Trauma - ICU phase

Resuscitative phase

• Restoration of body temperature
• Optimisation of oxygen delivery
• Correction of clotting profiles
• Improvement of physiological endpoints
• Monitoring for, and minimising, IAH and ACS
• Recognition of additional injuries

Early life support (24-72 hours)

• Management of post-traumatic respiratory failure
• Search for occult injuries
• Nutritional support
• Establish medical history, mechanism of injury
• Intra-cranial hypertension
• SIRS
• MODS
• Prophylaxis
  • PPI
  • Enoxaparin
  • Consider IVC filter

>72 hours (prolonged life support)

• Indicates more serious injury, if present
• Provide organ support
• Isolate and eliminate inflammatory foci
• Avoid infectious complications

Metabolic response to trauma

• Ebb - during severe illness
  • Pro-inflammatory response can predominate - SIRS, shock
    • TNF, IL-1, IL-8 triggered by actual tissue damage; DAMPs (damage associated molecular patterns) released from damaged cells (c.f. PAMPs with infection)
    • Pro-coagulant
    • Activate neutrophils, etc
    • Generation of free radicals
  • Cortisol, vasopressin, aldosterone and glucagon up
  • Water and salt retention
• Flow - during recovery
  • Pro-inflammatory pathway should subside, replaced by a hyperdynamic/hypermetabolic state
  • Higher insulin, but also higher glucose
  • Higher catecholamines
  • Increased cardiac output
  • Higher temperature