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KEY POINTS

KEY POINTS

  • The primary goal of critical care in the trauma patient is restoration of hemodynamic stability and organ function via continuation of early trauma care, hemostatic resuscitation, organ support, and specific injury management.

  • The ultimate goal of optimal intensive care unit (ICU) care is to achieve zero preventable deaths after injury.

  • High-intensity ICU physician staffing is associated with significantly reduced ICU and hospital mortality and significantly lower failure to rescue rates.

  • Although Advanced Trauma Life Support has standardized trauma care in the initial hour after injury, there is little standardization subsequently in the ICU.

  • ICU admission order sets should be used to optimize early ICU care on admission.

  • Damage control resuscitation and massive transfusion protocols decrease mortality from hemorrhagic shock, which is the most common cause of early mortality in trauma.

  • National evidence-based guidelines should be used to guide postinjury ICU care.

  • Daily goals checklist and the ABCDEF Bundle enhance ICU patient safety and progress.

  • All preventive strategies should be implemented to prevent hospital-acquired infections.

  • Traumatic brain injury management is based on the Brain Trauma Foundation guidelines.

  • Septic shock has a mortality rate of 40%; the Surviving Sepsis Campaign (SSC) guidelines and 2018 SSC bundle provide recommendations to improve outcomes.

  • Acute respiratory distress syndrome (ARDS) has a high mortality rate, and use of national ARDS guidelines reduces mortality.

INTRODUCTION

We have had great advances in the care of the injured patient from prehospital and emergency department care to care in the intensive care unit (ICU). Care in the ICU is designed to provide optimal resuscitation, reestablish homeostasis, and minimize secondary and iatrogenic complications (particularly organ failure). Over the past 20 years, critical care has matured greatly, resulting in dramatically higher survival rates for our critically injured patients. Excluding early deaths in the operating room, most trauma hospital deaths will occur in the ICU. In the ICU, the outcome of critically injured patients is dependent on a solid understanding of the pathophysiology and evolution of traumatic injuries, optimal postinjury resuscitation, and prevention of complications. Meticulous attention to detail in all ICU care provided to trauma patients is essential if we are to achieve the ultimate goal of zero preventable trauma mortality.

MORTALITY IN TRAUMA

Despite an organized system of trauma care in the United States, the number of trauma deaths increased by 22.8% from 2002 to 2010 for those age 25 years and older, with a concurrent increase in the US population of 9.7%. The largest increase in trauma deaths was in the 50- to 60-year-old cohort.1 The two most common causes of early trauma mortality are hemorrhagic shock and traumatic brain injury, both of which require extensive ICU care. The 2016 National Academies of Sciences, Engineering, and Medicine report, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury,”2 presents a vision for a national ...

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