I. Guidelines for Mechanical Ventilation of the Trauma Patient

摘要

Approximately 25% of major trauma patients require prolonged (>=4 days) ventilatory support after injury (National Trauma Databank, 2003). Endotracheal intubation and mechanical ventilation provide vital support yet are associated with disadvantages, including a greater risk of pneumonia and aggravation of alveolar injury, respectively. There is increasing evidence that the manner by which trauma patients are ventilated and weaned might have significant effects on outcome. For example, strategies like daily spontaneous breathing trials have been shown to expedite the process of weaning and reduce the time to extubation. Additionally, in patients with acute lung injury (ALI;1),there is increasing evidence that alveolar stretch induced by large inspired tidal volumes plays a significant role in the development of ventilatory-induced lung injury through the incitement of an exaggerated alveolar inflammatory response.2 Further, this cycle of injury and inflammation is not limited to the alveolus because increased circulating levels of inflammatory mediators are seen in patients ventilated at larger tidal volumes, suggesting that selection of a particular ventilatory strategy has systemic effects.