Advances in the management of the critically injured patient in the operating room

Authors: Rock KC, Bakowitz M, McCunn M.

Care of trauma patients continues to improve through better understanding of optimal timing of operating room (OR) interventions, improved monitoring for patients with head injury and hemodynamic compromise, optimization of volume status, and use of appropriate vasoactive agents. Investigation of the pathophysiology of trauma patients as they progress to the chronic phase continues to advance interventions in the ICU and the OR. This article is an evidence-based update of anesthetic considerations for these patients, including management of intracranial pressure, cardiac monitoring, management of the damage control abdomen, fluid and hemodynamic management, and control of coagulopathies.

Variability of ICU Use in Adult Patients With Minor Traumatic Intracranial Hemorrhage

Authors: Nishijima DK, Haukoos JS, Newgard CD, Staudenmayer K, White N, Slattery D, Maxim PC, Gee CA, Hsia RY, Melnikow JA, Holmes JF.

STUDY OBJECTIVE: Patients with minor traumatic intracranial hemorrhage are frequently admitted to the ICU, although many never require critical care interventions. To describe ICU resource use in minor traumatic intracranial hemorrhage, we assess (1) the variability of ICU use in a cohort of patients with minor traumatic intracranial hemorrhage across multiple trauma centers, and (2) the proportion of adult patients with traumatic intracranial hemorrhage who are admitted to the ICU and never receive a critical care intervention during hospitalization. In addition, we evaluate the association between ICU admission and key independent variables.

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