units of red blood or the need for body fluid replacement), pelvic injury corrected with angiographic embolization, among critical physiological factors come to the, and injuries where visceral organ and vascular injuries have occurred together are indicators, applied after establishing a wide vascular. 2002; 32: 195–202. 2005; 36: 1001–1010. There were 24 deaths (37%), the majority from uncontrolled haemorrhage (18 patients). Results: 37 Full PDFs related to this paper. La chirurgie d’urgence ajoute une agression au stress biologique du traumatisme. 50 diagnostic and 13 interventional cases were evaluated. Bilomas and bile leaks were diagnosed in 16 cases post-injury. J Trauma. Damage control surgery (DCS) is a strategy originally described in the context of exsanguinating abdominal trauma, where the completeness of operative repair is sacrificed in order to limit physiologic deterioration.14,15 This technique has been extended to include other body regions. In 29 of 33 cases, mechanism of injury was blunt trauma and all were FAST positive during primary survey. Management of these cases has changed significantly in the last decade with the emergence of a new paradigm termed damage control. Is the evolving management of intra-abdominal hypertension and abdominal compartment syndrome improving survival? Attention is directed at using all available techniques for controlling bleeding, including packing. After major sources of hemorrhage were controlled, the following clinical and laboratory mean values were observed: red cell transfusions--22 units, core temperature--32.1 C, and pH--7.09. and acidosis revisited. Arch Surg. However, reconstructive surgeries, stoma forming, and nutrition ostomies are not applied in this quick laparotomy. 14 avril 2016 . Conclusion: Damage control surgery and damage control management of the patient are important for improved survival rates and success of treatment before the lethal triad occurs deeply. Training of the surgeon, hospital volume and learning curves are becoming increasingly more important to maximize patient safety, surgeon expertise and cost effectiveness. The authors conclude that patients with hypothermia, acidosis, and coagulopathy are at high risk for imminent death, and that prompt termination of laparotomy with the use of the above techniques is a rational approach to an apparently hopeless situation. By using our site, you agree to our collection of information through the use of cookies. This review provides an overview how to identify and minimize intra- and postoperative complications. In patients with clinical evidence of biliary complications, CT scan is a useful diagnostic and therapeutic tool. 1999; 94: 199–207. Assessment of the adequacy of the circulating volume accompanies active rewarming and correc-tion of coagulopathy. AE at admission was associated with a significantly higher rate of biliary complications. Ann Surg. Damage control surgery has increased as a popular application in patients with a deteriorated general condition due to a severe trauma incident. Logistic regression showed that red cell transfusion rate and pH may be helpful in determining when to consider abbreviated laparotomy. Closed system drainages and a nasoenteric feeding tube are placed if necessary. The SECURE device was evaluated in a prospective non-randomized single-centre trial with patients undergoing 6 F invasive cardiac procedures. Surgical treatment was found to be associated with higher complication rate. Accordingly, use of topical thrombin appears effective in saving patients and staffs time, minimizing the blood loss, Background: Crit Care Med. Damage control surgery (DCS) = “chirurgie de sauvetage” Damage control resuscitation (DCR) Correction des détresses physiologiques Chirurgie de réparation définitive Le « damage control » chirurgical. 2. The new SECURE device demonstrates that it is feasible in diagnostic and interventional cardiac catheterization. Regarding complications non-survivors had significantly prolonged bleeding and higher rate of Acute respiratory distress syndrome (ARDS) (p = 0.0001; p = 0.0001), while survivors had significantly higher rate of pleural effusion (p = 0.0001). There were two access site complications (hematoma > 5 cm). Prolonged operative times and persistent bleeding lead to the lethal triad of coagulopathy, acidosis, and hypothermia, resulting in a mortality of 90%. Four hundred seventy-eight consecutive patients requiring an open abdomen for the management of intra-abdominal hypertension or abdominal compartment syndrome. Operative techniques in liver trauma are some of the most challenging. The term “damage control” reportedly originated from the United States Navy and it represents “the capacity of a ship to absorb damage and maintain mission integrity” [1]. Time to hemostasis (TTH), time to ambulation (TTA) and data regarding short-term and 30-day clinical follow-up were recorded. There was significant difference in the amount of red blood cells (RBC) transfusion in the first 24 h between survivors and non-survivors (p = 0.001). years. 2010; 4: 5. doi:10.1186/1754-9493-4-5. liver or colonic injury. reserves and control of acidosis, coagulopathy, critical physiological factors come to the fore in. Objective: The basis of damage control surgery rests on quick control of life-threatening bleeding, injuries, and septic sources in the appropriate patients before restoring their physiological reserves as a first step followed by ensuring of the physiological reserves and control of acidosis, coagulopathy, and hypothermia prior to complementary surgery. It also leads to the impairment of the immune system. Six patients were re- hospitalized after discharge due to late complica- tions. During the past 7.5 years, 200 patients were treated with unorthodox techniques to abruptly terminate the laparotomy and break the cycle. Results: Damage control surgery facilitates a strategy for life-saving intervention for critically ill patients by abbreviated laparotomy with subsequent reoperation for delayed definitive repair after physiological resuscitation. Am J Respir Crit Care Med. 2. Overall mortality rate was 33.1 %. and preventive strategies. ‘Damage Control Surgery’ Chirurgie abrégée en trauma Soazig Le Guillan, md frcsc Université de Montréal . The main objective here is the elimination of problems caused by the acidosis, coagulopathy, and hypothermia triangle. 1997; 42: 857–862. Damage control surgery is indicated in patients suffering from multiple trauma to avoid aggressive and haemorrhagic, long-duration surgical procedures, performed by general Procedures of less than one hour, aim controlling haemorrhage, restoring tissues’ controlling sepsis, and immobilizing fractured limbs. No major adverse events were identified during hospitalization or at the 30 day follow-up. 5.5. In the rapid/primary surgery stage, the purpose is controlling bleeding and contamination. With the exception of intravascular shunts, there were survivors who were treated by each of the unorthodox techniques. The duration of stay in the intensive care unit was 19 + 14 and 29 + 17 days, respectively. Femoral vascular access and closure approaches have been greatly refined by the demands of transcatheter aortic valvular replacement (TAVR), with computed tomography (CT) assessment for procedure planning, the use of micropuncture and ultrasound, and crossover techniques. DOI: 10.1186/s13017-015-0031-8. This research was scheduled as a retrospec- tive study. Surgical management of AAST grades III-V hepatic trauma by Damage control surgery with perihepatic packing and Definitive hepatic repair–single centre experience, The results of damage control surgery in abdominal trauma, Complications of high grade liver injuries: Management and outcomewith focus on bile leaks, Complications in colorectal surgery: Risk factors and preventive strategies. be prolonged, is to maintain acceptable vital functions until reaching the hospital [8–10]. Eleven patients who underwent damage control surgery during 2000-2006 were included in the study. hemorrhage, prevent contamination and protect from further injury in severely traumatized patients [1-7]. Of 102 patients who died before reoperation 68 (67%) did so within 2 hours of the initial procedure. Definitive hepatic repair was performed in 62(51.2 %) patient. Both univariate and multivariate analyses were performed to identify patient and management factors associated with improved survival. Ninety-eight patients (49%) survived to undergo planned reoperation (mean delay 48.1 hours), and 66 of 98 (67%) survived to leave the hospital. Damage control surgery and intensive care 715. This paper. calcium signal induced by human von Willebrand factor. The leading cause of death among trauma patients remains uncontrolled hemorrhage and accounts for approximately 30–40% of trauma-related deaths. The principles of damage control surgery and resuscitationlisted below are of tantamount importance for the care of the patientwho is hypothermic, coagulopathic, acidotic, and resistant to fluidresuscitation. Clinically significant decreases in resource utilization and an increase in same-admission primary fascial closure from 59% to 81% were recognized. Sajs. La technique a été abandonnée du fait de complications septiques.3 Pour être bénéfique, le traitement opératoire doit compenser ses effets délétères et replacer l’organisme dans des conditions favorables à la guérison. Blood. Over the last two decades, public health measures and better pre-hospital care have led to an increasing number of seriously injured patients surviving their initial accident and arriving in hospital.1These injured patients often have injuries to multiple body cavities, massive haemorrhage, and near exhausted physiological reserve. Topical thrombin was applied to the surgical intensive care unit was 19 + and. Break the cycle is done was no statistically significant difference in terms of the needles as retrograde. Approach, which causes collagen shrinking and swelling done [ 7 ] ( 85 % ), patient s. Addressed the metabolic acidosis will gradually improve improving survival % were recognized ARDS,. 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