Invasive Intervention in Polytrauma Patients in Intensive Care Unit. Basic Data and Monitoring

Abstract

Polytrauma is considered one of the most important causes of morbidity and mortality all over the world. Many of polytrauma patients have to be admitted to the intensive care unit, the managemenet of these patients requires the intensice care back-up facilities. Advanced Trauma Life Support (ATLS) is designed to improve the way of treatment of such patients achieved by “Trauma Team” which made up of group of doctors, nurses, operation department assistants and radioghraps. The aim of the trauma team is to provide a safe and efficient evaluation of the patient identify all injuries and instigate definitive management of such injuries. Scoring systems in trauma patients can improve outcome of the traumatized patients. It’s classified to physiological, anatomical and combined (physiological and anatomical scores). Early management of polytrauma patients is divided to primary and secondary survey. A- Primary Survey this can be summarized as first five letters of English alphabets (ABCDE) • Airway with cervical spine control. • Breathing. • Circulation. • Disability. • Exposure and environmental control. B- Secondary Survey • Is a head to toe examination for presence of other non-life threatening injuries. The main guidelines for management of polytrauma patients include: • Airway and ventilation management. • Evaluation and treatment of the circulatory state. • Initial neurologic evaluation of the trauma patient. • Missed injuries and tertiary survey. • Other considerations during the first day. Advanced Trauma Life Support (ATLS) and Sequential Trauma Educational Programs (STEPs) have a great role to improve polytrauma patients management. (ATLS) is now widely accepted as the standard of care for initial assessment and treatment in trauma centers. The premise of the (ATLS) program is to treat the greatest threat to life first. It also advocates that application of indicated treatment for life threatening injury, with the most time-critical interventions performed early. In critical care, the monitoring is essential to the daily care of ICU patients, as the optimization of patient’s hemodynamic, ventilation, temperature, nutrition, and metabolism is the key to improve patients' survival. Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. The emerging concept has been the enhancement of macrocirculation through sequential optimization of heart function and then judging the adequacy of perfusion/oxygenation on specific parameters in a strategy which was aptly coined “goal directed therapy.” On the other hand, the maintenance of normal temperature is critical and should be regularly monitored. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation. Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery.