AB092. SOH23ABS_229. Polytrauma in the intensive care unit
Anaesthesia Session

AB092. SOH23ABS_229. Polytrauma in the intensive care unit

Areebah Hassan1, Michael Gilmartin1, Mekki Medani2, Ian Martin3, Catherine Nix1, Nick Barrett1

1Department of Anaesthesia and Intensive Care, University Hospital Limerick, Limerick, Ireland; 2Department of Vascular Surgery, University Hospital Limerick, Limerick, Ireland; 3Department of Anaesthesia and Intensive Care, The Mater Hospital, Dublin, Ireland


Background: Recently, the Irish Minister for Health designated the Mater Hospital in Dublin and Cork University Hospital as the two major centres for the provision of trauma care in the state. These trauma centres will provide all major relevant specialist services, leading to better outcomes for severely injured patients.

Methods: A 28-year-old man was brought into the emergency department after a road traffic accident; his primary computed tomography (CT) scan showed a small parenchymal haemorrhage in the right frontal cortex, cervical spine fractures, a left humerus fracture, multiple left sided rib fractures resulting in a flail chest and a pneumothorax, extensive pelvic fractures, splenic and renal lacerations, and a thoracic aortic laceration with pseudo-aneurysm. He underwent an emergency endovascular stent placement of the aorta and an exploration of the humoral fracture. As our centre did not have the expertise to provide operative management of the pelvic, cervical, and thoracic fractures, the decision was made to keep the patient intubated and immobilized until his chest injuries had improved. A magnetic resonance imaging (MRI) spine was organized in an effort to remove spinal precautions and facilitate gradual mobilization. On two occasions, the patient derecruited when he was transferred to the MRI safe machine. The patient developed bilateral pneumonia and associated severe acute respiratory distress syndrome (ARDS). Despite bronchioalveolar lavage, the patient required two level 2 lung recruitment strategies [nitric and airway pressure release ventilation with time control adaptive ventilation (APRV-TCAV)] to stabilize his lung. He was accepted to the Mater Hospital for extracorporeal membrane oxygenation (ECMO). Ultimately, he did not need ECMO but 24 hours of APRV-TCAV improved his oxygenation significantly. While in the major trauma centre, he was reviewed by three specialist services, expediting his recovery and treatment.

Results: While in a major trauma centre, he was reviewed by 3 specialist services, expediting his recovery and treatment. The temporary use of APRV-TCAV enabled the immediate resuscitation and mechanical ventilation of the patient. It ensured that he was ventilated and oxygenated adequately, permitted time to stabilise and transfer the patient to a centre where the patient received multiple disciplinary team review, resulting in successful extubation and recovery.

Conclusions: Major Irish trauma centres will provide all major relevant specialist services for severely injured polytrauma patients in the future. This will likely lead to better outcomes. In the meantime, APRV-TCAV can be a useful treatment or bridging modality when proning is a contraindication in a patient with severe respiratory failure.

Keywords: Acute respiratory distress syndrome (ARDS); derecruitment; intensive care unit; polytrauma; ventilation


Acknowledgments

Funding: None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.


doi: 10.21037/map-23-ab092
Cite this abstract as: Hassan A, Gilmartin M, Medani M, Martin I, Nix C, Barrett N. AB092. SOH23ABS_229. Polytrauma in the intensive care unit. Mesentery Peritoneum 2023;7:AB092.

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