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Mechanical ventilation in trauma

Papadakos, Peter Ja; Karcz, Marcinb; Lachmann, Burkhardc

Current Opinion in Anesthesiology: April 2010 - Volume 23 - Issue 2 - p 228–232
doi: 10.1097/ACO.0b013e328336ea6e
Trauma and transfusion: Edited by Peter Papadakos

Purpose of review The purpose of this review is to evaluate new concepts in mechanical ventilation in trauma. We begin with the keystone of physiology prior to embarking on a discussion of several new modes of mechanical ventilation. We will discuss the use of noninvasive ventilation as a mode to prevent intubation and then go on to airway pressure release ventilation, high-frequency oscillatory ventilation, and computer-based, closed loop ventilation.

Recent findings The importance of preventing further injury in mechanical ventilation lies at the heart of the introduction of several new strategies of mechanical ventilation. New modes of ventilation have been developed to provide lung recruitment and alveolar stabilization at the lowest possible pressure.

Summary The old modes of continuous positive airway pressure and bilevel positive airway pressure have been actively introduced in clinical practice in the case of trauma patients. Used with proper pain management protocols, there has been a decrease in the incidence of intubation in blunt thoracic trauma. Airway pressure release ventilation has been gaining a role in the management of thoracic injury and may lead to less incidence of physiologic trauma to mechanically ventilated patients. High-frequency oscillatory ventilation has been shown to be effective in patient care by its ability to open and recruit the lung in trauma patients and in those with acute respiratory distress syndrome but it may not have a role in patients with inhalational injury. Closed loop ventilation is a technology that may better control major pulmonary parameters and lead to more rapid titration from the ventilator to spontaneous breathing.

aDepartment of Anesthesiology, Surgery and Neurosurgery, USA

bDepartment of Anesthesiology, University of Rochester, Rochester, New York, USA

cDepartment of Anesthesiology and Operative Intensive Care, Charite Universitats Median Berlin, Campus Verchow Klinikum Humbolt University, Berlin, Germany

Correspondence to Peter J. Papadakos, MD, FCCM, Director, Critical Care Medicine, Department of Anesthesiology, Surgery and Neurosurgery, University of Rochester, Rochester, NY 14642, USA E-mail: Peter_Papadakos@URMC.Rochester.edu

© 2010 Lippincott Williams & Wilkins, Inc.