Eastern Association for the Surgery of Trauma: A Review of the Management of the Open Abdomen—Part 2 “Management of the Open Abdomen”

Diaz, José J.; Dutton, William D.; Ott, Mickey M.; Cullinane, Daniel C.; Alouidor, Reginald; Armen, Scott B.; Bilanuik, Jaroslaw W.; Collier, Bryan R.; Gunter, Oliver L.; Jawa, Randeep S.; Jerome, Rebecca N; Kerwin, Andrew J.; Kirby, John P.; Lambert, Anne L.; Riordan, William P.; Wohltmann, Christopher

doi:10.1097/ta.0b013e318227220c

Cited by 83 publications

(45 citation statements)

References 65 publications

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“…Although the mortality of trauma patients requiring massive transfusion exceeds 50% [3], at least 10% of deaths after traumatic injury are potentially preventable, and 15% of those are due to hemorrhage; many of these deaths occur within the first few hours of definitive care, with coagulopathy playing a crucial role [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

2017

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Hemorrhage is the most important contributing factor of acute-phase mortality in trauma patients. Previously, traumatologists and investigators identified iatrogenic and resuscitation-associated causes of coagulopathic bleeding after traumatic injury, including hypothermia, metabolic acidosis, and dilutional coagulopathy that were recognized as primary drivers of bleeding after trauma. However, the last 10 years has seen a widespread paradigm shift in the resuscitation of critically injured patients, and there has been a dramatic evolution in our understanding of trauma-induced coagulopathy. Although there is no consensus regarding a definition or an approach to the classification and naming of trauma-associated coagulation impairment, trauma itself and/or traumatic shockinduced endogenous coagulopathy are both referred to as acute traumatic coagulopathy (ATC), and multifactorial trauma-associated coagulation impairment, including ATC and resuscitation-associated coagulopathy is recognized as trauma-induced coagulopathy. Understanding the pathophysiology of trauma-induced coagulopathy is vitally important, especially with respect to the critical issue of establishing therapeutic strategies for the management of patients with severe trauma.

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Section: Introductionmentioning

confidence: 99%

Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

2017

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“…In particular, open abdomen management resulted in an increase in severe morbidities, such as anastomotic breakdown, ventral hernias, and enteroatmospheric fistula [92,93]. Aggressive resuscitation increased the incidence of these complications [26].…”

Section: Adverse Effects Of Dcsmentioning

confidence: 99%

Damage control resuscitation: a practical approach for severely hemorrhagic patients and its effects on trauma surgery

Mizobata

2017

j intensive care

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Coagulopathy observed in trauma patients was thought to be a resuscitation-associated phenomenon. The replacement of lost and consumed coagulation factors was the mainstay in the resuscitation of hemorrhagic shock for many decades. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. It consists of three steps: abbreviated surgery to control the hemorrhage and contamination, resuscitation in the intensive care unit (ICU), and planned re-operation with definitive surgery. The resuscitation strategy of DCS focused on the rapid reversal of acidosis and prevention of hypothermia through the first two steps. However, direct treatment of coagulopathy was not emphasized in DCS. Recently, better understanding of the pathophysiology of coagulopathy in trauma patients has led to the logical opinion that we should directly address this coagulopathy during major trauma resuscitation. Damage control resuscitation (DCR), the strategic approach to the trauma patient who presents in extremis, consists of balanced resuscitation, hemostatic resuscitation, and prevention of acidosis, hypothermia, and hypocalcemia. In balanced resuscitation, fluid administration is restricted and hypotension is allowed until definitive hemostatic measures begin. The administration of blood products consisting of fresh frozen plasma, packed red blood cells, and platelets, the ratio of which resembles whole blood, is recommended early in the resuscitation. DCR strategy is now the most beneficial measure available to address trauma-induced coagulopathy, and it can change the treatment strategy of trauma patients. DCS is now incorporated as a component of DCR. DCR as a structured intervention begins immediately after rapid initial assessment in the emergency room and progresses through the operating theater into the ICU in combination with DCS. By starting from ground zero with the performance of DCS, DCR allows the trauma surgeon to correct the coagulopathy of trauma. The effect of the reversal of coagulopathy in massively hemorrhagic patients may change the operative strategy with DCS.

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“…However, the use of the OA technique has resulted in improved survivals in critically ill or injured patients [21] and is now part of every surgeon's armamentarium. Despite this acceptance, the Eastern Association for the Surgery of Trauma has stated that there is a void in the knowledge-base concerning the postoperative management of OA patients [22]. Less dramatic, but more of a population concern is the often unappreciated scourge of incisional hernia following laparotomy which, when carefully followed, affects 20% of unselected patients and up to 50% of high risk patients [23−25].…”

Section: Recent Advancesmentioning

confidence: 99%