title: Ventilation in Trauma Patients: The First 24 h is Different!
abstract: Ventilation of major trauma patients is often needed in both the acute (emergency department and early ICU phase) and subsequent phases of trauma care for those who need ICU admission. What is unclear is whether ICU ventilation strategies should be directly extrapolated to the acute phase of treatment.
  
  
  
  This paper reviews the ARDS.net study, highlights recent developments in ventilation strategies, and provides practical ventilation guidance to the trauma surgeon for acute phase (in the ED or ICU) and the subsequent phase of ICU care.
  
  
  
  The acute phase of care in the ED and the ICU is different from the subsequent phases of ICU care as the lung is more recruitable and there are other aspects of resuscitation from metabolic acidosis and traumatic brain injury, which require a different ventilation strategy to the traditional ARDS.net approach.
  
  
  
  The acute phase is different from the subsequent phase of care and there appears to be some inappropriate extrapolation of ICU practice to the acute phase. Application of the proposed ventilation strategies should ensure an optimal outcome. It is important to treat patients as individuals during assessment and treatment.
authors.affiliation: Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4091, South Africa. Hardcastle@ukzn.ac.za.|Department of Surgery, University of KwaZulu-Natal, Durban, South Africa. Hardcastle@ukzn.ac.za.
authors.forename: Timothy Craig
authors.initials: TC
authors.lastname: Hardcastle
authors.affiliation: Trauma Service, Inkosi Albert Luthuli Central Hospital, 800 Vusi Mzimela Rd, Mayville, Durban, 4091, South Africa.|Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
authors.forename: David J J
authors.initials: DJJ
authors.lastname: Muckart
authors.affiliation: Department of Surgery, Harborview Medical Center, University of Washington, Surgery Clinic, 410 9th Ave, 7th Floor, Seattle, WA, 98104, USA.
authors.forename: Ronald V
authors.initials: RV
authors.lastname: Maier
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000503:physiopathology / Q000628:therapy; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008168:Lung / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000503:physiopathology* / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D013997:Time Factors