Trauma and critical care II: abdominal trauma

The Intensivist is involved in the management of patients with abdominal trauma from their original presentation in the Emergency Department, where assessment of haemodynamic stability will influence the decision to opt for surgical, as opposed to conservative, treatment. Subsequently a large percentage of these patients, particularly those with blunt abdominal injuries, may require level 2 (HDU) or level 3 (ITU) care to monitor progress, correct any coagulopathy, maintain organ support and allow for early recognition of the major sequelae of such injuries. These include severe sepsis, trauma-related pancreatitis and the abdominal compartment syndrome. All are associated with significant morbidity and mortality, usually many days or weeks after admission. This article, in addition to reviewing some of the contributory factors involved in trauma-related coagulopathy, will discuss these sequelae and some of the concepts and strategies currently used in their management. It also includes an overview of therapies used in a critical care setting to maintain nutrition and renal homeostasis in the event of sequential organ failure.