The tenets of intrathoracic packing during damage control thoracic surgery for trauma patients: a systematic review

Manzano-Núñez, Ramiro; Chica, Julián; Gomez, Alexandra; Naranjo, María Paula; Chaves, Harold; Muñoz, Luis E.; Rengifo, Javier E.; Caicedo-Holguín, Isabella; Puyana, Juan Carlos; García, Alberto

doi:10.1007/s00068-020-01428-8

Cited by 8 publications

(15 citation statements)

References 57 publications

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“…The most common management was placement of the REBOA in zone I, with sternotomy in 65.2% of patients and thoracotomy in 17.3%. No significant differences were found between observed and expected mortality, nor higher requirement for blood components 19 . García et at.…”

Section: Discussionmentioning

confidence: 69%

“…Entre ellos se encuentran: la necesidad de toracotomía de resucitación, la presencia de más de una fuente de hemorragia intratorácica, la presencia de fuentes de sangrado extratorácico, una lesión vascular mayor, la necesidad de resección pulmonar anatómica y el riesgo de síndrome compartimental torácico ( Tabla 1 ). Durante el procedimiento quirúrgico el hallazgo de hemotórax masivo, la inestabilidad hemodinámica persistente, la hipotermia persistente o progresiva, la presencia de lesiones destructivas de la pared torácica, la coagulopatía clínica y la persistencia de acidosis en los gases arteriales deben orientar a la decisión de control de daños 16 , 18 , 19 .…”

Section: Indicacionesunclassified

“… Herida pulmonar periférica: El control de la herida se puede realizar mediante la compresión manual del tejido o mediante la colocación de una pinza de Duval 14 , 25 ( Figura 2 ). El control transitorio de heridas pequeñas puede lograrse con la colocación de una o dos compresas entre la pared torácica y el parénquima pulmonar 19 , 25 - 27 . El control transitorio de una herida transfixiante puede realizarse con la inserción de una compresa en el tracto de la herida ( Figura 3 ) 25 .…”

Section: Abordaje Quirúrgicounclassified

“…Para este efecto, una vez se ha logrado el control de la hemorragia mediante el pinzamiento del hilio pulmonar, el cirujano revisa la magnitud de la lesión y decide si se trata de una herida periférica que puede ser manejada con una resección en cuña o una tractotomía. Si se trata de una herida central que justifica una resección 19 , se identifica si es posible ocluir selectivamente la circulación de un lóbulo lesionado, o si debe mantener ocluido el hilio 14 . A menos que la condición del paciente se haya estabilizado y mejore definitivamente durante el procedimiento, será preferible concluir la cirugía con maniobras abreviadas para permitir la reanimación, y practicar la lobectomía o neumonectomía de manera semi-electiva en un procedimiento posterior, dentro de las siguientes 24 horas, en compañía de cirugía de tórax.…”

Section: Abordaje Quirúrgicounclassified

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Damage control surgery in lung trauma

et al. 2021

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Damage control techniques applied to the management of thoracic injuries have evolved over the last 15 years. Despite the limited number of publications, information is sufficient to scatter some fears and establish management principles. The severity of the anatomical injury justifies the procedure of damage control in only few selected cases. In most cases, the magnitude of the physiological derangement and the presence of other sources of bleeding within the thoracic cavity or in other body compartments constitutes the indication for the abbreviated procedure. The classification of lung injuries as peripheral, transfixing, and central or multiple, provides a guideline for the transient bleeding control and for the definitive management of the injury: pneumorraphy, wedge resection, tractotomy or anatomical resection, respectively. Identification of specific patterns such as the need for resuscitative thoracotomy, or aortic occlusion, the existence of massive hemothorax, a central lung injury, a tracheobronchial injury, a major vascular injury, multiple bleeding sites as well as the recognition of hypothermia, acidosis or coagulopathy, constitute the indication for a damage control thoracotomy. In these cases, the surgeon executes an abbreviated procedure with packing of the bleeding surfaces, primary management with packing of some selected peripheral or transfixing lung injuries, and the postponement of lung resection, clamping of the pulmonary hilum in the most selective way possible. The abbreviation of the thoracotomy closure is achieved by suturing the skin over the wound packed, or by installing a vacuum system. The management of the patient in the intensive care unit will allow identification of those who require urgent reintervention and the correction of the physiological derangement in the remaining patients for their scheduled reintervention and definitive management.

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Section: Discussionmentioning

confidence: 69%

Section: Indicacionesunclassified

Section: Abordaje Quirúrgicounclassified

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Damage control surgery in lung trauma

et al. 2021

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“…Any existing lung injuries could have been treated using lung-sparing techniques (27). Intrathoracic vascular injuries could have been repaired depending on the vessel injured and the grade of the vascular injury (25).…”

Section: Surgical Maneuvers That We Would Have Performed With Reboa In Placementioning

confidence: 99%

Use of REBOA in the universe of magical realism: a real-world review

Manzano-Núñez

Chica-Yanten

Naranjo

et al. 2021

Colomb. J. Anesthesiol.

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While reading the novella “Chronicle of a Death Foretold” by the Colombian Nobel Laureate Gabriel García-Marquez, we were surprised to realize that the injuries sustained by the main character could have been successfully treated had he received modern trauma care in which REBOA may have been considered. This is a discussion of Mr. Nasar's murder to explore whether he could have been saved by deploying REBOA as a surgical adjunct to bleeding control and resuscitation. In reading García-Marquez's novel we noted the events that unfolded at the time of Santiago Nasar's murder. To contextualize the claim that Mr. Nasar could have survived, had his injuries been treated with REBOA, we explored and illustrated what could have done differently and why. On the day of his death, Mr. Nasar sustained multiple penetrating stab wounds. Although he received multiple stab wounds to his torso, the book describes seven potentially fatal injuries, resulting in hollow viscus, solid viscus, and major vascular injuries. We provided a practical description of the clinical and surgical management algorithm we would have followed in Mr. Nasar's case. This algorithm included the REBOA deployment for hemorrhage control and resuscitation. The use of REBOA as part of the surgical procedures performed could have saved Mr. Nasar's life. Based on our current knowledge about REBOA in trauma surgery, we claim that its use, coupled with appropriate surgical care for hemorrhage control, could have saved Santiago Nasar's life, and thus prevent a death foretold.

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