Damage control in the critically ill and injured patient

K. J. Brasel, J. Ku, C. C. Baker, E. J. Rutherford

Research output: Contribution to journalReview article

11 Scopus citations

Abstract

Ideally, the trauma celiotomy should be considered in three phases, which may or may not be separated temporally. They are: a) damage control; b) restitution of physiologic reserve; and c) reconstruction. Perhaps the most important and effective aspect of damage control is to decide to pursue this alternative early. The surgeon may often be able to predict those patients who are at such high risk that damage control should be considered in the preoperative planning. Patients who can be included in this category are: patients with profound shock, hypothermia, and acidosis preoperatively; coagulopathic patients; patients with severe debilitating problems such as cirrhosis, chronic obstructive pulmonary disease (COPD), and severe atherosclerotic vascular disease. Consideration should be given to making an expeditious trip to the operating room with damage control celiotomy followed by resuscitation in the ICU. It is more important to fight a holding maneuver in the initial battle so that the patient will stay alive long enough for the surgeon to help save his or her life and win the war. The goals of damage control are to: a) identify injuries; b) control hemorrhage; and c) control contamination. Initial attention should be directed to suturing of vascular injuries, decreasing the level of contamination from bowel injuries, and packing of solid organ injuries. Efforts should not be made to restore bowel continuity or perform definitive procedures if the patient is in severe physiologic distress. Guidelines for use of the damage control approach include any trauma patient requiring a celiotomy who meets any of the following criteria: a) developing a base deficit worse than -15 mmol/L in a patient <55 yrs or worse than -8 mmol/L in a patient >55 yrs or in any patient with a head injury; b) lactate of >5 mmol/L; e) temperature of <35°C; d) a prothrombin time of >16 secs; e) partial thromboplastin time of >50 secs; f) transfusion of≥10 units of blood over 4 hrs; g) a pH of <7.18; h) oxygen consumption index of ≤110 mL/min/m2; or i) need for a prolonged operation.

Original languageEnglish (US)
Pages (from-to)73-86
Number of pages14
JournalNew Horizons: Science and Practice of Acute Medicine
Volume7
Issue number1
StatePublished - Jan 1 1999
Externally publishedYes

Keywords

  • Acidosis
  • Hemorrhagic diathesis
  • Hypothermia
  • Lactic acid
  • Laparotomy
  • Multiple trauma
  • Shock

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Fingerprint Dive into the research topics of 'Damage control in the critically ill and injured patient'. Together they form a unique fingerprint.

  • Cite this