Damage Control Surgery—The Intensivist's Role

Abstract

"Damage control" surgery has evolved during the past 20 years from an accepted surgical technique in the traumatized, moribund patient to an expanded role in critically ill, nontraumatized patients. Physicians caring for these patients in extremis have begun to recognize a pattern of severe physiologic derangement that prompts an abbreviated laparotomy after hemorrhage and contamination control. Emphasis then shifts from the operating theater to the intensive care unit, where the patient's physiologic deficits are corrected. Once these derangements have been resolved, the patient is taken back to the operating room for definitive, reconstructive surgical care. The purpose of this article is to review the concept of "damage control" in reference to the patient whose pathophysiologic depletion prompts the need for it. Resuscitation in the intensive care unit will be summarized, pitfalls will be identified, and treatment plans will be delineated. Complications such as abdominal compartment syndrome and difficult abdominal wall closures will also be discussed.

The Effectiveness of a Damage Control Resuscitation Strategy for Vascular Injury in a Combat Support Hospital: Results of a Case Control Study

“…9 Modern research has focused on developing resuscitation strategies that serve to reverse those classic physiologic derangements that often lead to death. 17 Predicting the need for massive transfusion, need for a lifesaving intervention or mortality based on vital signs, and presenting physiologic parameters like INR or base deficit can avoid undue delay and justify effective resuscitation plans. 4,18 -21 "Staying out of trouble, rather than getting out of trouble" is an indispensable concept in damage control surgery because hemorrhagic deaths after injury typically occur within 2 hours to 4 hours.…”

Surgical Treatment Management of Abdominal Gunshot Injuries

“…При выборе объема операции возникает дилемма: оперировать по-страдавшего в полном и окончательном объеме либо поступить согласно триаде "Damage control," при которой лечение пациента включает три этапа: 1) первичная (сокращенная) опера-ция; 2) интенсивная терапия -компенсация кровопотери и нарушения витальных функций; 3) окончательная операция на гемодинамически и волемически стабильном пациенте [9,11].…”

Uncommon isolated near total small bowel mesenteric tear after blunt abdominal trauma and successful damage control surgery

“…[1][2][3] In blunt abdominal trauma the damage control resuscitation strategy is one of the major therapeutic advances and its application is based on three pillars: Abbreviated surgery, haemostatic resuscitation and reversal of hypotension.…”