[Damage control surgery].

Abstract

Trauma patients who receive exsanguinating torso injuries often develop hypothermia, metabolic acidosis, and coagulopathy before death. A new strategy for trauma surgery has been developed to avoid the occurrence of these events and hence prevent trauma deaths. The strategy is called "damage control surgery" and consists of three maneuvers: a) damage control; b) restoration of physiologic stability; and c) definitive surgery. The goals of damage control are to: a) identify injuries; b) control ongoing hemorrhage; and c) control intestinal spillage. Damage control is followed by intensive care to restore the physiologic reserve. Once secondary resuscitation in the ICU is accomplished, planned reoperation should be performed to repair anatomic injuries. Planned reoperation is usually possible within 36 hours after the initiation of intensive care. Some patients who undergo damage control develop abdominal compartment syndrome characterized by increased intraabdominal pressure, increased peak airway pressure, decreased urine output, and decreased cardiac output. Early decompression surgery should be considered in such patients.