Severe respiratory failure may develop in the trauma patient as a consequence of direct lung injury, in response to trauma‐associated systemic inflammatory response syndrome (SIRS), as a result of infection, or at times as an unintended consequence of the life‐saving management of the acute traumatic injury. Approximately 0.5% of all adult trauma patients develop some form of pulmonary dysfunction along the acute lung injury (ALI) – acute respiratory distress (ARDS) spectrum, with the incidence of severe respiratory failure reaching 10–20% in multisystem trauma victims. Of concern, mortality in patients with acute respiratory failure who go on to develop severe pulmonary dysfunction can be as high as 37–50% with the use of conventional therapeutic modalities. Extracorporeal membrane oxygenation (ECMO) has been proposed as a rescue strategy when less invasive primary or adjunctive attempts fail. Numerous case reports and single‐center studies demonstrate potential benefits of early implementation of veno‐venous (VV)‐ECMO for the treatment of severe respiratory failure associated with trauma or sequelae of trauma. In this clinical context, VV‐ECMO can be employed to correct for both ventilatory and oxygenation failure while allowing the treating physician to provide much needed rest to the patient's lungs and permit healing to take place. The use of ECMO (mainly veno‐venous, with limited use of veno‐arterial circuits for cardiac indications) has been described in patients with severe chest injuries, traumatic pneumonectomy, bronchopleural fistulas, and various forms of respiratory failure refractory to conventional therapies.
Part of the book: Extracorporeal Membrane Oxygenation
Blood products are frequently required in an inpatient setting for a number of serious conditions. It is of the utmost importance that providers are aware of the potential for adverse reactions and human error when ordering or administering these products. Patients who require blood products should have a signed informed consent form and a type and screen performed prior to transfusion. The patient’s identity should be confirmed using two patient identifiers. There are two major categories for blood transfusion reactions, immune-mediated and nonimmune-mediated. Common manifestations of a transfusion reaction are nonspecific and may be attributed to a patient’s other medical problems, so the index of suspicion must be high in order to identify and treat these reactions.
Part of the book: Vignettes in Patient Safety