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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Published in:

Open Access 01-12-2012 | Review

Critical care considerations in the management of the trauma patient following initial resuscitation

Authors: Roger F Shere-Wolfe, Samuel M Galvagno Jr, Thomas E Grissom

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2012

Abstract

Background

Care of the polytrauma patient does not end in the operating room or resuscitation bay. The patient presenting to the intensive care unit following initial resuscitation and damage control surgery may be far from stable with ongoing hemorrhage, resuscitation needs, and injuries still requiring definitive repair. The intensive care physician must understand the respiratory, cardiovascular, metabolic, and immunologic consequences of trauma resuscitation and massive transfusion in order to evaluate and adjust the ongoing resuscitative needs of the patient and address potential complications. In this review, we address ongoing resuscitation in the intensive care unit along with potential complications in the trauma patient after initial resuscitation. Complications such as abdominal compartment syndrome, transfusion related patterns of acute lung injury and metabolic consequences subsequent to post-trauma resuscitation are presented.

Methods

A non-systematic literature search was conducted using PubMed and the Cochrane Database of Systematic Reviews up to May 2012.

Results and conclusion

Polytrauma patients with severe shock from hemorrhage and massive tissue injury present major challenges for management and resuscitation in the intensive care setting. Many of the current recommendations for “damage control resuscitation” including the use of fixed ratios in the treatment of trauma induced coagulopathy remain controversial. A lack of large, randomized, controlled trials leaves most recommendations at the level of consensus, expert opinion. Ongoing trials and improvements in monitoring and resuscitation technologies will further influence how we manage these complex and challenging patients.

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Title: Critical care considerations in the management of the trauma patient following initial resuscitation
Authors: Roger F Shere-Wolfe
Samuel M Galvagno Jr
Thomas E Grissom
Publication date: 01-12-2012
Publisher: BioMed Central
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine / Issue 1/2012
Electronic ISSN: 1757-7241
DOI: https://doi.org/10.1186/1757-7241-20-68

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Critical care considerations in the management of the trauma patient following initial resuscitation

Abstract

Background

Methods

Results and conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results and conclusion

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