Review the use of mechanical ventilation in trauma.
Evaluate the role of mechanical ventilation in potentiating alveolar recruitment, optimizing intrapulmonary gas distribution, and narrowing time constant discrepancies.
Discuss ventilatory management strategies for minimizing atelectasis and parenchymal lung damage in critically injured patients.
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).