'Damage Control' in Severely Injured Patients: Why, When, and How?
| Autor: | Otmar Trentz, Ludwig Labler, Marius Keel |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Damage control
Resuscitation medicine.medical_specialty Reconstructive surgery Abdominal compartment syndrome business.industry Mortality rate medicine.disease Intensive care unit Surgery law.invention Systemic inflammatory response syndrome law Damage control surgery Medicine business Intensive care medicine |
| Popis: | The concept of "damage control” is established in the management of severely injured patients. This strategy saves life by deferring repair of anatomic lesions and focusing on restoring the physiology. The "lethal triad” hypothermia, coagulopathy, and acidosis are physiological criteria in the selection of injured patients for ”damage control”. Other criteria, such as scoring of injury severity or the time required to accomplish definitive repair, are also useful in determining the need for ”damage control”. The staged sequential procedures of ”damage control” include, after the selection of patients (stage 1), "damage control surgery” or "damage control orthopedics” (stage 2), resuscitation in the intensive care unit (stage 3), "second-look” operations or scheduled definitive surgery (stage 4), and the secondary reconstructive surgery (stage 5). The concept of ”damage control” was carried out in a third of 622 severely injured patients in our division. Although level I evidence is lacking, the incidence of posttraumatic complications and the mortality rate were reduced. However, better understanding of the significance and kinetics of physiological parameters including inflammatory mediators could help to optimize the "damage control” concept concerning the selection of patients and the time points of staged sequential surgery |
| Databáze: | OpenAIRE |
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