Advanced Technologies in Trauma Critical Care Management
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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Postoperative surgical and trauma patients in the mid-1900s benefitted from the nexus of several concepts that led to the establishment of intensive care units ICUs in major medical centers across the country -Cohorting critically ill patients in a specialized unit -Use of mechanical ventilation to support patients with respiratory failure -Use of both non-invasive and invasive hemodynamic monitors -Frequent measurement of blood gas values and other laboratory parameters. The history of these advances and their application in modern critical care has been thoroughly reviewed by multiple expert authors.1 5 What sets the trauma ICU apart from other critical care environments is the frequent need for ongoing massive resuscitation and the periodic use of the ICU as an extension of the operating room for invasive procedures. In the trauma ICU, particular emphasis is placed on frequent reassessment of patients with severe injuries, on continuing the damage control therapy initiated in the emergency department or the operating room, and on providing an environment for the application of standardized treatment protocols for managing a range of clinical problems from traumatic brain injury to thromboprophylaxis in the acutely injured patient.7,8 This care environment is characterized by a high degree of specialization and the use of advanced technologies however, recent studies have also highlighted the importance of simple practices such as hand hygiene and a daily rounds checklist for improving outcomes.9,10 Furthermore, the benefits of ICU-based therapies are widely recognized as beneficial in both the developed and developing world, which should push researchers to continue to explore novel therapies that are both cost-conscious and scalable.11 The following paragraphs describe a range of technologies that have transformed the care of trauma patients in the ICU in recent years.
- Medicine and Medical Research