Damage Control Orthopedic Surgery.

The concept of damage control surgery was first described for the purpose of treating medically un-stable patients with abdominal trauma. The purpose of such surgery is rapid control of hemorrhage and contamination, not definitive repair of injuries. The goal is to improve survival of patients with the potentially lethal triad of hypothermia, acidosis and coagulopathy. Definitive repair of injuries and abdominal closure are not performed at the time of initial laparotomy. Rather, the abdominal wound is left open, a dressing is placed, and the patient is transported to the intensive care unit for continued re-suscitation. This includes optimization of hemodynamic condition, respiratory support, warming, and correction of coagulopathy. Following successful resuscitation, when the patient is medically stable, a return to the operating room is scheduled for repair of injuries and abdominal closure.

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Critical Care Considerations for Damage Control in a Trauma Patient

AACN Advanced Critical Care ◽

10.4037/aacnacc2021817 ◽

2021 ◽

Vol 32 (1) ◽

pp. 64-75

Author(s):

Shannon Gaasch

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Cause Of Death ◽

Damage Control ◽

Operative Procedure ◽

Fixed Ratio ◽

Damage Control Surgery ◽

Fluid Restriction ◽

Damage Control Resuscitation ◽

Lethal Triad

Traumatic injury remains the leading cause of death among individuals younger than age 45 years. Hemorrhage is the primary preventable cause of death in trauma patients. Management of hemorrhage focuses on rapidly controlling bleeding and addressing the lethal triad of hypothermia, acidosis, and coagulopathy. The principles of damage control surgery are rapid control of hemorrhage, temporary control of contamination, resuscitation in the intensive care unit to restore normal physiology, and a planned, delayed definitive operative procedure. Damage control resuscitation focuses on 3 key components: fluid restriction, permissive hypotension, and fixed-ratio transfusion. Rapid recognition and control of hemorrhage and implementation of resuscitation strategies to control damage have significantly improved mortality and morbidity rates. In addition to describing the basic principles of damage control surgery and damage control resuscitation, this article explains specific management considerations for and potential complications in patients undergoing damage control interventions in an intensive care unit.

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Damage control in the intensive care unit: what should the intensive care physician know and do?

Colombia Medica ◽

10.25100/cm.v52i2.4810 ◽

2021 ◽

Vol 52 (2) ◽

pp. e4174810

Author(s):

Monica Vargas ◽

Alberto Garcia ◽

Yaset Caicedo ◽

Michael Parra ◽

Carlos Alberto Ordoñez

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Damage Control ◽

Damage Control Surgery ◽

Severe Trauma ◽

Massive Hemorrhage ◽

Care Physician ◽

Trauma Patients ◽

Physiological Alterations ◽

Definitive Repair

When trauma patients are admitted into the intensive care unit after undergoing damage control surgery, they generally present some degree of bleeding, hypoperfusion, and injuries that require definitive repair. Trauma patients admitted into the intensive care unit after undergoing damage control surgery can present injuries that require a definite repair, which can cause bleeding and hypoperfusion. The intensive care team must evaluate the severity and systemic repercussions in the patient. This will allow them to establish the need for resuscitation, anticipate potential complications, and adjust the treatment to minimize trauma-associated morbidity and mortality. This article aims to describe the alterations present in patients with severe trauma who undergo damage control surgery and considerations in their therapeutic approach. The intensivist must detect the different physiological alterations presented in trauma patients undergoing damage control surgery, mainly caused by massive hemorrhage. Monitor and support strategies are defined by the evaluation of bleeding and shock severity and resuscitation phase in ICU admission. The correction of hypothermia, acidosis, and coagulopathy is fundamental in the management of severe trauma patients.

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Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

The American Surgeon ◽

10.1177/000313480507100309 ◽

2005 ◽

Vol 71 (3) ◽

pp. 219-224 ◽

Cited By ~ 12

Author(s):

JosÉ A. Montalvo ◽

JosÉ A. Acosta ◽

Pablo RodrÍguez ◽

Kathia Alejandro ◽

AndrÉs SÁrraga

Keyword(s):

Surgical Complications ◽

Causes Of Death ◽

Surgical Complication ◽

Damage Control ◽

Multiple Logistic Regression Analysis ◽

Hypovolemic Shock ◽

Damage Control Surgery ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

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The open abdomen

10.1093/med/9780199682874.003.0102 ◽

2021 ◽

pp. 1179-1184

Author(s):

Omar A. Khan ◽

Emma Rose McGlone ◽

Marcus Reddy

Keyword(s):

Negative Pressure ◽

Open Abdomen ◽

Damage Control ◽

Damage Control Surgery ◽

Temporary Abdominal Closure ◽

Systemic Complications ◽

Advantages And Disadvantages ◽

Abdominal Closure ◽

Local And Systemic Complications ◽

Abdominal Compartment

This chapter introduces the concept of the open abdomen and describes the various aetiologies of this complex condition, including the rationale for elective laparostomy in damage control surgery and as a treatment for abdominal compartment syndrome. The significance of the open abdomen is described in terms of its local and systemic complications, which form the basis of the established classification. Important considerations in the acute systemic management of patients with this condition are outlined, and methods of temporary abdominal closure are described. Advantages and disadvantages of these alternatives, including the use of negative-pressure wound therapy, are discussed.

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Adding the Capacity for an Intensive Care Unit Dedicated to COVID 19, Preserving the Operational Capability of a French Golden Hour Offset Surgical Team in Sahel

Military Medicine ◽

10.1093/milmed/usaa273 ◽

2020 ◽

Author(s):

Henri de Lesquen ◽

Marie Bergez ◽

Antoine Vuong ◽

Alexandre Boufime-Jonqheere ◽

Nicolas de l’Escalopier

Keyword(s):

Intensive Care Unit ◽

Critical Care ◽

Intensive Care ◽

Large Scale ◽

Damage Control ◽

Surgical Care ◽

Damage Control Surgery ◽

Surgical Team ◽

Golden Hour ◽

Surgical Teams

Abstract Introduction In April 2020, the military medical planning needs to be recalibrated to support the COVID-19 crisis during a large-scale combat operation carried out by the French army in Sahel. Material and Methods Since 2019, proper positioning of Forward Surgical Teams (FSTs) has been imperative in peer-to-near-peer conflict and led to the development of a far-forward surgical asset: The Golden Hour Offset Surgical Team (GHOST). Dedicated to damage control surgery close to combat, GHOST made the FST aero-mobile again, with a light logistical footprint and a fast setting. On 19 and 25 March 2020, Niger and Mali confirmed their first COVID-19 cases, respectively. The pandemic was ongoing in Sahel, where 5,100 French soldiers were deployed in the Barkhane Operation. Results For the first time, the FST had to provide, continuously, both COVID critical care and surgical support to the ongoing operation in Liptako. Its deployment on a Main Operating Base had to be rethought on Niamey, to face the COVID crisis and support ongoing operations. This far-forward surgical asset, embedded with a doctrinal Role-1, sat up a 4-bed COVID intensive care unit while maintaining a casualty surgical care capacity. A COVID training package has been developed to prepare the FST for this innovative employment. This far-forward surgical asset was designed to support a COVID-19 intensive care unit before evacuation, preserving forward surgical capability for battalion combat teams. Conclusion Far-forward surgical assets like GHOST have demonstrated their mobility and effectiveness in a casualty care system and could be adapted as critical care facilities to respond to the COVID crisis in wartime.

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Modified Opsite® Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x155446 ◽

2007 ◽

Vol 89 (1) ◽

pp. 57-61 ◽

Cited By ~ 15

Author(s):

JM Wilde ◽

MA Loudon

Keyword(s):

Critically Ill ◽

Damage Control ◽

Injured Patient ◽

Damage Control Surgery ◽

Traumatic Experience ◽

Fascial Closure ◽

Trauma Patients ◽

Temporary Abdominal Closure ◽

Abdominal Closure ◽

Operative Severity Score

INTRODUCTION Laparostomy techniques have advanced since the advent of damage control surgery for the critically injured patient. Numerous methods of temporary abdominal closure (TAC) are described in the literature with most reports focusing on trauma. We describe a modified technique for TAC and report its use in a series of critically ill non-trauma patients. PATIENTS AND METHODS Eleven patients under the care of one consultant underwent TAC over a 36-month period. A standardised technique was used in all cases and this is described. Severity of illness at the time of the first laparotomy was assessed using the Portsmouth variant of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). RESULTS Nineteen TACs were performed in 11 patients with a variety of serious surgical conditions. In-hospital mortality was zero despite seven of the patients having an individual P-POSSUM predicted mortality in excess of 50%. The laparostomy dressing proved simple in construction, facilitated nursing care and was well-tolerated in the critical care environment. All patients underwent definitive fascial closure during the index admission. CONCLUSIONS Laparostomy is a useful technique outwith the context of trauma. We have demonstrated the utility of the modified Opsite® sandwich vacuum pack for TAC in a series of critically ill patients with a universally favourable outcome. This small study suggests that selective use of TAC may reduce surgical mortality.

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Resusitasi Pengendalian Kerusakan Di Unit Perawatan Intensif

Majalah Kedokteran UKI ◽

10.33541/mk.v36i2.3096 ◽

2021 ◽

Vol 36 (2) ◽

pp. 71-75

Author(s):

Dhanu Pitra Arianto ◽

Nurita Dian Kestriani

Keyword(s):

Damage Control ◽

Damage Control Surgery ◽

Massive Bleeding ◽

Trauma Patients ◽

Damage Control Resuscitation ◽

Early Management ◽

Severe Haemorrhage ◽

Lethal Triad ◽

Clotting Cascade ◽

Injured Patients

Abstrak Resusitasi dengan pengendalian kerusakanmenggambarkan suatu pendekatan ke perawatan awal pada pasien dengan cedera berat. Tujuan pendekatan ini untuk menjaga pasien tetap stabil dengan menghindari intervensi dan kondisi yang berisiko kepada keadaan perburukan dengan mengendalikan trias kematian, yaitu hipotermia, koagulopati, dan asidosis. Merupakan hal yang penting bahwa konsep dan kepraktisan pendekatan ini dipahami oleh semua yang terlibat dalam manajemen awal pasien trauma. Pendekatan ini dimulai dengan pemberian produk darah sejak awal, penghentian perdarahan dan pengembalian volume darah yang bertujuan untuk mengembalikan stabilitas fisiologis dengan cepat. Resusitasi dengan pengendalian kerusakan memilikibeberapa tambahan pendekatan dari bidang farmakologis dan laboratorium untuk meningkatkan perawatan pasien yang mengalami perdarahan. Pendekatan ini termasuk trombelastografi sebagai ukuran rinci kaskade pembekuan, asam traneksamat sebagai antifibrinolitik. Kata kunci : hipotermia, koagulopati, asidosis, perdarahan masif Damage Control Resuscitation in Intensive Care Unit Abstract Damage control resuscitation (DCR) describes an approach to the early care of very seriously injured patients. The aim is to keep the patient alive whilst avoiding interventions and situations that risk worsening their situation by driving the lethal triad of hypothermia, coagulopathy and acidosis.It is critical that the concepts and practicalities of this approach are understood by all those involved in the early management of trauma patients. Damage control resuscitation forms part of an overall approach to patient care rather than a specific intervention and has evolved from damage control surgery. It is characterised by early blood product administration, haemorrhage arrest and restoration of blood volume aiming to rapidly restore physiologic stability. The infusion of large volumes of crystalloid is no longer appropriate, instead the aim is to replace lost blood and avoid dilution and coagulopathy. In specific situations, permissive hypotension may also be of benefit, particularly in patients with severe haemorrhage from an arterial source. Damage control resuscitation has been augmented by both pharmacologic and laboratory adjuncts to improve the care of the hemorrhaging patient. These include thrombelastography as a detailed measure of the clotting cascade, tranexamic acid as an antifibrinolytic. Keywords: hypothermia, coagulopathy, acidosis, massive bleeding

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Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia

Panamerican Journal of Trauma, Critical Care & Emergency Surgery ◽

10.5005/jp-journals-10030-1164 ◽

2017 ◽

Vol 6 (1) ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Carlos A Ordóñez ◽

Albaro J Nieto ◽

Javier A Carvajal ◽

Juan M Burgos ◽

Adriana Messa ◽

...

Keyword(s):

Damage Control ◽

Case Series ◽

Damage Control Surgery ◽

Descriptive Study ◽

Clinical Severity ◽

Damage Control Resuscitation ◽

Obstetric Hemorrhage ◽

Rapid Control ◽

Expected Mortality ◽

Overall Mortality

ABSTRACT Objective The aim of this case series is to describe the experience of implementing damage control resuscitation (DCR) in patients with major obstetric hemorrhage (MOH) between January 2005 and December 2015 in the Fundación Valle del Lili, Cali, Colombia. Materials and methods This is a prospective descriptive study of a case series from 108 patients with MOH who were subjected to DCR. All patients were operated on using a standardized surgical technique in accordance with the institutional protocol. Results The median age was 28 years, with a gestational age of 38 weeks. The principal associated diagnosis was severe preeclampsia (in 39% of cases). A total of 96 patients presented massive postpartum hemorrhage, and 75% of these cases presented after a cesarean section. In all patients, normal control of bleeding was achieved, 60% during the first surgical period. The Acute Physiology and Chronic Health Evaluation score was 14, with an overall mortality of 6.48%, far below the expected mortality according to the clinical severity of these patients. Conclusion This study includes the biggest series of pregnant women with MOH, in a critical condition, in whom DCR was used, during which rapid control of bleeding was achieved, associated with a significantly lower mortality than expected. How to cite this article Escobar MF, Carvajal JA, Burgos JM, Messa A, Ordoñez CA, García AF, Granados M, Forero AM, Casallas JD, Thomas LS, Nieto AJ. Damage Control Surgery for the Management of Major Obstetric Hemorrhage: Experience from the Fundación Valle Del Lili, Cali, Colombia. Panam J Trauma Crit Care Emerg Surg 2017;6(1):1-7.

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Vacuum packing closure for temporal abdominal closure in damage control surgery: Is vacuum packing closure superior to other temporal closure procedures?

Nihon Kyukyu Igakukai Zasshi ◽

10.3893/jjaam.21.835 ◽

2010 ◽

Vol 21 (10) ◽

pp. 835-842

Author(s):

Hiroaki Watanabe ◽

Koji Idoguchi ◽

Tatsuya Nishiuchi ◽

Kazuo Ishikawa ◽

Yasuaki Mizushima ◽

...

Keyword(s):

Damage Control ◽

Damage Control Surgery ◽

Abdominal Closure

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Experience of the MALA Bag in the Open Abdomen Management in an Obstetrical Intensive Care Unit

Acta Médica Portuguesa ◽

10.20344/amp.2019 ◽

2013 ◽

Vol 26 (6) ◽

pp. 699

Author(s):

María de Jesús Angeles Vásquez ◽

Luis Emilio Reyes Mendoza ◽

Ricardo Mauricio Malagón Reyes ◽

Hugo Mendieta Zerón

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Open Abdomen ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Sepsis ◽

History Of ◽

The Mean ◽

Surgical Option ◽

Previous Cesarean

Introduction: Current indications for open abdomen management are damage control surgery, severe intra-abdominal sepsis, abdominal compartment syndrome, abdominal wall closure under tension and mass loss of the abdominal wall.Objective: To describe the experience in open abdomen management using the MALA (mayor absorción de líquido abdominal [greater absorption of abdominal liquid]) bag at the Maternal-Perinatal Hospital Mónica Pretelini Saénz, Health Institute of the State of Mexico.Material and Methods: This was a bidirectional, descriptive and observational study. All patients with the diagnosis of open abdomen managed with the MALA bag admitted to the Obstetric Intensive Care Unit from February 2009 to June 2012 were included.Results: From 25 cases identified in the period of the study, seven were eliminated for incomplete files, remaining 18 cases for the analysis. The mean age was 31.5 years. 78% of the patients were multigravidas, 50% of them with a history of 2 or more deliveries, 83% had a previous cesarean section and 78% were hysterectomized. Evisceration was present in one patient. The main indication for surgical management was damage control. One patient died and a second was transferred to another institution, the rest were discharged by clinical improvement. 12 patients (67%) spent less than 14 days in the Obstetric Intensive Care Unit, only one patient required morethan 30 days in the unit. Discussion: Halve the women who required this surgical alternative, were above 30 years of age. Stressing is the fact that from the 18 admitted patients, 14 (78%) had undergone obstetric hysterectomy, with the etiology of uterine atony in most cases. Damage control surgery seems to be the most elective surgical option to use MALA bag followed by ACS and abdominal sepsis.Conclusion: The MALA bag can offer an economic and effective surgical option for the open abdomen management as well as adrainage technique.

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