Mechanical Ventilation in the Trauma Patient

Introduction: Patients with multiple injuries are known to develop lung injury, which can result in long-term disability or even death. Respiratory failure has been observed in trauma patients for a long time; some degree of acute respiratory distress syndrome (ARDS) occurs in these patients. Objective: Review the principal types of trauma that may require intubation and mechanical ventilation. Discussion: Head trauma, thoracic trauma with pneumothorax, flail chest, cardiac injuries with simple ECG alterations to myocardial rupture, pulmonary contusion, and abdominal trauma may occur in trauma patients. In all these clinical situations, invasive mechanical ventilation may be used depending on the severity of injuries. It is fundamental to maintain oxygenation and ventilation/perfusion ratio and avoid ventilator-related lung injuries because mechanical ventilation can increase morbidity and mortality. Early noninvasive ventilation may reduce the need for intubation. Prone position can also be used to help patients with respiratory distress. In patients with ARDS, it is fundamental to limit barotrauma, volutrauma, and atelectrauma. Goals should include an SpO2 ≥ 88–95% and a pH ≥7.3. During artificial ventilation, the appropriate range of PaCO2 varies depending on the condition of the patient. In special cases, one-lung-independent lung ventilation (OL-ILV), independent lung ventilation (TL-ILV), or extracorporeal membrane oxygenation (ECMO) may be used. The principal goal of ECMO is to support gas exchange while allowing a reduction in the intensity of mechanical ventilation. Conclusion: Trauma patients need an ABCD approach with a detailed examination and assessment to allow all the correct diagnosis and treatment approaches as well as mechanical ventilation indications.