J Trauma
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Clinical Trial Controlled Clinical Trial
Permissive hypercapnia in trauma patients.
The use of a normal tidal volume in patients with progressive loss of alveolar airspace may increase inspiratory pressure and overdistend remaining functional alveoli. Permissive hypercapnia (PH) is a ventilator management technique that emphasizes control of alveolar pressure, rather than PCO2. The purpose of this study was to determine if the use of PH is associated with an improved outcome from adult respiratory distress syndrome (ARDS). ⋯ The duration of mechanical ventilation was greater in PH patients [49.2 +/- 15.2 vs. 20.8 +/- 10 days (p < 0.01)]. Survival was also greater in the PH group [91% vs. 48% (p < 0.01)]. A reduction in intensity of mechanical ventilation is associated with a prolongation of ventilatory support and an improved outcome from ARDS.
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Traditional practice of mechanical ventilation includes tactics to reduce lung injury, such as avoidance of excessive airway pressure, patient distress, and tidal volume. Gas exchange objectives have received priority, however, and a degree of lung injury has been accepted as inevitable. The current trend toward increasing use of permissive hypercapnia is based on the recognition that lung injury induced by mechanical ventilation may be reduced by compensated hypercapnia with few serious adverse effects and contraindications.
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The aim of this study was to assess Advanced Trauma Life Support (ATLS) training status of general surgeons, its perceived utility, and its relation to clinical trauma practice. ⋯ The ATLS course represents a standard of initial trauma care education in which only one-third of surgeons report current participation. Many view ATLS as not relevant or useful, yet take trauma call. To ensure standard education and patient care, an ATLS course curriculum specifically geared to the general surgeon should be developed and made a mandatory component of residency training or a requirement for board certification and trauma call credentialing.
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To document the incidence of barotrauma, pneumonia, and respiratory death associated with a mechanical ventilation protocol based on permissive hypercapnia in pediatric burn patients. ⋯ A conventional ventilation protocol based on permissive hypercapnia is associated with acceptable rates of barotrauma and pneumonia. The low incidence of respiratory death associated with this strategy suggests that it also minimizes ventilator-induced lung injury.
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To determine the efficacy and safety of a two-tier trauma response, using prehospital criteria for matching trauma center assets with severity of injury. ⋯ Utilization of a two-tier response to trauma patients is effective, safe, and results in substantial cost savings.