Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology
Autor(a) principal: | |
---|---|
Data de Publicação: | 2012 |
Outros Autores: | |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://revista.spcir.com/index.php/spcir/article/view/47 |
Resumo: | Hypothermia, coagulopathy and metabolic acidosis are at serious risk to develop in severe trauma patients. These metabolic derange- ments known as lethal triad contribute to an increase in mortality rate in these patients. Damage control surgery emerged as an alter- native, with a positive impact on survival, to definitive and prolonged procedures which deplete the patient ́s physiological reserves leading inexorably to a vicious cycle and death. The timing of damage control surgery is crucial, because after the establishment of the lethal triad the outcome of the procedure is severely worsened. Nowadays, the decision is frequently delayed to last resort, when phy- siological derangements are already present. Therefore formal guidelines for its early application are necessary in order to avoid delays and avoidable deaths. Selection criteria for damage control surgery are highly controversial, varying substantially in the literature. The purpose of this article is therefore to revise the selection criteria for damage control surgery proposed in the literature, justified on the underlying pathophysiology of trauma. Despite all controversy, an improvement in patient outcome will emerge of the clarification of criteria, as well as of appropriate timing, to perform damage control surgery. Keywords: "blood coagulation disorders"[MeSH Terms]; "acidosis"[MeSH Terms]; "hypothermia"[MeSH Terms]; "intra-abdominal hypertension"[MeSH Terms]; "wounds and injuries"[MeSH Terms] |
id |
RCAP_b5fda64044647ab997b3b6242863dde9 |
---|---|
oai_identifier_str |
oai:revista.spcir.com:article/47 |
network_acronym_str |
RCAP |
network_name_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository_id_str |
7160 |
spelling |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiologyA cirurgia de controlo de danos em contexto de trauma: A fisiopatologia como suporte para a sua realizaçãoHypothermia, coagulopathy and metabolic acidosis are at serious risk to develop in severe trauma patients. These metabolic derange- ments known as lethal triad contribute to an increase in mortality rate in these patients. Damage control surgery emerged as an alter- native, with a positive impact on survival, to definitive and prolonged procedures which deplete the patient ́s physiological reserves leading inexorably to a vicious cycle and death. The timing of damage control surgery is crucial, because after the establishment of the lethal triad the outcome of the procedure is severely worsened. Nowadays, the decision is frequently delayed to last resort, when phy- siological derangements are already present. Therefore formal guidelines for its early application are necessary in order to avoid delays and avoidable deaths. Selection criteria for damage control surgery are highly controversial, varying substantially in the literature. The purpose of this article is therefore to revise the selection criteria for damage control surgery proposed in the literature, justified on the underlying pathophysiology of trauma. Despite all controversy, an improvement in patient outcome will emerge of the clarification of criteria, as well as of appropriate timing, to perform damage control surgery. Keywords: "blood coagulation disorders"[MeSH Terms]; "acidosis"[MeSH Terms]; "hypothermia"[MeSH Terms]; "intra-abdominal hypertension"[MeSH Terms]; "wounds and injuries"[MeSH Terms] Os doentes traumatizados graves apresentam um elevado risco de desenvolver coagulopatia, hipotermia e acidose metabólica, alterações conhecidas genericamente como tríade letal, o que contribui para um aumento marcado da taxa de mortalidade. Surgiu assim a cirurgia de controlo de danos que demonstrou um impacto positivo na sobrevida destes doentes, evitando cirurgias complexas e demoradas que aumentam ainda mais a depleção das reservas fisiológicas e consequentemente conduzem à entrada num ciclo vicioso. A ausência de guidelines que orientem o uso desta abordagem cirúrgica deixa a sua utilização quase exclusivamente dependente do critério do cirurgião, decisão essa que é frequentemente tardia e de último recurso, quando já se estabeleceram todos os componentes da tríade letal, o que tem um impacto negativo no outcome. Perante a controvérsia relativamente aos critérios de seleção para cirurgia de controlo de danos, o objetivo deste trabalho consistiu numa revisão das indicações para realização de cirurgia de controlo de danos sugeridas na literatura, bem como da fisiopatologia do politraumatizado que está subjacente aos princípios da sua utilização. Concluiu-se que, apesar da polémica que persiste, a melhoria do outcome dos doentes politraumatizados graves passará pela clarificação das indicações, em tempo adequado, para a realização de controlo de danos. Palavras-chave: Cirurgia de controlo de danos; Coagulopatia; Hipotermia; Acidose metabólica; Síndrome do Compartimento abdo- minal; Trauma. Sociedade Portuguesa de Cirurgia2012-06-29info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttps://revista.spcir.com/index.php/spcir/article/view/47Revista Portuguesa de Cirurgia; No 21 (2012): Junho 2012 - II Série; 21-32Revista Portuguesa de Cirurgia; No 21 (2012): Junho 2012 - II Série; 21-322183-11651646-6918reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spcir.com/index.php/spcir/article/view/47https://revista.spcir.com/index.php/spcir/article/view/47/44Copyright (c) 2016 Revista Portuguesa de Cirurgiainfo:eu-repo/semantics/openAccessCoelho, AndreiaPinto-de-Sousa, João2024-03-14T22:05:25Zoai:revista.spcir.com:article/47Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T04:00:54.179219Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology A cirurgia de controlo de danos em contexto de trauma: A fisiopatologia como suporte para a sua realização |
title |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology |
spellingShingle |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology Coelho, Andreia |
title_short |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology |
title_full |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology |
title_fullStr |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology |
title_full_unstemmed |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology |
title_sort |
Damage control surgery in trauma patients: criteria for management of patients based on the underlying pathophysiology |
author |
Coelho, Andreia |
author_facet |
Coelho, Andreia Pinto-de-Sousa, João |
author_role |
author |
author2 |
Pinto-de-Sousa, João |
author2_role |
author |
dc.contributor.author.fl_str_mv |
Coelho, Andreia Pinto-de-Sousa, João |
description |
Hypothermia, coagulopathy and metabolic acidosis are at serious risk to develop in severe trauma patients. These metabolic derange- ments known as lethal triad contribute to an increase in mortality rate in these patients. Damage control surgery emerged as an alter- native, with a positive impact on survival, to definitive and prolonged procedures which deplete the patient ́s physiological reserves leading inexorably to a vicious cycle and death. The timing of damage control surgery is crucial, because after the establishment of the lethal triad the outcome of the procedure is severely worsened. Nowadays, the decision is frequently delayed to last resort, when phy- siological derangements are already present. Therefore formal guidelines for its early application are necessary in order to avoid delays and avoidable deaths. Selection criteria for damage control surgery are highly controversial, varying substantially in the literature. The purpose of this article is therefore to revise the selection criteria for damage control surgery proposed in the literature, justified on the underlying pathophysiology of trauma. Despite all controversy, an improvement in patient outcome will emerge of the clarification of criteria, as well as of appropriate timing, to perform damage control surgery. Keywords: "blood coagulation disorders"[MeSH Terms]; "acidosis"[MeSH Terms]; "hypothermia"[MeSH Terms]; "intra-abdominal hypertension"[MeSH Terms]; "wounds and injuries"[MeSH Terms] |
publishDate |
2012 |
dc.date.none.fl_str_mv |
2012-06-29 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/47 |
url |
https://revista.spcir.com/index.php/spcir/article/view/47 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spcir.com/index.php/spcir/article/view/47 https://revista.spcir.com/index.php/spcir/article/view/47/44 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2016 Revista Portuguesa de Cirurgia info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2016 Revista Portuguesa de Cirurgia |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Cirurgia |
dc.source.none.fl_str_mv |
Revista Portuguesa de Cirurgia; No 21 (2012): Junho 2012 - II Série; 21-32 Revista Portuguesa de Cirurgia; No 21 (2012): Junho 2012 - II Série; 21-32 2183-1165 1646-6918 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
|
_version_ |
1799138183306280960 |