Modern Approaches to Intensive Therapy of Patients with Thoracic Trauma in Politrauma

Abstract

The review article presents data on the modern possibilities of intensive care for patients with thoracic trauma in case of polytrauma. It should be noted that over the past 5 years, the number of patients with thoracic injuries in polytrauma who require intensive care in the intensive care unit has increased by 10 times. For their treatment, advanced intensive care methods are used, but, despite this, the mortality rate of this category of patients remains one of the highest, reaching 80%. Moreover, it is combined thoracic trauma that plays a leading role in thanatogenesis. Studying the clinical manifestations of thoracic trauma in patients with polytrauma will help to improve the quality of medical care and the results of treatment of such patients. One of the reasons for the high mortality and disability of patients with thoracic trauma during polytrauma is the lack of a single integrated pathogenetic approach to assessing the severity of the condition of patients and the tactics of intensive care. The values of direct damage to internal organs, the main vessels of the chest and mediastinum in the development of a number of formidable complications are not fully defined, and it is not clearly stated in which cases support for vital functions is needed or their replacement. In the practice of conducting intensive care with thoracic trauma on the background of software in different institutions, often opposite methods and approaches to tactics of conducting intensive care are used. This indicates that the problem of intensive care patients of this contingent is far from being solved and is of certain scientific and practical interest. The role of primary and secondary injuries in combined thoracic trauma has not been studied, the boundaries of compensatory and adaptive reactions have not been determined. Moreover, there is no single concept for intensive care patients with thoracic trauma during polytrauma. This type of damage is accompanied by deep disorders of homeostasis systems, which determine the severity of the clinical course and cause a high level of complications and disability. Unsatisfactory results of intensive care are often associated with insufficient ideas about the pathogenesis of the early post-traumatic period in patients with polytrauma, which leads to errors in determining the volume, timing, feasibility and sequence of intensive care. Conclusion. We believe that the improvement of treatment outcomes for this category of patients can be achieved only with a comprehensive, objectively substantiated approach to the choice of intensive care tactics, focused on the clinical features of thoracic trauma on the background of polytrauma