Developments in trauma management: From the field to the intensive care unit
Corresponding Author
Karl Kang Young
Adult Intensive Care Unit, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR.
*Email: [email protected]Search for more papers by this authorCorresponding Author
Karl Kang Young
Adult Intensive Care Unit, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR.
*Email: [email protected]Search for more papers by this authorAbstract
There have not been dramatic changes in trauma management in recent years. Nevertheless, there are noteworthy developments that might eventually change both paradigms of trauma systems and clinical management. In the present study, organizational aspects of mass casualty scenarios and what we have learned from the experiences of military doctors are examined. Then, the perennial theme of fluid resuscitation; when, what and how much to give, is examined. The management of bleeding and minimization of allogeneic blood transfusions raise the topics of recombinant factor VIIa and oxygen carrying blood substitutes. Finally, an aspect of intensive care management that is very topical, that of immunonutrition and the modulation of sepsis in intensive care, is examined.
References
- 1 Lhowe DW, Briggs SM. Planning for mass civilian casualties overseas. Clin. Orthop. 2004; 422: 109–13.
- 2 Frykberg E. Medical management of disasters and mass casualties from terrorist bombings: how can we cope. J. Trauma 2002; 53: 201–12.
- 3 Smith J, Greaves I. Crush injury and crush syndrome: a review. J. Trauma 2003; 54: S226–30.
- 4 Sumann G, Kampfl A, Wenzel V, Schobersberger W. Early intensive care intervention for trauma care: what alters the outcome? Curr. Opin. Crit. Care 2002; 8: 587–92.
- 5 Schulman CS. A FASTer method of detecting abdominal trauma. Nursing Management 2003; 34: 47–9.
- 6 Sarkisian AE, Khondkarian RA, Amirbekian NM. Sonographic screening of mass casualties for abdominal and renal injuries following the 1988 Armenian earthquake. J. Trauma 1991; 31: 247–50.
- 7 Chawda MN, Hildebrand F, Pape HC, Giannoudis PV. Predicting outcome after multiple trauma: which scoring system? Injury, Int. J Care Injured 2004; 35: 347–58.
- 8 Gabbe BJ, Cameron PA, Finch CF. Is the revised trauma score still useful? ANZ J. Surg. 2003; 73: 944–8.
- 9 Hoey BA, Schwab CW. Level I center triage and mass casualties. Clin. Orthop. 2004; 422: 23–9.
- 10 American College of Surgeons Committee on Trauma. Field categorization of trauma victims. Bull. Am. Coll. Surg. 1986; 71: 17–21.
- 11 Holcomb JB. Fluid resuscitation in modern combat casualty care: lessons learned from Somalia. J. Trauma 2003; 54: S46–51.
- 12 Thomas SJ, Kramer GC, Herndon DN. Burns: military options and tactical solutions. J. Trauma 2003; 54: S207–18.
- 13 Revell M, Porter K, Greaves I. Fluid resuscitation in prehospital trauma care: a consensus view. Emerg. Med. J. 2002; 19: 494–8.
- 14 Allison K, Porter K. Consensus on the pre-hospital approach to burns patient management. Accid. Emerg. Nurs. 2004; 12: 53–7.
- 15 Scalea T. What's new in trauma in the past 10 years. Int. Anesthesiol. Clin. 2002; 40: 1–17.
- 16 Hoyt DB. What's new in general surgery: trauma and critical care. J. Am. Coll. Surg. 2002; 194: 335–51.
- 17 Rozycki GS. What's new in trauma and critical care. J. Am. Coll. Surg. 2004; 198: 798–805.
- 18 Boldt J. Fluid choice for resuscitation of the trauma patient: a review of the physiological, pharmacological, and clinical evidence. Can. J. Anesth. 2004; 51: 500–13.
- 19 Boldt J. New light on intravascular Volume replacement regimens: what did we learn from the past three years? Anesth. Analg. 2003; 97: 1595–604.
- 20 Cochrane Injuries Group Albumin Reviewers. Human albumin administration in critically ill patients: a systematic review of randomized controlled trials. BMJ 1998; 317: 235–40.
- 21 Wilkes MM, Navickis RJ. Patient survival after human albumin administration: a meta-analysis of randomized, controlled trials. Ann. Intern. Med. 2001; 135: 149–64.
- 22 The SAFE study investigators. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N. Engl. J. Med. 2004; 350: 2247–56.
- 23 Revell M, Greaves I, Porter K. Endpoints for fluid resuscitation in hemorrhagic shock. J. Trauma 2003; 54: S63–7.
- 24 Stern SA. Low-Volume fluid resuscitation for presumed hemorrhagic shock: helpful or harmful? Curr. Opin. Crit. Care 2001; 7: 422–30.
- 25 Krausz MM. Fluid resuscitation strategies in the Israeli Army. J. Trauma 2003; 54: S39–42.
- 26 Brisebois RJ. Fluid resuscitation in the Canadian Forces. J Trauma 2003; 54: S36–8.
- 27 Kwan I, Bunn F, Roberts I (on behalf of the WHO pre-hospital trauma care steering committee). Timing and Volume of fluid administration for patients with bleeding (review). Cochrane Database Syst. Rev. 2005; 1. (Date of most recent update: 28 April 2003).
- 28 Bunn F, Roberts I, Tasker R, Akpa E. Hypertonic versus near isotonic crystalloid for fluid resuscitation in critically ill patients. Cochrane Database Syst. Rev. 2005; 1. (Date of most recent update: 26 May 2004).
- 29 Kramer GC. Hypertonic resus citation: physiologic mechanisms and recommendations for trauma care. J. Trauma 2003; 54: S89–99.
- 30 Chiara O, Pelosi P, Brazzi L et al. Resuscitation from hemorrhagic shock: experimental model comparing normal saline, dextran, and hypertonic saline solutions. Crit. Care Med. 2003; 31: 1915–22.
- 31 Bhardwaj A, Ulatowski JA. Hypertonic saline solutions in brain injury. Curr. Opin. Crit. Care 2004; 10: 126–31.
- 32 Lapointe LA, Von Rueden KT. Coagulopathies in Trauma patients. AACN Clin. Issues 2002; 13: 192–203.
- 33 Hoffman M. The cellular basis of traumatic bleeding. Mil. Med. 2004; 169: 5–7.
- 34 Hardy J-F, De Moerloose P, Samama M. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can. J. Anesth. 2004; 51: 293–310.
- 35 Mattox KL. Timing of transfusion in trauma. Vox Sang. 2004; 87 (Suppl. 2): S222–6.
- 36 Moore FA, McKinley BA, Moore EE. The next generation in shock resuscitation. Lancet 2004; 363: 1988–96.
- 37 Kenet G, Walden R, Eldad A, Martinowitz U. Treatment of traumatic bleeding with recombinant factor VIIa (case report, letter). Lancet 1999; 354: 1879.
- 38 Rossaint R, Boffard K, Warren B et al. Decreased transfusion utilization using recombinant factor VIIa as an adjunct in trauma. Intensive Care Med. 2004; 30 (Suppl.): Abstract 771.
- 39 Martinowitz U, Kenet G, Lubetski A, Luboshitz J, Segal E. Possible role of recombinant activated factor VII (rFVIIa) in the control of hemorrhage associated with massive trauma. Can. J. Anesth. 2002; 49: S15–20.
- 40 Martinowitz U, Zaarur M, Bar-Lavie Y, Blumenfeld A, Martonovits G. Treating traumatic bleeding in a combat setting: possible role of recombinant activated factor VII. Mil. Med. 2004; 169 (Suppl.): 16–18.
- 41 Dejgaard A. Update on Novo Nordisk's clinical trial programme on NovoSeven®. Blood Coagul. Fibrinolysis 2003; 14 (Suppl. 1): S39–41.
- 42 Meng ZH, Wolberg AS, Monroe DM, Hoffman M. The effect of temperature and pH on the activity of factor VIIa: implications for the efficacy of high-dose factor VIIa in hypothermic and acidotic patients. J. Trauma 2003; 55: 886–91.
- 43 Lynn M, Jerokhimov I, Jewelewicz D et al. Early use of recombinant factor VIIa improves mean arterial pressure and may potentially decrease mortality in experimental hemorrhagic shock: a pilot study. J. Trauma 2002; 52: 703–7.
- 44 Batorova A, Martinowitz U. Continuous infusion of coagulation factors. Haemophilia 2002; 8: 170–77.
- 45 Proctor KG. Blood substitutes and experimental models of trauma. J. Trauma 2003; 54: S106–9.
- 46 McCowen KC, Bistrian BR. Immunonutrition: problematic or problem solving? Am. J. Clin. Nutr. 2003; 77: 764–70.
- 47 Montejo JC, Zarazaga A, Lopez-Martinez J et al. Immunonutrition in the intensive care unit. A systematic review and consensus statement. Clin. Nutr. 2003; 22: 211–33.
- 48 Sacks GS, Genton L, Kudsk KA. Controversy of immunonutrition for surgical critical-illness patients. Curr. Opin. Crit. Care 2003; 9: 300–5.
- 49 Biffl WL, Moore EE, Haenel JB. Nutrition support of the trauma patient. Nutrition 2002; 18: 960–65.
- 50 Alexander JW. Nutritional pharmacology in surgical patients. Am. J. Surg. 2002; 183: 349–52.
- 51 Grimm H, Kraus A. Immunonutrition – supplementary amino acids and fatty acids ameliorate immune deficiency in critically ill patients. Langenbeck's Arch. Surg. 2001; 386: 369–76.
- 52 Tapiero H, Mathé G, Couvreur P, Tew KD. Glutamine and glutamate. Biomed. Pharmacother. 2002; 56: 446–57.
- 53 Wilmore DW. The effect of glutamine supplementation in patients following elective surgery and accidental injury. J. Nutr. 2001; 131: S2543–9.
- 54 Savy GK. Glutamine supplementation. J. Infus. Nurs. 2002; 25: 65–90.
- 55 Holeèek M. Relation between glutamine, branched-chain amino acids, and protein metabolism. Nutrition 2002; 18: 130–33.
- 56 Flynn NE, Meininger CJ, Haynes TE, Wu G. The metabolic basis of arginine nutrition and pharmacotherapy. Biomed. Pharmacother. 2002; 56: 427–38.
- 57 Castell LM. Can glutamine modify the apparent immunodepression observed after prolonged, exhaustive exercise? Nutrition 2002; 18: 371–5.
- 58 Calder PC. Long-chain n-3 fatty acids and inflammation: potential application in surgical and trauma patients. Braz. J. Med. Biol. Res. 2003; 36: 433–46.
- 59 Roth E, Manhart N, Wessner B. Assessing the antioxidative status in critically ill patients. Curr. Opin. Clin. Nutr. Metab. Care 2004; 7: 161–8.
- 60 Gilgun-Sherki Y, Rosenbaum Z, Melamed E, Offen D. Antioxidant therapy in acute nervous system injury: current state. Pharmacol. Rev. 2002; 54: 271–84.