Presentation is loading. Please wait.

Presentation is loading. Please wait.

POST-TRAUMATIC RESPIRATORY INSUFFIENCY Dr.R.Selvakumar Assistant Professor, Dept. of Anaesthesiology, Madurai Medical College, Madurai TNOA-08.

Similar presentations


Presentation on theme: "POST-TRAUMATIC RESPIRATORY INSUFFIENCY Dr.R.Selvakumar Assistant Professor, Dept. of Anaesthesiology, Madurai Medical College, Madurai TNOA-08."— Presentation transcript:

1 POST-TRAUMATIC RESPIRATORY INSUFFIENCY Dr.R.Selvakumar Assistant Professor, Dept. of Anaesthesiology, Madurai Medical College, Madurai TNOA-08

2 RESPIRATORY FAILURE DUE TO TRAUMA: DIRECTINDIRECT TNOA-08

3 DIRECT CAUSES OF RESPIRATORY FAILURE: Direct airway trauma, airway obstructionDirect airway trauma, airway obstruction Chest injuryChest injury flail chest pneumo/haemothorax pulmonary contusion cardiac tamponade Circulatory failureCirculatory failure Head injuryHead injury TNOA-08

4 INDIRECT CAUSES LONG BONE FRACTURES IMPACT IN THE LUNGS TNOA-08

5 PATHOLOGY OF LUNG INJURY AFTER TRAUMA: Trauma – Local release of inflammatory mediators( cytokines) from the Neutrophils - spread – activation of neuroendocrine, complement, coagulative and fibrinolytic pathways TNOA-08

6 PATHOLOGY:…contd… Microvascular occlusion from fibrin and platelet aggregates - Interstitial leakage of protein and neutrophil rich fluid LEADING TO DIFFUSE ALVEOLAR DAMAGE TNOA-08

7

8 PATHOLOGY: contd… Decrease in pulmonary compliance Pulmonary flooding Decrease in FRC Increased vascular shunting V-Q mismatch END RESULT IS HYPOXEMIA TNOA-08

9 TRAUMA LONG BONE & HIP FRACTURE FAT EMBOLISATION SYNDROME ACUTE LUNG INJURY ARDS MULTI ORGAN DYSFUNCTION SYNDROME TNOA-08

10 DO ALL THE TRAUMA PATIENTS DEVELOP FAT EMBOLISM AND ARDS…? YES AND NO TNOA-08

11 90% of trauma patients show fat globules in the lung capillaries 90% of trauma patients show fat globules in the lung capillaries 1-5 % of these patients develop ARDS 1-5 % of these patients develop ARDS

12 WHICH UNLUCKY PATIENTS DEVELOP A.R.D.S…? Patients with a primed inflammatory response Patients with a primed inflammatory response Secondary injury ( HITS ) Secondary injury ( HITS ) circulatory imbalance residual hypovolemia blood transfusion Fat embolism

13 HOW TO DIAGNOSE ARDS..? Clinical signs Clinical signs Low O 2 saturation in spite Low O 2 saturation in spite of oxygen supplement of oxygen supplement Chest X-ray ABGPCWP TNOA-08

14 OXIMETRY FORMS THE MAINSTAY OF DIAGNOSIS The biggest limitation is the relationship between paO 2 and SpO 2 TNOA-08

15 paO2 SpO2 OXYHAEMOGLOBIN DISSOCIATION CURVE TNOA % 80mm of Hg 60 90%

16 JUST BECAUSE O 2 SATURATION IS NORMAL, U CANT RULE OUT ARDS…. IN NUTSHELL…, TNOA-08

17 IF FAT EMBOLISM IS ONE OF THE REASON FOR ARDS…. What is the impact of the timing and type of surgery for fractures..? TNOA-08

18 EARLY FIXATION OF FRACTURES HELP TO REDUCE THE INCIDENCE OF ARDS In isolated fractures In isolated fractures With injury to multiple systems With injury to multiple systems TNOA-08

19 THE BENEFITS OF EARLY FIXATION… Reduction of mortality Reduction of mortality No increase in the incidence of FE No increase in the incidence of FE Decreased duration of mechanical ventilation Decreased duration of mechanical ventilation Decreased incidence of nosocomial infection and Decreased incidence of nosocomial infection and Thromboembolic disease Thromboembolic disease Decreased cost of treatment Decreased cost of treatment IN ISOLATED FRACTURES… TNOA-08

20 IN SEVERELY INJURED PATIENTS WITH MULTIPLE INJURIES… oLife threatening complications take priority oTemporary external stabilisation oPro-inflammatory condition oClinically occult tissue hypoxia and hypoperfusion- o? Role of reamed nailing oThink of unreamed nailing,compression plates,venting during nailing, lavage of the medullary canal etc.. during nailing, lavage of the medullary canal etc.. TNOA-08

21 PROBLEMS OF EARLY FIXATION IN MULTIPLE INJURIES inadequate time for total evaluation inadequate time for total evaluation Missed abdominal and head injury Missed abdominal and head injury The problems of massive blood transfusion The problems of massive blood transfusion Exhaustion of the team Exhaustion of the team Inadequacies of the studies claiming good results Inadequacies of the studies claiming good results after early fixation after early fixation AND FINALLY.... THINK ABOUT THE POOR ANESTHETIST TNOA-08

22 If definitive fixation is delayed in Pro-inflammatory patients with multiple fractures … When can we go for definitive surgery…? TNOA-08

23 ARGUMENT CONTINUES….. TNOA-08

24 TREATMENT OF ARDS: Oxygen therapy – venti mask preferred Oxygen therapy – venti mask preferred Non-invasive ventilation- mask CPAP Non-invasive ventilation- mask CPAP Mechanical ventilation with or without PEEP Mechanical ventilation with or without PEEP Supportive – nutritional,antibiotics etc.. Supportive – nutritional,antibiotics etc.. No role for steroids,heparin, anti inflammatory drugs No role for steroids,heparin, anti inflammatory drugs TNOA-08

25 SUMMARISING… Post-traumatic respiratory failure occurs because Post-traumatic respiratory failure occurs because of development of an inflammatory response of development of an inflammatory response Fat embolisation may lead to development ARDS Fat embolisation may lead to development ARDS Reaming of nailing doesnt seem to increase Reaming of nailing doesnt seem to increase the incidence of ARDS the incidence of ARDS Monitoring with pulseoximetry and ABG is essential in Monitoring with pulseoximetry and ABG is essential in the diagnosis of ARDS the diagnosis of ARDS The proof for the beneficial effect from modification of the The proof for the beneficial effect from modification of the timing and technique of fracture stabilisation is lacking timing and technique of fracture stabilisation is lacking TNOA-08

26 CONCLUSION: initial and deligent resuscitation and initial and deligent resuscitation and early fixation of fractures to certain extent prevent the incidence of ARDS… TNOA-08


Download ppt "POST-TRAUMATIC RESPIRATORY INSUFFIENCY Dr.R.Selvakumar Assistant Professor, Dept. of Anaesthesiology, Madurai Medical College, Madurai TNOA-08."

Similar presentations


Ads by Google