Institutional members access full text with Ovid®

Airway management and initial resuscitation of the trauma patient

Diez, Christian; Varon, Albert J

Current Opinion in Critical Care: December 2009 - Volume 15 - Issue 6 - p 542–547
doi: 10.1097/MCC.0b013e328331a8a7
Trauma: Edited by Richard Dutton

Purpose of review: This review will analyze and comment on selected recent literature pertaining to airway management and initial fluid resuscitation in the trauma patient. It will also review airway devices currently being used in the trauma setting.

Recent findings: Although a recent study has questioned the efficacy of manual inline immobilization, this technique continues to be endorsed by trauma guidelines and is safely used in most trauma centers. Clinicians have also incorporated the use of videolaryngoscopy and other adjuncts for difficult airway management in trauma patients. However, no single airway management tool has proven to be superior in this setting. Crystalloid solutions remain frontline therapy for the initial resuscitation of the hemorrhagic trauma patient, as studies with hypertonic saline and vasopressors have not shown superior results. Conversely, increased amounts of fresh frozen plasma and fibrinogen have been reported to increase survival in trauma patients.

Summary: As trauma continues to be a major cause of morbidity and mortality worldwide, the use of newer airway adjuncts needs to be specifically investigated in trauma patients, as this population frequently has airway management difficulties. Further research is also required to elucidate the type and amount of fluid that will provide an adequate organ perfusion without increasing nonsurgical bleeding.

Department of Anesthesiology, Division of Trauma Anesthesiology, University of Miami Miller School of Medicine, Ryder Trauma Center, Miami, Florida, USA

Correspondence to Christian Diez, MD, Assistant Professor of Clinical Anesthesiology, Department of Anesthesiology, Division of Trauma Anesthesiology, University of Miami Miller School of Medicine, Ryder Trauma Center (T-239A), 1800 NW 10th Avenue, Miami, FL 33136, USA Tel: +1 305 585 1191; fax: +1 305 545 6195; e-mail: cdiez@med.miami.edu

© 2009 Lippincott Williams & Wilkins, Inc.