Damage control in penetrating cardiac trauma.

Autor:	González-Hadad A; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.; Centro Médico Imbanaco, Cali, Colombia., Ordoñez CA; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.; Universidad Icesi, Cali, Colombia., Parra MW; Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA., Caicedo Y; Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia., Padilla N; Fundacion Valle del Lili, Centro de Investigaciones Clinicas (CIC), Cali, Colombia., Millán M; Universidad Icesi, Cali, Colombia.; Fundación Valle del Lili, Department of Surgery, Division of Transplant Surgery, Cali, Colombia., García A; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.; Universidad Icesi, Cali, Colombia., Vidal-Carpio JM; Hospital General Teofilo Davila, Servicio de Emergencias, Cuenca, Ecuador.; Universidad de Cuenca, Department of Surgery, Cuenca, Ecuador., Pino LF; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia., Herrera MA; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia., Quintero L; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Centro Médico Imbanaco, Cali, Colombia., Hernández F; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia., Flórez G; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia., Rodríguez-Holguín F; Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia., Salcedo A; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.; Centro Médico Imbanaco, Cali, Colombia.; Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia., Serna JJ; Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.; Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.; Centro Médico Imbanaco, Cali, Colombia.; Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia., Franco MJ; Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia., Ferrada R; Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.; Centro Médico Imbanaco, Cali, Colombia., Navsaria PH; University of Cape Town, Faculty of Health Sciences, Groote Schuur Hospital, Trauma Center, Anzio Road, Observatory, Cape Town, South Africa.
Jazyk:	angličtina
Zdroj:	Colombia medica (Cali, Colombia) [Colomb Med (Cali)] 2021 Apr 03; Vol. 52 (2), pp. e4034519. Date of Electronic Publication: 2021 Apr 03.
DOI:	10.25100/cm.v52i2.4519
Abstrakt:	Definitive management of hemodynamically stable patients with penetrating cardiac injuries remains controversial between those who propose aggressive invasive care versus those who opt for a less invasive or non-operative approach. This controversy even extends to cases of hemodynamically unstable patients in which damage control surgery is thought to be useful and effective. The aim of this article is to delineate our experience in the surgical management of penetrating cardiac injuries via the creation of a clear and practical algorithm that includes basic principles of damage control surgery. We recommend that all patients with precordial penetrating injuries undergo trans-thoracic ultrasound screening as an integral component of their initial evaluation. In those patients who arrive hemodynamically stable but have a positive ultrasound, a pericardial window with lavage and drainage should follow. We want to emphasize the importance of the pericardial lavage and drainage in the surgical management algorithm of these patients. Before this concept, all positive pericardial windows ended up in an open chest exploration. With the coming of the pericardial lavage and drainage procedure, the reported literature and our experience have shown that 25% of positive pericardial windows do not benefit and/or require further invasive procedures. However, in hemodynamically unstable patients, damage control surgery may still be required to control ongoing bleeding. For this purpose, we propose a surgical management algorithm that includes all of these essential clinical aspects in the care of these patients. Competing Interests: Conflicts of interest: The authors declare that they have no conflict of interest. (Copyright © 2021 Colombia Medica.)
Databáze:	MEDLINE
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