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Titolo:
Evolution in damage control for exsanguinating penetrating abdominal injury
Autore:
Johnson, JW; Gracias, VH; Schwab, CW; Reilly, PM; Kauder, DR; Shapiro, MB; Dabrowski, GP; Rotondo, MF;
Indirizzi:
Univ Penn, Sch Med, Dept Surg, Div Traumatol & Surg Crit Care, Philadelphia, PA 19104 USA Univ Penn Philadelphia PA USA 19104 Crit Care, Philadelphia, PA 19104 USA E Carolina Univ, Brody Sch Med, Div Trauma & Surg Crit Care, Dept Surg, Greenville, NC USA E Carolina Univ Greenville NC USA it Care, Dept Surg, Greenville, NC USA
Titolo Testata:
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE
fascicolo: 2, volume: 51, anno: 2001,
pagine: 261 - 271
Fonte:
ISI
Lingua:
ENG
Soggetto:
PLANNED REOPERATION; CONSECUTIVE PATIENTS; COMPARTMENT SYNDROME; MASSIVE TRANSFUSION; VASCULAR INJURIES; MULTIPLE INJURIES; PRIMARY CLOSURE; TRAUMA PATIENTS; SEVERITY SCORE; COLON INJURIES;
Keywords:
damage control; penetrating injury;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
84
Recensione:
Indirizzi per estratti:
Indirizzo: Gracias, VH Ctr Trauma, 3440 Market St,1st Floor, Philadelphia, PA 19104 USA Ctr Trauma 3440 Market St,1st Floor Philadelphia PA USA 19104
Citazione:
J.W. Johnson et al., "Evolution in damage control for exsanguinating penetrating abdominal injury", J TRAUMA, 51(2), 2001, pp. 261-271

Abstract

Objective Damage control (DQ has proven valuable in exsanguinated patients. The purpose of this study was to quantify and qualify the impact of current damage control principles applied in a penetrating abdominal injury (PAI) population. Methods. Over a 3-year period (June 1997-May 2000), of 271 laparotomies for PAI, 24 patients underwent DC (8.9%). Demographics, injury grade, resuscitative and operative parameters, acid-base status, coagulation profiles, fluid/transfusion requirements, definitive repairs, abdominal closure, complications, and outcomes were reviewed. Data were compared with our DC experience a decade earlier. Fisher's exact test was used for comparisons. Results. Overall survival improved for equivalent Injury Severity Score, Revised Trauma Score, TRISS, admission systolic blood pressure, operating room systolic blood pressure, and Penetrating Abdominal Trauma Index score. Solids (1.2 vs. 1.3), hollow organ (1.5 vs. 1.7), and major vascular injuries (0.5 vs. 0.8) per patient remain unchanged. Currently, there was less hypothermia with equivalent operating room times. In intensive care unit survivors, acid-base status was similar but coagulopathy and hypothermia were less severe. Definitive colon management has shifted from ostomies to anastomoses. Eventual fascial closure occurred in 14 of 19 (74%) compared with 12 of 14 (86%) in the historical group. There were three gastrointestinal fistulae (one pancreatic), one anastomotic leak, and three intra-abdominal abscesses. Conclusion. Continued application of DC principles has led to improved survival with PAL Better control of temperature, experience with the open abdomen, and intensive care unit care may be causative.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 05/07/20 alle ore 10:09:02