Acute post-traumatic respiratory physiology and insufficiency

Respiratory insufficiency is one of the most serious physiologic consequences of trauma. From a physiologic viewpoint, early respiratory support for the injured patient is concerned primarily with the safe assurance and maintenance of (1) adequate ventilation (fresh gas exchange to remove secreted CO₂) and (2) adequate tissue oxygenation (inflation of alveoli, supplemental oxygen administration, and oxygen delivery to the tissues). From a pragmatic viewpoint, this aspect of care is aimed at answering the following questions: 1. Will the patient need ventilatory support (manual or mechanical breaths)? 2. Will the patient need oxygenation support (hemorrhage control and transfusion, supplemental oxygen, positive pressure lung inflations, or even positive end-expiratory pressure) accompanied by circulatory support? 3. What are the potential complications of these support interventions (for example, barotrauma and circulatory compromise)?