Current Opinion in Anaesthesiology:
TRAUMA AND TRANSFUSION: Edited by Richard P. Dutton
Dutton, Richard P.a,b,c
aAnesthesia Quality Institute
bAmerican Society of Anesthesiologists
cDepartment of Anesthesia and Critical Care, University of Chicago, Chicago, Illinois, USA
Correspondence to Richard P. Dutton, MD, MBA, 520 N. Northwest Highway, Park Ridge, IL 60068, USA. Tel: +1 847 268 9226; e-mail: firstname.lastname@example.org
Although fluid management and resuscitation have always been at the heart of trauma care, in recent years there has been an explosion of new research and new practice in these areas as well. This volume of Current Opinion in Anesthesiology features some of the most active and prolific scientists in the international trauma community, addressing some of the hottest topics in current clinical thinking.
The volume begins with a chapter by Dr Jacob Stensballe (pp. 212–218), an anesthesiologist and Blood Banker from the Rikshospital in Copenhagen. With his mentor, Dr Per Johannsen, Dr Stensballe has pursued a unique combination of careers, one that gives him an important perspective on the use of blood products in trauma and surgical resuscitation. Dr Stensballe's laboratory studies of coagulation have helped to define the previously unknown interface between the endothelial glycocalyx and the humoral components of the clotting cascade. His translation of this work into clinical guidelines for the assessment and treatment of bleeding patients is changing practice around the world. In this chapter, he reviews all of the recent publications in this area and provides an informed summary of the current state of the art.
This is followed by a review (pp. 219–224) of the ‘three compartment’ model of traumatic brain injury (TBI) written by another international expert. Dr Deborah Stein is the long-time Chief of Neurocritical Care at the R Adams Cowley Shock Trauma Center of the University of Maryland, the busiest trauma center in the USA. In this capacity, Dr Stein has developed a new description of the pathophysiology of severe TBI that has led to significant changes in how patients with this potentially lethal condition are managed. With co-author Dr Margaret Lauerman, Dr Stein reviews the recent publications in this field and offers guidance on the clinical management for one of the most difficult populations in the trauma center.
Following is a return to the theory and practice of transfusion (pp. 225–232), written by Dr Donat Spahn and Dr Oliver Theusinger of the University of Zurich. These learned gentlemen are the foremost international leaders in the use of viscoelastic testing to guide the early resuscitation of patients with massive hemorrhage. Their factor-specific, precisely targeted, algorithm for resuscitation has created a new paradigm in the field and generated significant controversy in comparison with the next-most-recent proposal: early and aggressive use of plasma and red blood cells in a 1 : 1 ratio. That these two competing approaches should both appear in the literature in the last decade indicates the dynamic nature of this area of medical science and reflects a robust commitment of scientific resources to improving patient outcomes.
Continuing the international theme of this volume, the following chapter addresses a different area of active progress in trauma care: the great disparity in clinical resources (and outcomes) between the developed and the developing world. Dr Armagan Dagal, Dr Sarah Greer, and Dr Maureen McCunn have combined to review (pp. 233–239) the state of trauma system development around the world. They highlight the growing importance of trauma as a cause of death in the developing world – closely linked to the penetration of automotive technology – and describe the recent efforts by the World Health Organization to address this as a public health issue. They elaborate on the importance of performance measurement in this effort, with the need to understand trauma morbidity and mortality in underserved areas as a first step in the process of improvement. They note the development and promotion of the perioperative mortality rate as a key indicator of national public health that will lead to a better understanding of trauma and surgical care around the world.
Reflecting the growing interest in trauma care as a subspecialty of anesthesiology, Dr Joshua Tobin (pp. 240–245) has contributed an item describing the development of a curriculum for training residents and fellows. This piece summarizes the key cognitive processes and knowledge base that trainees should absorb, reflecting the consensus of the newly formed Trauma Anesthesia Society and the ongoing work of the American Society of Anesthesiologists Committee on Trauma and Emergency Preparedness. Although focused by the structure and requirements of the American College of Graduate Medical Education, the elements of this curriculum will be useful for anesthesia educators around the world.
The final chapter of this volume is a review of recent science in one of the most exciting areas of trauma and surgical care: the postinjury inflammatory response. Affecting everything from coagulation and bleeding to wound healing and long-term functional outcomes, the body's reaction to injury remains one of the most important and least well understood topics in human physiology. Dr Jean Francois Petit, himself a leading researcher in this field, has joined with Dr Albert Pierce to assemble the recent publications on injury and inflammation and synthesize their meaning. In a few short pages (pp. 246–252), they present one of the best and most current descriptions of the pathophysiology of injury and inflammation that I have read. Although incredibly complex, the details of interactions between endothelial cells, the bloodstream, and the organization as a whole are slowly unraveling to the scientific eye. It is not hard to imagine that this will be one of the most active and most productive areas of trauma science in the coming decade.
This has been a fascinating volume to pull together. In addition to exploring the boundaries of science in trauma and transfusion – ever dynamic and ever expanding – I have had the pleasure of interacting with some of the best clinicians and scientists on the planet. I am certain that you will learn as much from them as I have.
Conflicts of interest
There are no conflicts of interest.