Critical Care in Trauma

  • Luiz G. Reys
  • Jennifer Nguyen
  • Camilo A. Avella Molano
  • Rishi Rattan
  • Gerrard Daniel PustEmail author


The goal of care in trauma patients is to reestablish homeostasis, treat morbidity, prevent complications and mortality, and functionally rehabilitate this subset of patients. To achieve this goal, the intensivist utilizes and coordinates a multidisciplinary, evidence-based approach to ensure that resources are effectively and efficiently allocated to the patients that need them. Airway management and breathing are the highest priority when evaluating a trauma patient. The goal is to protect the airway, improve gas exchange, and relieve respiratory distress. Sedation is a useful tool in the ICU setting and increases patient safety and comfort. Critical illness, anxiety, pain, and delirium can result in significant agitation, which may lead to an increased stress response.

Trauma patients are at an increased risk of developing pneumonia because of the need for prolonged mechanical ventilation, increased risk of aspiration, lung injury, and/or pain. Positioning, oral hygiene, aiding the clearing of secretions, and pain control can drastically reduce the risk. In addition, for those patients requiring prolonged intubation and mechanical ventilation, the implementation of weaning trials is beneficial. Multiple factors increase the risk of developing a deep vein thrombosis (DVT), including hypoperfusion due to blood loss and inadequate resuscitation, tissue injury, immobilization, and inflammation. It is recommended that chemical DVT prophylaxis is started within 72 hours from the time of injury barring any contraindications.


Critical care Ventilation Sedation Pneumonia Deep vein thrombosis 


  1. 1.
    Moore EE, Mattox KL, Feliciano DV. Trauma. 8th ed. New York, NY: McGraw-Hill; 2017.Google Scholar
  2. 2.
    Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41:263.CrossRefGoogle Scholar
  3. 3.
    Silveira PH. Unidades de Terapia Intensiva. Resolução CREMESP n° 71, de 08 de novembro de 1995.Google Scholar
  4. 4.
    Correa LC. Medicina Baseada em Evidências. New York, NY: Mbe; 2010.Google Scholar
  5. 5.
    Norton D, Mason P, Johannigman J. Critical care. US Department of Defense (US DoD). In:Emergency war surgery. Third United States revision. Washington, DC: Department of the Army, Office of the Surgeon General, Borden Institute; 2004.Google Scholar
  6. 6.
    Stephen AH, Adams CA Jr, Cioffi WG. Chapter 21. Surgical critical care. In: Sabiston textbook of surgery. Ed. New York, NY: Elsevier; 2017. p. 547–576.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Luiz G. Reys
    • 1
  • Jennifer Nguyen
    • 2
    • 3
  • Camilo A. Avella Molano
    • 4
  • Rishi Rattan
    • 5
  • Gerrard Daniel Pust
    • 6
    Email author
  1. 1.University of BrasiliaBrasiliaBrazil
  2. 2.Ryder Trauma Center – Jackson Health SystemMiamiUSA
  3. 3.Miller School of Medicine, University of MiamiMiamiUSA
  4. 4.Universidad de Los AndesBogotaColombia
  5. 5.Division of Trauma Surgery & Critical Care, DeWitt Daughtry Family Department of SurgeryMiller School of Medicine, University of MiamiMiamiUSA
  6. 6.Division of Trauma and Surgical Critical Care, The DeWitt Daughtry Family Department of SurgeryRyder Trauma Center/Jackson Memorial Hospital, Miller School of Medicine, University of MiamiMiamiUSA

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