Critical care challenges after severe trauma surgery

PURPOSE OF REVIEW: To examine the key elements of the management of patients with severe trauma in intensive care units (ICUs), including fluids, vasopressors, transfusion and coagulation, respiratory function management, and rhabdomyolysis. RECENT FINDINGS: The management of patients with severe trauma requires perfect coordination between prehospital care, hospital care in the trauma bay, and ICU care. ICU management must ensure that bleeding and coagulopathy are controlled and that organ dysfunction are treated. Severe trauma Patients admitted to ICU at high risk of requiring surgery or angiography-embolization, and ultrasound is essential for assessing the progression of traumatic injuries. Fluid and vasopressor management must be individualized based on hemodynamic monitoring. Maintaining an Hb level ≥9 g/dl may be neuroprotective. While norepinephrine remains the vasopressor of choice, vasopressin may have nephroprotective effects and enhance coagulation. Severe rhabdomyolysis associated with hemorrhagic shock is associated with increased mortality. Compartment syndrome is one of the most frequent complications particularly in patients with severe trauma with long bone fractures and abdominal-pelvic trauma. Regional anesthesia is essential to provide targeted analgesia. SUMMARY: This review presents several key elements of postinterventional care for severe trauma patients admitted to the ICU. Improving the management of these patients requires trauma centers and high-quality research.