title: Critical care issues in solid organ injury: Review and experience in a tertiary trauma center.
abstract: OBJECTIVE
  Solid organ (spleen and liver) injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature.
  
  
  METHODS
  Retrospective cohort of solid organ injury (spleen and liver) patients was done from January 2010 to December 2011 in tertiary level trauma Center.
  
  
  RESULTS
  Out of 624 abdominal trauma patients, a total of 212 patients (70%) were admitted in intensive care unit (ICU). Their ages ranged from 6 to 74 years (median 24 years). Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents.
  
  
  CONCLUSIONS
  A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury.
authors.affiliation: Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Chhavi
authors.initials: C
authors.lastname: Sawhney
authors.affiliation: Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manpreet
authors.initials: M
authors.lastname: Kaur
authors.affiliation: Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Babita
authors.initials: B
authors.lastname: Gupta
authors.affiliation: Department of Anesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: P M
authors.initials: PM
authors.lastname: Singh
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Subodh
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Surgery, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M C
authors.initials: MC
authors.lastname: Misra
keywords: Critical care; deadly triad; hepatic injury; liver trauma; solid organ injury; splenic trauma