Trauma Critical Care

Abstract

The surgical approach to the most injured patients has changed in recent years. Many patients arrive in the intensive care unit with problems that in the past would have been definitively addressed in the operating room, or led to the patient's demise due to continued attempts to complete all surgical procedures, despite deteriorating physiology. As a result, the triad of hypothermia, acidosis, and coagulopathy, along with the frequent complication of abdominal compartment syndrome, are critical factors that require correction in the intensive care unit. Prompt correction is necessary not only to allow expeditious completion of required surgical procedures, but because this triad, unless interrupted, invariably leads to death during resuscitation.

Management of Critical Bleeding in Trauma Patients: Between Recommendations and Reality

“…According to American College of Surgeons and Advanced Trauma Life Support classification of haemorrhage severity, loss of 50% of blood volume require 4 or more units for 3 hours, while loss of one blood volume means that for 24 hours the patient will receive 10 units [20,21]. This aggressive restoration of blood volume prior to surgical treatment [22,23] may lead to rebleeding and worsen survival. Administration of blood products may lead to potentially fatal complications.…”

Massive transfusion in multi-trauma patients

“…It is postulated that the major effect on clotting factors during hypothermia is on the kinetic activity of clotting enzymes. Therefore, the appropriate treatment for hypothermia induced coagulopathy is rewarming rather than administration of clotting factors [6]. Coagulopathy develops in the early phase after injury and is not related to fluid resuscitation.…”

“…After brain injury (60%), hemorrhagic shock (30-40%) is the most common cause of death in trauma patients [3][4][5]. Resuscitation strategies during damage control surgery may be as important as anatomical repair in order to improve long-term outcomes [6]. Early recognition of the need for massive transfusion, in combination with aggressive surgical and non-surgical hemorrhage control, results in significant decrease of early mortality.…”

Hypothermia: an under-estimated risk

“…In trauma patients, hypothermia is associated with coagulopathy [10], which is a result of impaired platelet function and thrombocytopenia caused by extravascular sequestration of platelets. Furthermore, as body temperature decreases, coagulation cascade enzymes tend to lose their function.…”