Damage control surgery: it's evolution over the last 20 years

Abstract

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics. A host of new resuscitation strategies and technologies have been developed over the past two decades, from permissive hypotension and damage control resuscitation to advanced ventilators and hemostatic agents, which have allowed for a more focused resuscitation, allowing some of the morbidity of this model to be reduced. The combination of the simple, malleable paradigm along with better understanding of resuscitation has proven to be a potent blend. As such, what was once an almost lethal injury (combined vascular and visceral injury) has become a survivable one.

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.…”

Serviço de Atendimento Móvel de Urgência 192: Violência Contra A Mulher

“…13 Também é importante mencionar que novas evidências sugerem que o uso intempestivo de reposição volêmica pode contribuir para pior prognóstico das vítimas de trauma, preferindo-se manter o paciente em hipotensão permissiva em situações onde os recursos materiais, técnicos e a gravidade do trauma o permitam. 14,15 Neste estudo, a grande maioria das vítimas apresentou um RTS de 7,8408, com expectativa de sobrevivência acima de 98%, e a vítima com RTS igual a 5,299 apresentava mais de 80% de chance de sobrevivência de acordo com Champion. 16 Por estas características, grande parte das ocorrências são subnotificadas, contribuindo para reforçar a invisibilidade da violência contra a mulher.…”

Cirurgia para controle de danos: estado atual

“…No entanto, mais estudos ainda são necessários para concluir qual a melhor relação quantitativa entre concentrados de hemácias, plasmas frescos congelados e bolsas de plaquetas. Certamente, o antigo conceito de ressuscitação volêmica agressiva com altos volumes de cristaloide, visando a parâmetros suprafisiológicos, deve ser evitado 35 . Devido ao alto custo do fator recombinante VIIa, sua utilização ainda é questionada e estudos que avaliem seu custo-benefício ainda são necessários.…”