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Field Intensive Care - Weaning and Extubation
  1. Lt Col R Thornhill, Consultant in Anaesthesia and Intensive Care Medicine1,
  2. JL Tong2,
  3. K Birch, Consultant in Anaesthesia and Intensive Care3 and
  4. R Chauhan, StR in Anaesthesia4
  1. 1Nottingham University Hospitals and RCDM
  2. 2Royal Centre for Defence Medicine and Honorary Senior Lecturer at the University of Birmingham
  3. 3North Bristol NHS Trust
  4. 4Queens Hospital, Burton-Upon-Trent
  1. Department of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Raddlebarn Road, Selly Oak, Birmingham, B29 6JD rjthorn{at}btinternet.com

Abstract

Injury following ballistic trauma is the most prevalent indication for providing organ system support within an ICU in the field. Following damage control surgery, postoperative ventilatory support may be required, but multiple factors may influence the indications for and duration of invasive mechanical ventilation. Ballistic trauma and surgery may trigger the Systemic Inflammatory Response Syndrome (SIRS) and are important causative factors in the development of Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS). However, their pathophysiological effect on the respiratory system is unpredictable and variable. Invasive mechanical ventilation is associated with numerous complications and the return to spontaneous ventilation has many physiological benefits. Following trauma, shorter periods of ICU sedation-amnesia and a protocol for early weaning and extubation, may minimize complications and have a beneficial effect on their psychological recovery. In the presence of stable respiratory function, appropriate analgesia and favourable operational and transfer criteria, we believe that the prompt restoration of spontaneous ventilation and early tracheal extubation should be a clinical objective for casualties within the field ICU.

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