Damage control surgery--the intensivist's role.
"Damage control" surgery has evolved during the past 20 years from an accepted surgical technique in the traumatized, moribund patient to an expanded role in critically ill, nontraumatized patients. Physicians caring for these patients in extremis have begun to recognize a pattern of severe physiologic derangement that prompts an abbreviated laparotomy after hemorrhage and contamination control. Emphasis then shifts from the operating theater to the intensive care unit, where the patient's physiologic deficits are corrected. Once these derangements have been resolved, the patient is taken back to the operating room for definitive, reconstructive surgical care. The purpose of this article is to review the concept of "damage control" in reference to the patient whose pathophysiologic depletion prompts the need for it. Resuscitation in the intensive care unit will be summarized, pitfalls will be identified, and treatment plans will be delineated. Complications such as abdominal compartment syndrome and difficult abdominal wall closures will also be discussed.
Sagraves
Scott G
SG
Department of Surgery, East Carolina University, Brody School of Medicine, 600 Moye Blvd, Greenville, NC 27834, USA. ssagrave@pcmh.com
Toschlog
Eric A
EA
Rotondo
Michael F
MF
D000138:Acidosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D003422:Critical Care / Q000266:history / Q000379:methods*; D004211:Disseminated Intravascular Coagulation / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006488:Hemostasis, Surgical / Q000379:methods; D049673:History, 20th Century; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D007362:Intensive Care Units / Q000458:organization & administration; D018579:Patient Selection; D010819:Physician's Role; D015642:Radiology, Interventional / Q000379:methods; D012086:Reoperation / Q000379:methods; D012121:Respiration, Artificial / Q000379:methods; D012151:Resuscitation / Q000379:methods; D017694:Rewarming / Q000379:methods; D013514:Surgical Procedures, Operative / Q000379:methods; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*