ICU Management of Trauma Patients

Samuel A. Tisherman, MD, FCCM; Deborah M. Stein, MD, MPH, FCCM

Disclosures

Crit Care Med. 2018;46(12):1991-1997. 

In This Article

Abstract and Introduction

Abstract

Objectives: To describe the current state of the art regarding management of the critically ill trauma patient with an emphasis on initial management in the ICU.

Data Sources and Study Selection: A PubMed literature review was performed for relevant articles in English related to the management of adult humans with severe trauma. Specific topics included airway management, hemorrhagic shock, resuscitation, and specific injuries to the chest, abdomen, brain, and spinal cord.

Data Extraction and Data Synthesis: The basic principles of initial management of the critically ill trauma patients include rapid identification and management of life-threatening injuries with the goal of restoring tissue oxygenation and controlling hemorrhage as rapidly as possible. The initial assessment of the patient is often truncated for procedures to manage life-threatening injuries. Major, open surgical procedures have often been replaced by nonoperative or less-invasive approaches, even for critically ill patients. Consequently, much of the early management has been shifted to the ICU, where the goal is to continue resuscitation to restore homeostasis while completing the initial assessment of the patient and watching closely for failure of nonoperative management, complications of procedures, and missed injuries.

Conclusions: The initial management of critically ill trauma patients is complex. Multiple, sometimes competing, priorities need to be considered. Close collaboration between the intensivist and the surgical teams is critical for optimizing patient outcomes.

Introduction

Trauma remains the most common cause of mortality in the 1–45 years old age groups. The most frequent causes of death are hemorrhagic shock and traumatic brain injury (TBI).[1] As prehospital, emergency department, and operative management have improved, more critically injured patients are surviving to admission to the ICU, presenting numerous, sometimes competing, challenges for management. This review focuses on the initial assessment and management of the critically ill trauma patient. Other issues that are germane for subsequent management of these patients, such as nutrition,[2] stress ulcer prophylaxis,[3,4] and venous thromboembolism prophylaxis,[5,6] have been reviewed elsewhere.

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