The research agenda for trauma critical care

  • Karim Asehnoune
  • Zsolt Balogh
  • Giuseppe Citerio
  • Andre Cap
  • Timothy Billiar
  • Nino Stocchetti
  • Mitchell J. Cohen
  • Paolo Pelosi
  • Nicola Curry
  • Christine Gaarder
  • Russell Gruen
  • John Holcomb
  • Beverley J. Hunt
  • Nicole P. Juffermans
  • Mark Maegele
  • Mark Midwinter
  • Frederick A. Moore
  • Michael O’Dwyer
  • Jean-François Pittet
  • Herbert Schöchl
  • Martin Schreiber
  • Philip C. Spinella
  • Simon Stanworth
  • Robert Winfield
  • Karim Brohi
Research Agenda

Abstract

In this research agenda on the acute and critical care management of trauma patients, we concentrate on the major factors leading to death, namely haemorrhage and traumatic brain injury (TBI). In haemostasis biology, the results of randomised controlled trials have led to the therapeutic focus moving away from the augmentation of coagulation factors (such as recombinant factor VIIa) and towards fibrinogen supplementation and administration of antifibrinolytics such as tranexamic acid. Novel diagnostic techniques need to be evaluated to determine whether an individualised precision approach is superior to current empirical practice. The timing and efficacy of platelet transfusions remain in question, while new blood products need to be developed and evaluated, including whole blood variants, lyophilised products and novel red cell storage modalities. The current cornerstones of TBI management are intracranial pressure control, maintenance of cerebral perfusion pressure and avoidance of secondary insults (such as hypotension, hypoxaemia, hyperglycaemia and pyrexia). Therapeutic hypothermia and decompressive craniectomy are controversial therapies. Further research into these strategies should focus on identifying which subgroups of patients may benefit from these interventions. Prediction of the long-term outcome early after TBI remains challenging. Early magnetic resonance imaging has recently been evaluated for predicting the long-term outcome in mild and severe TBI. Novel biomarkers may also help in outcome prediction and may predict chronic neurological symptoms. For trauma in general, rehabilitation is complex and multidimensional, and the optimal timing for commencement of rehabilitation needs investigation. We propose priority areas for clinical trials in the next 10 years.

Keywords

Haemorrhage Trauma Shock Traumatic brain injury Coagulopathy Intracranial hypertension 

Supplementary material

134_2017_4895_MOESM1_ESM.docx (38 kb)
Supplementary material 1 (DOCX 38 kb)

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Copyright information

© Springer-Verlag GmbH Germany and ESICM 2017

Authors and Affiliations

  • Karim Asehnoune
    • 1
    • 2
  • Zsolt Balogh
    • 7
  • Giuseppe Citerio
    • 3
    • 4
  • Andre Cap
    • 9
  • Timothy Billiar
    • 8
  • Nino Stocchetti
    • 5
  • Mitchell J. Cohen
    • 10
  • Paolo Pelosi
    • 6
  • Nicola Curry
    • 11
  • Christine Gaarder
    • 12
  • Russell Gruen
    • 13
  • John Holcomb
    • 14
  • Beverley J. Hunt
    • 15
  • Nicole P. Juffermans
    • 16
  • Mark Maegele
    • 17
  • Mark Midwinter
    • 18
  • Frederick A. Moore
    • 19
  • Michael O’Dwyer
    • 20
  • Jean-François Pittet
    • 21
  • Herbert Schöchl
    • 22
  • Martin Schreiber
    • 23
  • Philip C. Spinella
    • 24
  • Simon Stanworth
    • 25
  • Robert Winfield
    • 26
  • Karim Brohi
    • 20
  1. 1.Department of Anesthesiology and Critical Care MedicineHôtel Dieu, Centre hospitalier universitaire (CHU) de NantesNantesFrance
  2. 2.Laboratory EA 3826University of NantesNantesFrance
  3. 3.School of Medicine and SurgeryUniversity of Milan-BicoccaMonzaItaly
  4. 4.Neurointensive Care Unit, Department of Emergency and Intensive CareSan Gerardo Hospital, ASST-MonzaMonzaItaly
  5. 5.Department of Physiopathology and TransplantMilan University and Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore PoliclinicoMilanItaly
  6. 6.Department of Surgical Sciences and Integrated Diagnostics, IRCCS AOU San Martino-ISTUniversity of GenoaGenoaItaly
  7. 7.John Hunter Hospital and University of NewcastleNewcastleAustralia
  8. 8.Department of SurgeryUniversity of PittsburghPittsburghUSA
  9. 9.US Army Institute of Surgical ResearchSan AntonioUSA
  10. 10.University of Colorado School of MedicineDenver Health Medical CenterAuroraUSA
  11. 11.Oxford University Hospital NHS Trust, John Radcliffe HospitalOxfordUK
  12. 12.Department of TraumatologyOslo University HospitalOsloNorway
  13. 13.Lee Kong Chian School of MedicineNanyang Technological UniversityNanyangSingapore
  14. 14.Center for Translational Injury ResearchUniversity of Texas Health Science CenterHoustonUSA
  15. 15.Departments of Haematology and PathologyGuy’s and St Thomas’ NHS Foundation TrustLondonUK
  16. 16.Department of Intensive CareAcademic Medical CenterAmsterdamThe Netherlands
  17. 17.Department for Traumatology and Orthopedic Surgery, Cologne-Merheim Medical CentreUniversity of Witten/HerdeckeCologneGermany
  18. 18.Rural Clinical School (Bundaberg)University of QueenslandBundabergAustralia
  19. 19.Department of SurgeryUniversity of FloridaGainesvilleUSA
  20. 20.Centre for Trauma SciencesQueen Mary University of LondonLondonUK
  21. 21.Critical Care Division, Department of AnesthesiologyUniversity of Alabama at BirminghamBirminghamUSA
  22. 22.Department of Anesthesiology and Intensive Care Medicine, AUVA Trauma Centre SalzburgAcademic Teaching Hospital of the Paracelsus Medical UniversitySalzburgAustria
  23. 23.Department of SurgeryOregon Health and Science UniversityPortlandUSA
  24. 24.Department of PediatricsWashington University in St Louis School of MedicineWashingtonUSA
  25. 25.NHS Blood and TransplantJohn Radcliffe HospitalOxfordUK
  26. 26.University of Kansas, Medical CenterKansas CityUSA

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