Extracorporeal lung assist in the adult trauma patient

Polytrauma management - a single centre experience

The management of polytraumatised patients remains challenging in spite of advances and improvements in trauma care in recent decades. Trauma systems require enormous staff resources as well as technical equipment. Internal and external quality management processes are necessary to identify weak points and improve treatment quality. Continuous training of all professionals involved in trauma care is necessary to assure high quality, up-to-date therapy in patients with multiple injuries. Standard operating procedures such as prehospital trauma algorithms and clinical management protocols (ie, ATLS) can help to standardise and compare treatment of patients suffering from major trauma. In this overview, we describe the development and current state of our trauma department. Differences in our cohort of polytraumatised patients compared to other facilities and current strategies for initial treatment of these patients are also discussed.

Successful utilization of ECMO to treat an adult burn patient with ARDS

We present an interesting case of the first adult reported in the United States to suffer from thermal burns, adult respiratory distress syndrome (ARDS) and to be treated with extracorporeal membrane oxygenation (ECMO) who survived. Our patient is a 26 year old male who sustained thermal burns (12% TBSA) to his face and anterior trunk and broncoscopically demonstrable inhalation injury. He was transported to our regional burn center for burn wound care and ventilatory support. The patient was treated with silver sulfadiazine 1% to his wounds which healed per primam. Because of low oxygen saturation he required increasing FIO2. The following parameters: FIO2= 1, PEEP = 17, minute ventilation of 15.1 1, peak airway pressure of 45 and mean of 27, along with chest X-rays corroborated the severity of ARDS. The patient failed volume control ventilation. A trial of pressure ventilation was attempted but the patient only reached O2 saturation in the low 80s. At this point, the decision was made to transfer the patient to a hospital capable of ECMO treatment. The patient was subsequently treated with veno venous ECMO. Six weeks later the patient was discharged from the hospital off all ventilatory support.