Damage control surgery in the era of damage control resuscitation

Abstract

† Damage control strategies prioritize physiological and biochemical stabilization over the full anatomical repair of all injuries. † Damage control strategies are useful for a subset of trauma patients and are not appropriate in all cases. † Selection criteria for damage control management include the mechanism of injury and the degree of physiological derangement. Damage control surgery (DCS) is a concept of abbreviated laparotomy, designed to prioritize short-term physiological recovery over anatomical reconstruction in the seriously injured and compromised patient. Over the last 10 yr, a new addition to the damage control paradigm has emerged, referred to as damage control resuscitation (DCR). This focuses on initial hypotensive resuscitation and early use of blood products to prevent the lethal triad of acidosis, coagulopathy, and hypothermia. This review aims to present the evidence behind DCR and its current application, and also to present a strategy of overall damage control to include DCR and DCS in conjunction. The use of DCR and DCS have been associated with improved outcomes for the severely injured and wider adoption of these principles where appropriate may allow this trend of improved survival to continue. In particular, DCR may allow borderline patients, who would previously have required DCS, to undergo early definitive surgery as their physiological derangement is corrected earlier.

Early inflammatory response in polytraumatized patients: Cytokines and heat shock proteins. A pilot study

“…Therefore, it can be suspected that the release of HSPA1A into serum could provide the organism with a way to monitor the extent of damage to organs and tissue after trauma and that because its plasma levels are associated with MODS raises the possibility that HSPA1A could serve as a useful prognostic trauma biomarker early after severe injury. Patients with HSPA1A sera concentrations up to 10 times higher than the normal, would be candidates for submission to a "damage control surgery" (DCS) as a treatment strategy of temporarization which increases radically the survival in these most seriously injured patients [24].…”

Penetrating pelvic trauma: Initial assessment and surgical management in emergency

“…The target is a mean arterial pressure of 60 mmHg (permissive hypotension). Transfusion of concentrated red blood cells, clotting factors and platelets with a ratio of 1/1/1 is started immediately [2].…”

Les traumatismes pénétrants du pelvis : accueil, bilan et prise en charge chirurgicale en urgence

“…L'objectif tensionnel est une PAM à 60 mmHg (hypotension permissive). La transfusion concentrés de globules rouges, de facteurs de coagulation et de concentrés plaquettaires est débutée immédiatement avec des ratios de 1/1/1 [2]. …”