Hemodynamic Monitoring in Trauma

  • J. D. Edwards
Conference paper
Part of the Update in Intensive Care and Emergency Medicine book series (UICM, volume 11)


Trauma remains the leading cause of preventable death in young adults [1]. Several recent reports in the UK have highlighted possible inadequacies in the provision of all aspects of traumacare-initial clinical assessment and resuscitation, definitive radiological investigation and surgery and provision of intensive care [2, 3]. Management of trauma victims from the cardiorespiratory point of view has until recently been dominated by the concept of an “ebb phase” of metabolic rate and oxygen consumption (VO2) which was said to last for the first 48 hrs after injury [4]. The therapeutic implication of this concept was never directly stated but was tacitly accepted by many clinicians to mean that in the early post-traumatic period normal values of cardiac output (CO) would suffice. This lead to the restoration of blood pressure and urine output as the goals of resuscitation. In fact the importance of achieving an adequate urine output before surgery in wounded soldiers was demonstrated by Ladd in the Korean conflict (see below) [5]. Even this simple message was unheard of by the majority of physicians not practising in trauma centres. The “ebb phase” concept has recently been questioned [6]. The human data on which it was based is unconvincing. The classic, much quoted series, was of only 7 patients with trivial injuries. These were studied after elective orthopaedic procedures. There is strong circumstantial evidence in the literature that an “ebb phase” does not exist - possibly the reverse.


Hemodynamic Monitoring Blunt Chest Trauma Pulmonary Artery Occlusion Pressure Trauma Victim Oxygen Extraction Ratio 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Baker CC, Oppenheimer L, Stephens B, Lewis RL, Trunkey DD (1980) Epidemiology of trauma deaths. J Surg 140: 144–150CrossRefGoogle Scholar
  2. 2.
    Goris RJA, Draaisma J (1982) Causes of death after blunt trauma. J Trauma 22:141–146PubMedCrossRefGoogle Scholar
  3. 3.
    Spence MT, Redmond AD, Edwards JD (1988) Trauma audit - the use of TRISS. Health Trends 20: 94–97PubMedGoogle Scholar
  4. 4.
    Cuthbertson DP (1942) Post-shock metabolic response. Lancet i: 433–437CrossRefGoogle Scholar
  5. 5.
    Goris RJA, te Boekhorst TP A, Nuytinck JKS, Gimbrere JSF (1985) Multiple-organ failure. Arch Surg 120: 1109–1115PubMedCrossRefGoogle Scholar
  6. 6.
    Little R (1987) Thermoregulation and metabolic rate in injury. In: Vincent JL (ed) Update in intensive care and emergency medicine, vol 3. Springer, Berlin Heidelberg New York Tokyo, pp 16–25Google Scholar
  7. 7.
    Edwards JD, Redmond AD, Nightingale P, Wilkins RG (1988) Oxygen consumption following trauma: a reappraisal in severely injured patients requiring mechanical ventilation. Br J Surg 75: 690–691PubMedCrossRefGoogle Scholar
  8. 8.
    Woods I, Wilkins RG, Edwards JD, Martin PD, Faragher EB (1987) Danger of using core/peripheral temperature gradient as a guide to therapy in shock. Crit Care Med 15: 850–852PubMedCrossRefGoogle Scholar
  9. 9.
    Shoemaker WC, Appel P, Czer LSC, et al (1980) Pathogenesis of respiratory failure (ARDS) after hemorrhage and trauma. Crit Care Med 8: 504–12PubMedCrossRefGoogle Scholar
  10. 10.
    Bland RD, Shoemaker WC, Abraham E, Cobo JC (1985) Hemodynamic and oxygen transport patterns in surviving and non-surviving post-operative patients. Crit Care Med 13: 85–90PubMedCrossRefGoogle Scholar
  11. 11.
    Rady MY, Edwards JD, Nightingale P, Mortimer AJ (1989) Cardiorespiratory patterns in survivors and non-survivors following blunt chest trauma. Br J Hosp Med 42: 142Google Scholar
  12. 12.
    Bruns FJ, Fraley DS, Haigh J, Marquez JM, Martin DJ, Matuschak GM, Snyder JY (1987) Control of organ blood flow. Oxygen transport in the critically ill. J Crit Care 2: 87–124Google Scholar
  13. 13.
    Dahn MS, Lange P, Lobdell CCRNK, Hans B, Jacobs LA, Mitchell RA (1987) Splanchnic and total body oxygen consumption differences in septic and injured patients. Surgery, pp 69–80Google Scholar
  14. 14.
    Venus B, Matsuda T, Copiozo JB, Mathru M (1981) Prophylactic intubation and continuous positive airway pressure in the management of inhalation injury in burn victims. Crit Care Med 9: 519–523PubMedCrossRefGoogle Scholar
  15. 15.
    Aikawa N (1989) Rationale and guidelines of fluid resuscitation in extensive burns. In: Vincent JL (ed) Update in intensive care and emergency medicine, vol 8. Springer, Berlin Heidelberg New York Tokyo, pp 395–400Google Scholar
  16. 16.
    Twigley AJ, Hillman KM (1985) The end of the crystalloid era? Anaesthesia 40: 860-871PubMedCrossRefGoogle Scholar
  17. 17.
    Newman RJ, Jones IS (1984) A prospective study of 413 consecutive car occupants with chest injuries. J Trauma 24: 129–35PubMedCrossRefGoogle Scholar
  18. 18.
    Harvey AC, Durbin J (1986) Effect of seat belt legislation on British road casualties. Journal of the Royal Statistical Society 149: 187–210CrossRefGoogle Scholar
  19. 19.
    Rady MY, Brough W, Edwards JD, Nightingale P, Mortimer AJ (1989) A prospective study of blunt chest trauma requiring admission to the intensive care unit. Br J Hosp Med 42: 147Google Scholar
  20. 20.
    Goris RJA (1987) Can ARDS and MOF be prevented? In: Vincent JL (ed) Update in intensive care and emergency medicine, vol 3. Springer, Berlin Heidelberg New York Tokyo, pp 155–162Google Scholar
  21. 21.
    Shoemaker WC, Appel PL, Kram HB (1986) Hemodynamic and oxygen transport effects of dobutamine in critically ill general surgical patients. Crit Care Med 14: 1032–37PubMedCrossRefGoogle Scholar
  22. 22.
    Border JR, Hassett J, LeDuca J, et al (1987) The gut origin septic states in blunt multiple trauma (ISS = 40) in the ICU. Ann Surg 206: 427–448PubMedCrossRefGoogle Scholar
  23. 23.
    Meadows D, Edwards JD, Wilkins RG, Nightingale P (1988) Reversal of intractable septic shock with norepinephrine therapy. Crit Care Med 16: 663–666PubMedCrossRefGoogle Scholar
  24. 24.
    Powers SR, Mannal R, Neclerio M, et al (1973) Physiologic consequences of positive end-expiratory pressure (PEEP) ventilation. Ann Surg 178: 265–72PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 1991

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  • J. D. Edwards

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