Early intensive care unit intervention for trauma care: what alters the outcome?
This review focuses on early management of multiple trauma patients with traumatic brain injury. Early usage of multislice computed tomography can substantially shorten the time spent on diagnostic workup in the emergency room and, therefore, speeds the initiation of lifesaving interventions for the control of hemorrhage. The important role of hemostatic angiographic embolization and its timing, in addition to surgical control of bleeding in patients suffering from pelvic fracture or organ lesions, is emphasized. The ongoing controversy regarding the strategy of fluid resuscitation is discussed. The concept of permissive hypotension seems to be promising but is absolutely contraindicated in patients with traumatic brain injury. Coagulation management should be guided by coagulation monitoring, including thromboelastography. A novel approach to reduce major bleeding is the application of recombinant factor VIIa. Strong effort should be directed toward the management of traumatic brain injury and the maintenance of cerebral perfusion pressure. The optimization of treatment of patients with multiple trauma, including brain injury, is a multidisciplinary task.
Sumann
Günther
G
Department of Anesthesiology and Critical Care Medicine, Leopold Franzens University, Innsbruck, Austria. guenther.sumann@uibk.ac.at
Kampfl
Andreas
A
Wenzel
Volker
V
Schobersberger
Wolfgang
W
D000465:Algorithms; D001930:Brain Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D009104:Multiple Trauma / Q000175:diagnosis / Q000628:therapy*