POSTOPERATIVE CARE AND COMPLICATIONS OF DAMAGE CONTROL SURGERY
Section snippets
THE IMMEDIATE POSTOPERATIVE PERIOD
The first concern in the surgical intensive care unit (SICU) is resuscitation. This has usually been an ongoing and losing battle in the operating room and is usually the reason for a damage control procedure in the first place. Much catching up must still be done. Most patients arrive in the SICU cold, coagulopathic, and acidotic, with ongoing hemorrhage. Steps to break this vicious circle must be aggressive and immediate.
RETURNING TO THE OPERATING ROOM
Returning a patient to the operating room after damage control can be either planned or unplanned. Damage control procedures usually imply that more work needs to be done in the operating room, so nearly all involve a planned reoperation. An unplanned return usually means that the surgeon decides to go back to the operating room sooner than planned or before resuscitation goals have been achieved. The indications for unplanned return have been discussed and include suspected surgical bleeding,
LATE POSTOPERATIVE CONCERNS AND COMPLICATIONS
These very ill patients benefit from an experienced surgical critical care team. The problems that must be addressed postoperatively include all organ systems and in many respects do not differ from those of other critically ill surgical patients. The consequences of shock, multiple transfusions, and massive injury result in the systemic inflammatory response syndrome, infection, and multiple organ failure in many of these patients. A primer of surgical critical care is not the purpose of this
SUMMARY
Damage control procedures are being used with increasing frequency as the physiologic limits of the surgical patient are approached and recognized. These patients are returned to the SICU, where rapid restoration of circulating volume, normothermia, maintenance of oxygen delivery, and correction of transfusion-associated coagulopathy are essential to the success of the technique, which requires expeditious reoperation and completion of definitive surgical management. The potential need for
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Cited by (0)
Address reprint requests to R. Russell Martin, MD Department of Surgery Brooke Army Medical Center San Antonio, TX 78234
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From Brooke Army Medical Center, San Antonio, Texas