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Early total care (ETC) approach

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 An essential prerequisite for ETC was optimization of retrieval conditions and a reduction
of the retrieval time. Furthermore, the improvements in intensive care medicine with
improved cardiovascular monitoring and facilities for prolonged ventilatory support
facilitated the development of a more aggressive surgical approach.
 The strict application of ETC even in patients with a high ISS, brain injury, or severe chest
trauma limited discussion about the best management for these polytraumatized patients.
 As it became evident that these specific subgroups of polytraumatized patients do not
benefit from ETC, the borderline patient was identified.
 These patients were demonstrated to be at particular risk of a poor late outcome.

Indications:
• Stable hemodynamics
• No need for vasoactive/inotropic stimulation
• No hypoxemia, no hypercapnia
• Lactate <2 mmol/L
• Normal coagulation
• Normothermia
• Urinary output >1 mL/kg/h