Sepsis is a major cause of mortality and morbidity in the trauma patient. Sepsis following traumatic injury is related to the type of injury, together with the extent of injury and the anatomical location. Burn injuries are associated with the highest risk of sepsis. The diagnosis of sepsis in the trauma patient remains difficult. Interpretation of abnormal results is key to successful diagnosis, particularly in conjunction with clinical findings. This review will consider the specific features of sepsis in the context of trauma relating to epidemiology, risk factors, diagnosis and management.

Anaesthesia causes an impairment of pulmonary function, irrespective of whether the patient is breathing spontaneously, or is being mechanically ventilated. Impaired oxygenation of blood occurs in most subjects who are anaesthetised [6]. Lung function remains impaired postoperatively, and clinically significant pulmonary complications can be seen in 1% to 2% after minor surgery, and in up to 20% after upper abdominal and thoracic surgery [7]. AbstractInjury following ballistic trauma is the most prevalent indication for providing organ system support within an ICU in the field. Following damage control surgery, postoperative ventilatory support may be required, but multiple factors may influence the indications for and duration of invasive mechanical ventilation. Ballistic trauma and surgery may trigger the Systemic Inflammatory Response Syndrome (SIRS) and are important causative factors in the development of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). However, their pathophysiological effect on the respiratory system is unpredictable and variable. Invasive mechanical ventilation is associated with numerous complications and the return to spontaneous ventilation has many physiological benefits. Following trauma, shorter periods of ICU sedation-amnesia and a protocol for early weaning and extubation, may minimize complications and have a beneficial effect on their psychological recovery. In the presence of stable respiratory function, appropriate analgesia and favourable operational and transfer criteria, we believe that the prompt restoration of spontaneous ventilation and early tracheal extubation should be a clinical objective for casualties within the field ICU.