Evolution in Damage Control for Exsanguinating Penetrating Abdominal Injury

Johnson, Jon W.; Gracias, Vicente H.; Schwab, C. William; Reilly, Patrick; Kauder, Donald R.; Shapiro, Michael B.; Dabrowski, G. Paul; Rotondo, Michael M F

doi:10.1097/00005373-200108000-00007

Cited by 315 publications

(195 citation statements)

References 75 publications

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“…[97][98][99] To classify patients in a critical condition, general surgeons use the term ''triad of death,'' 81 consisting of the degree of shock, hypothermia, and coagulopathy. 109 Although these factors have been largely tested in patients with penetrating injuries, 110 we confirmed that they are also relevant for patients with blunt trauma and appear to be feasible for use in the decision-making process in the emergency room. 42,111 Additionally, we determined that the polytrauma patient with blunt injuries has additional problems in terms of soft tissue injuries which are underrepresented if the ''triad of death'' is used alone classify the patient.…”

Section: Resultssupporting

confidence: 60%

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

Pape

2008

Journal Orthopaedic Research

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In the treatment of polytrauma patients, multiple studies have shown how the timing and the type of the initial surgery of long bone fractures influence the incidence of systemic complications. Database analyses documented that unduly long surgical procedures undertaken early after trauma increase the risk of acute respiratory distress syndrom (ARDS), especially when femoral shaft fractures are stabilized. Animal research and prospective clinical studies also support the fact that the type of stabilization of a femoral shaft fracture may influence the systemic response to trauma. Reamed intramedullary reaming and nailing for a femoral shaft fracture is associated with an increased risk of pulmonary fat embolization from the medullary canal. This can result in pulmonary compromise if certain cofactors are also present. Modified reamers have been developed to reduce this side effect. The mediating effects are immunologic changes, varying according to the magnitude of the surgical procedure. Pro-inflammatory markers (e.g., Interleukins) may be used to assess the inflammatory response to injury as well as the magnitude of surgery and the systemic impact induced by surgery. Serum levels of such markers can be used clinically to tailor the amount of surgery that is performed to the clinical condition of the patient. The potentially negative impact of excessive surgery in high-risk patients can be avoided by using a new grading system for the assessment of the clinical status of the injured patient. Most recently, a large prospective randomized multicenter study has documented that this grading system is effective for identifying these borderline patients, and that in the borderline patient a staged surgical approach, such as temporary femoral stabilization with an external fixator, reduces the incidence of systemic complications. This work has changed the surgical management of multiply injured patients toward an approach that is tailored to the clinical condition of the patient, as indicated by well-defined clinical parameters as well as objective measurements of serum cytokine levels. ß

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Section: Resultssupporting

confidence: 60%

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

Pape

2008

Journal Orthopaedic Research

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“…Despite the use of damage control in trauma patients, the mortality-associated damage control has been reported above 40% in some series [114][115][116][117][118][119][120].…”

Section: Viability Of the Bowelmentioning

confidence: 99%

Management of Peritonitis in the Critically Ill Patient

Ordóñez

Puyana

2006

Surgical Clinics of North America

111

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“…In the literature, the timing of angiography in the management of severe liver trauma is controversial. According to Johnson et al, severe hepatic injury, of AAST grade IV or more, is an indication for immediate postoperative angiography (21). Our data showed that angiography after initial damage control surgery may not always be needed.…”

Section: Grade 3 4 17mentioning

confidence: 53%

Hasar Kontrol Cerrahi̇si̇ Sonrasi Anji̇yografi̇ Ruti̇n Olarak Yapilmali Midir?

Yanar

Özçınar

Sivrikoz³

et al. 2017

İstanbul Tıp Fakültesi Dergisi

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Objective:The management of traumatic liver injuries involves various strategies ranging from observation to operative intervention and includes various options such as angiography and/or damage-control surgery. In this study, we aimed to clarify whether routine angiography is necessary or can be reserved for selected patients with persistent bleeding after depacking. Methods: During the 11-year period from January 2000 to December 2010 all patients with blunt or penetrating trauma who sustained a liver injury and underwent a damage control laparotomy in our institution were retrospectively reviewed. Following variables were extracted from patient charts: demographics, the mechanism of injury, shock status, Injury Severity Score, liver injury grades, associated injuries, angioembolization, duration of hospitalisation, time to depacking, mortality. Angioembolization.was performed when persistent bleeding was encountered after depacking. Results: A total of 513 patients with hepatic injury were admitted during the study period. Damage control surgery was undertaken in 60 patients, of whom 21 patients underwent angioembolization. The factors associated with a high Injury Severity Score were admission in shock status (p=0.009) and associated organ injuries (p<0.001). Extremity injury was the most commonly encountered associated injury (n=15, 25.0%). In the damage control surgery group, mortality was not significantly different between angioembolization (n=4, 19%) and non-angioembolization (n=14, 33%) groups (p=0.369). Conclusion:The most patients with abdominal packing after liver trauma may not require routine angiography. Angioembolization may be used selectively in patients with persistent bleeding after depacking.

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Evolution in Damage Control for Exsanguinating Penetrating Abdominal Injury

Abstract: Continued application of DC principles has led to improved survival with PAI. Better control of temperature, experience with the open abdomen, and intensive care unit care may be causative.

Cited by 315 publications

References 75 publications

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

Effects of changing strategies of fracture fixation on immunologic changes and systemic complications after multiple trauma: Damage control orthopedic surgery

Management of Peritonitis in the Critically Ill Patient

Hasar Kontrol Cerrahi̇si̇ Sonrasi Anji̇yografi̇ Ruti̇n Olarak Yapilmali Midir?

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