Damage control surgery in the abdomen: An approach for the management of severe injured patients

Abstract

Damage control is well established as a potentially life-saving procedure in a few selected critically injured patients. In these patients the 'lethal triad' of hypothermia, acidosis, and coagulopathy is presented as a vicious cycle that often can not be interrupted and which marks the limit of the patient's ability to cope with the physiological consequences of injury. The principles of damage control have led to improved survival and to stopped bleeding until the physiologic derangement has been restored and the patient could undergo a prolong operation for definitive repair. Although morbidity is remaining high, it is acceptable if it comes in exchange for improved survival. There are five critical decision-making stages of damage control: I, patient selection and decision to perform damage control; II, operation and intraoperative reassessment of laparotomy; III, resuscitation in the intensive care unit; IV, definitive procedures after returning to the operating room; and V, abdominal wall reconstruction. The purpose of this article is to review the physiology of the components of the 'lethal triad', the indication and principles of abdominal damage control of trauma patients, the reoperation time, and the pathophysiology of abdominal compartment syndrome.

Early massive transfusion in trauma patients: Canadian single-centre retrospective cohort study

“…It was initiated as a quality improvement project to better understand local blood product utilization, and the results reflect current practice at the time (8-18 years ago). Since this study, pre-hospital trauma care, 30 surgical management of trauma, 54 and intensive care staffing 55 have all evolved, and Canadian physicians have adopted a more conservative approach to red blood cell transfusion in critically ill patients. 56 However, the trend to declining injury-related deaths in Canada during the study period may be due to prevention initiatives rather than to advances in the care of trauma patients.…”

Permissive Hypotension in Bleeding Trauma Patients: Helpful or Not and When?

“…27 Principles of damage control apply not only to the abdomen but also to many other regions of the body. 28 Damage control surgery is defined as a series of operations performed to definitively repair injuries of the abdomen or other parts of the torso in accordance with a patient's ability to tolerate the physiological consequences of injury and repair. 29 The main tenet of damage control surgery is that patients die from the so-called triad of death.…”

Lesões Traumáticas De Vísceras Ocas

“…Do ponto de vista de vísceras ocas, de maneira geral, esta abordagem significa o fechamento provisório das lesões (fechamento de cotos cegos, grampeamento provisório de feridas e empacotamento com compressas cirúrgicas), para proceder às reconstruções definitivas quando o paciente estiver em melhores condições gerais. 5 O exame físico continua a ser o mais importante instrumento para diagnosticar lesões abdominais que necessitem de laparotomia de urgência. Métodos diagnósticos auxiliares nos traumas abdominais incluem o Lavado Peritoneal Diagnóstico (LPD), exame ultrasonográfico "Focused Assessment with Sonography for Trauma" -FAST 3 e a Tomografia Computadorizada (TC), cuja evolução tecnológica tem permitindo a identificação de lesões sutis.…”