect of temperature on the chemotaxis, phagocytic engulfment, digestion and 02 consumption of human polymorphonuclear leukocytes. J Reticuloendothel Soc 27:561–564.PubMedGoogle Scholar
  22. 22.
    Sheffield CW, Hopf HW, Sessler DI (1993) Local heat reverses the decrease in subcutaneous oxygen tension produced by thermoregulatory vasoconstriction. Anesth Analg 76:S389.Google Scholar
  23. 23.
    Sessler DI, Olofsson CI, Rubinstein EH (1988) The thermoregulatory threshold in humans during nitrous oxide-fentanyl anesthesia. Anesthesiology 69:357–364.PubMedCrossRefGoogle Scholar
  24. 24.
    Sessler DI, Israel D, Pozos RS, Pozos M, Rubinstein EH (1988) Spontaneous post-anesthetic tremor does not resemble thermoregulatory shivering. Anesthesiology 68:843–850.PubMedCrossRefGoogle Scholar
  25. 25.
    Myers BD, Miller DC, Mehigan JT, Olcott CO, Golbetz H, Robertson CR, Derby G, Spencer R, Friedman S (1984) Nature of the renal injury following total renal ischemia in man. J Clin Invest 73:329–341.PubMedCrossRefGoogle Scholar
  26. 26.
    Lordon RE, Burton JR (1972) Posttraumatic renal failure in military personnel in Southeast Asia. Am J Med 53:137–147.PubMedCrossRefGoogle Scholar
  27. 27.
    Anderson RJ, Linas SL, Berns AS, Henrich WL, Miller TR, Gabow PA, Schrier RW (1977) Nonoliguric acute renal failure. N Engl J Med 296:1134–1138.PubMedCrossRefGoogle Scholar
  28. 28.
    Dixon BS, Anderson RJ (1985) Nonoliguric acute renal failure. Am J Kidney Dis 6:71–80.PubMedGoogle Scholar
  29. 29.
    Shin B, Mackenzie CF, Cowley RA (1979) Changing pattern of posttraumatic acute renal failure. Am Surg 45:182–189.PubMedGoogle Scholar
  30. 30.
    Brezis M, Agmon Y, Epstein FH (1994) Determinants of intrarenal oxygenation. Am J Physiol 267:F1059–F1062.PubMedGoogle Scholar
  31. 31.
    Brown CB, Ogg CS, Cameron JS (1981) High dose furosemide in acute renal failure: a controlled trial. Clin Nephrol 15:90–96.PubMedGoogle Scholar
  32. 32.
    Graziani G, Cantaluppi A, Casati S, Citterio A, Scalamogna A, Aroldi A, Silenzio R, Brancaccio D, Ponticelli C (1984) Dopamine and furosemide in oliguric acute renal failure. Nephron 37:39–42.PubMedCrossRefGoogle Scholar
  33. 33.
    Parker S, Graziano CC, Isaac M, Howland WS, Kahn RC (1981) Dopamine administration in oliguria and oliguric renal failure. Crit Care Med 9:630–632PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • W. Lingnau

There are no affiliations available

Personalised recommendations