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Thoracic Trauma and Management of Ventilation in the Critically Injured Patient

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Trauma and Combat Critical Care in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

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Abstract

Blunt chest trauma most commonly affects the chest wall in isolation, but if sufficiently forceful can also damage intrathoracic structures. Conversely, penetrating trauma commonly has minimal substantial effect on the chest wall (other than by creating a pneumothorax), but places intrathoracic structures at risk. Penetrating trauma more commonly requires operative intervention, but this is still only required in 15–20 % of patients presenting alive to hospital. Lung injury, either direct or indirect, is the commonest concern for the intensivist. Many theoretically attractive treatments for the acute respiratory distress syndrome have failed in definitive clinical trials, but several approaches reduce mortality and/or morbidity; these include low tidal volume ventilation, permissive hypercapnia, lung recruitment, PEEP strategies and prone positioning. Low dose steroids remain controversial. Rational, guideline-based use of prophylactic and therapeutic antibiotics, along with several non-antibiotic approaches including semi-recumbent positioning, improve patient outcomes and prevent emergence of resistant organisms. Extracorporeal CO2 removal with or without transmembrane oxygenation await confirmation of benefit in large trials in trauma, but evidence from other settings argues for their use, at least in select patients. Modern ventilators synchronise better to patient effort, allowing lighter sedation, earlier mobilisation and quicker extubation.

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Authors and Affiliations

  1. Joint Health Command, Australian Defence Force, Canberra, ACT, 2610, Australia

    Michael C. Reade MBBS, MPH, DPhil, FANZCA, FCICM

  2. The Burns, Trauma and Critical Care Research Centre, University of Queensland and Royal Brisbane and Women’s Hospital, Brisbane, QLD, 4029, Australia

    Michael C. Reade MBBS, MPH, DPhil, FANZCA, FCICM

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  1. Michael C. Reade MBBS, MPH, DPhil, FANZCA, FCICM
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Correspondence to Michael C. Reade MBBS, MPH, DPhil, FANZCA, FCICM .

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  1. Royal Navy and King's College Hospital, London, United Kingdom

    Sam D. Hutchings

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Reade, M.C. (2016). Thoracic Trauma and Management of Ventilation in the Critically Injured Patient. In: Hutchings, S. (eds) Trauma and Combat Critical Care in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-28758-4_9

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  • DOI: https://doi.org/10.1007/978-3-319-28758-4_9

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