Multi-trauma care in the Intensive Care Unit and the role of the nurse: A literature review

Abstract

Introduction: Multiple traumas occupy a significant part of the staff in the Intensive Care Unit (ICU), as multi-injured patients almost always require intensive care. These patients are distinguished, depending on the cause and type of injuries, in specific categories such as injuries, bleeding etc. During their stay in the ICU they may experience complications that need immediate treatment. The role of the nurse is mainly focused on the constant vigilance and the correct hierarchy of interventions. Aim: The purpose of this literature review is to investigate the care of the multi-injured in ICU and the role of the nurse on it. Method: A bibliographic review was performed on the sites 'PubMed', 'google scholar', 'Scopus' and 'open-archives', with the keywords: 'multi-injured', 'multi-injured in ICU', 'multi-injured care in ICU' , "the role of the nurse in ICU" and "patient with trauma in ICU", for the years 2007-21. A total of 28 articles were used, in English and Greek language. Results: An observational study in Greece (2011) showed that the most common cause of admission to ICUs was road accidents, while a study in China (2014-15) showed that acute intracerebral hemorrhage and brain injury were the most common causes of death. A study in South Korea (2010-15) found that the most common complication in multiple injuries in ICU was respiratory-related pneumonia (VAP), while in another study in the Netherlands (2013-18) 24.6% developed delirium/confusion within the ICU. Meta-analyses in China (2018) and Australia (2016) and a literature review in Canada (2016) showed that early enteral nutrition reduces complications, mortality, and length of stay in the ICU. According to a cohort study in USA (2012), early mobilization of the multi-injured also contributes to the reduction of complications. An observational study in England (2012-15) showed that surgery reduces mortality, while in a prospective study in Brazil (2010-11) the workload of nurses in ICUs with multiple injuries was high and correlated with various factors. Finally, in a contemporary study in Greece (2019) it was observed that 80% of patients in the ICU had experienced positive experiences from the nursing staff. Conclusions: In recent years, studies have been conducted internationally on the prevention, treatment and care of multiple injuries in ICUs. It is proposed to further strengthen the role of nurses, mainly through the institutionalization of protocols and training programs, to improve patient prognosis and reduce health costs in hospitals.