The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxid...The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.展开更多
Nowadays,fluid resuscitation of multiple trauma patients is still a challenging therapy.Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the pa...Nowadays,fluid resuscitation of multiple trauma patients is still a challenging therapy.Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient.Patients presenting with multiple trauma often develop hemorrhagic shock,which triggers a series of metabolic,physiological and cellular dysfunction.These disorders combined,lead to complications that significantly decrease survival rate in this subset of patients.Volume and electrolyte resuscitation is chal enging due to many factors that overlap.Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death.In literature,there is no exact formula for this purpose,and opinions are divided.This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock.According to the literature and from clinical experience,al aspects regarding post-resuscitation period need to be considered.Also,for every case in particular,emergency therapy management needs to be rigorously respected considering al physiological,biochemical and biological parameters.展开更多
文摘The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.
基金The authors have deeply grateful to Emergency County Hospital"Pius Brinzeu"for full support of this article
文摘Nowadays,fluid resuscitation of multiple trauma patients is still a challenging therapy.Existing therapies for volume replacement in severe haemorrhagic shock can lead to adverse reactions that may be fatal for the patient.Patients presenting with multiple trauma often develop hemorrhagic shock,which triggers a series of metabolic,physiological and cellular dysfunction.These disorders combined,lead to complications that significantly decrease survival rate in this subset of patients.Volume and electrolyte resuscitation is chal enging due to many factors that overlap.Poor management can lead to post-resuscitation systemic inflammation causing multiple organ failure and ultimately death.In literature,there is no exact formula for this purpose,and opinions are divided.This paper presents a review of modern techniques and current studies regarding the management of fluid resuscitation in trauma patients with hemorrhagic shock.According to the literature and from clinical experience,al aspects regarding post-resuscitation period need to be considered.Also,for every case in particular,emergency therapy management needs to be rigorously respected considering al physiological,biochemical and biological parameters.
