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30 - ITACCS Management of Mechanical Ventilation in Critically Injured Patients

Published online by Cambridge University Press:  18 January 2010

By
Maureen McCunn ,
Anne J. Sutcliffe ,
Walter Mauritz  and
Edited by
Charles E. Smith
Maureen McCunn
Affiliation:
Department of Anesthesia and Critical Care, Division of Trauma Anesthesiology, University of Maryland Medical Center, Baltimore, Maryland
Anne J. Sutcliffe
Affiliation:
Department of Anesthesia and Critical Care, Alexandra Hospital, Worcestershire, United Kingdom
Walter Mauritz
Affiliation:
Department of Anesthesiology and Intensive Care, Trauma Hospital Lorenz Bohler, Vienna, Austria The International Trauma Anesthesia and Critical Care Society (ITACCS) Critical Care Committee
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
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Summary

Objectives

  1. Review the use of mechanical ventilation in trauma.

  2. Evaluate the role of mechanical ventilation in potentiating alveolar recruitment, optimizing intrapulmonary gas distribution, and narrowing time constant discrepancies.

  3. Discuss ventilatory management strategies for minimizing atelectasis and parenchymal lung damage in critically injured patients.

PREMISE

Patients suffering severe trauma are at high risk for developing respiratory failure: both acute lung injury (ALI) and the acute respiratory distress syndrome (ARDS) (Appendix 1). Management strategies for these patients should begin upon arrival at the trauma center/emergency department by initially identifying who is most likely to develop severe respiratory insufficiency. The goal is to institute therapies early (i.e., “open lung” or “protective” lung ventilation) in the emergency room, the operating room, and the intensive care unit in an effort to lessen the degree or to prevent the formation of atelectasis and/or parenchymal damage to the lung.

STATEMENT OF THE ISSUE

One of the most basic and paradoxically advanced clinical skills in the practice of anesthesiology and critical care medicine is the management of mechanical ventilation.

Ideally, mechanical ventilation should potentiate alveolar recruitment, optimizing intrapulmonary gas distribution and narrowing time constant discrepancies. Ideal ventilator management should distribute pressure and volume to dependent and nondependent regions proportionally.

Recommendations for ventilator management, culled from several randomized, prospective trials, are suggested in Table 30.1. These recommendations refer to ALL locations where patients may be located following injury: the emergency department, operating room (OR), and intensive care units (ICUs).

Type
Chapter
Information
Trauma Anesthesia , pp. 465 - 470
Publisher: Cambridge University Press
Print publication year: 2008

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References

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  • ITACCS Management of Mechanical Ventilation in Critically Injured Patients
    • By Maureen McCunn, Department of Anesthesia and Critical Care, Division of Trauma Anesthesiology, University of Maryland Medical Center, Baltimore, Maryland, Anne J. Sutcliffe, Department of Anesthesia and Critical Care, Alexandra Hospital, Worcestershire, United Kingdom, Walter Mauritz, Department of Anesthesiology and Intensive Care, Trauma Hospital Lorenz Bohler, Vienna, Austria The International Trauma Anesthesia and Critical Care Society (ITACCS) Critical Care Committee
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.033
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  • ITACCS Management of Mechanical Ventilation in Critically Injured Patients
    • By Maureen McCunn, Department of Anesthesia and Critical Care, Division of Trauma Anesthesiology, University of Maryland Medical Center, Baltimore, Maryland, Anne J. Sutcliffe, Department of Anesthesia and Critical Care, Alexandra Hospital, Worcestershire, United Kingdom, Walter Mauritz, Department of Anesthesiology and Intensive Care, Trauma Hospital Lorenz Bohler, Vienna, Austria The International Trauma Anesthesia and Critical Care Society (ITACCS) Critical Care Committee
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.033
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • ITACCS Management of Mechanical Ventilation in Critically Injured Patients
    • By Maureen McCunn, Department of Anesthesia and Critical Care, Division of Trauma Anesthesiology, University of Maryland Medical Center, Baltimore, Maryland, Anne J. Sutcliffe, Department of Anesthesia and Critical Care, Alexandra Hospital, Worcestershire, United Kingdom, Walter Mauritz, Department of Anesthesiology and Intensive Care, Trauma Hospital Lorenz Bohler, Vienna, Austria The International Trauma Anesthesia and Critical Care Society (ITACCS) Critical Care Committee
  • Edited by Charles E. Smith, Case Western Reserve University, Ohio
  • Book: Trauma Anesthesia
  • Online publication: 18 January 2010
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547447.033
Available formats
×