[Ventilation according to the "open lung" concept of multiple trauma patients].
OBJECTIVE
The ventilation mode clearly influences the course of patients with multiple trauma on the ICU. Ventilation according the "open lung" approach rapidly opens up atelectatic lung regions. Generation of an adequate intrinsic PEEP enables to keep the lung open. We studied the consequences of the "open lung" approach on the lung function and monitored its side effects on patients with multiple trauma.


METHODS
18 consecutive patients with multiple trauma and additional thoracic trauma were routinely ventilated according the "open lung" approach between May and November 1999. We were mainly interested in data of lung mechanics, oxygenation and ventilation. Side effects on other organ systems and consequence for the infection rate were monitored.


RESULTS
Ventilation according the "open lung" approach enables early sufficient oxygenation and ventilation of patients with severe multiple trauma and accompanying thoracic trauma. The ventilation mode helps to prevent baro-, volu- and atelectrauma and thus fulfils the requirements for a present-day ventilation mode. An immediate complete healing of the lung damages was not found. Nevertheless, as a trend the length of ventilation support seems short. Even extensive osteosynthesis at multiple fractures was possible without delay. Side effects of the high opening pressure on the lung or other organs as well as sequels of the high intrinsic PEEP on liver, kidney or intestine were not found. The infection rate was low, therapeutic doses of antibiotics were necessary only in less than half of the ICU-stay.


CONCLUSIONS
Ventilation according the "open lung" approach is a very effective and safe way to ventilate patients after severe multiple trauma with accompanying thoracic trauma.
Knothe
C
C
Institut für Anästhesiologie und operative Intensivmedizin, Klinikum Rosenheim.
Huber
T
T
Hiltl
P
P
Regel
G
G
Bayeff-Filloff
M
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007239:Infections / Q000150:complications / Q000453:epidemiology; D008168:Lung / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000503:physiopathology* / Q000628:therapy*; D011175:Positive-Pressure Respiration; D012121:Respiration, Artificial / Q000009:adverse effects / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology; D013898:Thoracic Injuries / Q000503:physiopathology / Q000628:therapy
Beatmung nach dem "open-lung"-Konzept bei polytraumatisierten Patienten.