Multitrauma ICU Patient with Raised ICP for Thoracotomy

You are asked to urgently review a 45-year-old man in the intensive care unit (ICU) who requires a left thoracotomy for ongoing bleeding from a chest drain. The patient was involved in a high-speed motor vehicle accident twelve hours ago. He had an uncomplicated intubation in the emergency department on arrival and is now ventilated in the ICU after surgical management. His injuries and surgical management to date includes: Closed head injury - External ventricular drain (EVD) in situ. - Intermittent spikes in intracranial pressure measurements while in the intensive care unit. Bilateral rib fractures and lung contusions with bilateral chest drains in situ. External fixation of left femoral and tibial fractures. External fixation of pelvic fractures. When you arrive in the intensive care unit to review the patient, his observations are: HR 115 bpm BP 80/45 mmHg, unsupported SpO2 89% on FiO2 1.0