What do you understand by the term “Damage Control Surgery” (DCS) in relation to abdominal trauma? What important complications may occur following the initial admission to ICU after DCS?
Key feature. Damage Control Surgery involves a 4 phase approach to major emergency abdominal injuries:
• recognition of at risk patient
• Limited, focused surgery for control of haemorrhage and address contamination with temporary abdominal closure,
• restoration of near normal physiology – cardiovascular resuscitation, rewarming (usually active) if hypothermic, correction of coagulopathy (blood products and aFVII) and acidosis. – with optimization of ventilation and
• re laparotomy at 24 – 36 hours with removal of packs, definitive surgery and formal abdominal closure, where possible.
New onset or uncontrolled surgical bleeding
Abdominal compartment syndrome (ACS),
inability to wake and wean (open abdomen / planned return to theatre)
missed injuries in the multiply injured patient (need for full examination on admission)
An excellent article on this is available from 2004 (Critical Care Clinics). The topic of damage control surgery is also discussed briefly in the answer to Question 20 from the first paper of 2011. To simplify revision, that answer is replicated below:
Complications upon returning to the ICU:
Remember that the patient was not being definitively managed in theatre; if you are lucky they are bleeding slightly less than they were before they went to theatre, but in general the resuscitation is only half-complete. Not only that, but they were probably rushed through the ED, and a secondary survey (or trauma CT) may not have been performed.
Thus, one can anticipate the following:
Morrison, C. Anne, et al. "Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: preliminary results of a randomized controlled trial." Journal of Trauma and Acute Care Surgery 70.3 (2011): 652-663.
Kaafarani, H. M. A., and G. C. Velmahos. "Damage Control Resuscitation In Trauma." Scandinavian Journal of Surgery (2014): 1457496914524388.
Jaunoo, S. S., and D. P. Harji. "Damage control surgery." International Journal of Surgery 7.2 (2009): 110-113.
Schreiber, Martin A. "Damage control surgery." Critical care clinics 20.1 (2004): 101-118.