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'Damage control' in the intensive care unit

Introduction

'Damage control' therapy has been efficient in the control of haemorrhagic situations, particularly in serious trauma; assisting in the temporary control of severe bleeding in situations in which hypothermia, acidosis and coagulation disturbances aggravate the immediate prognosis.

Case report

A male, 55 years old, admitted to the emergency room wounded by a gunshot. Subdued exploratory laparotomy found hepatic injury, gastric injury and splenic blast. The surgical procedure was interrupted because of hypothermia (33.3°C) and acidosis (pH 7.20), temporary haemostasis carried out with compresses and haemostatic surgical instruments. The patient was admitted to the intensive care unit hypothermal, in metabolic acidemia, haemodynamically unstable, and needing vasoactive drugs and mechanical ventilation. After 8 hours, when the acid–basic balance, temperature and coagulation were normal, the patient underwent surgery for correction of the hepatic wound with epiplonplasty and peritoneostomy. When back at the intensive care unit, the patient was monitored with a pulmonary artery catheter, received large spectrum antibiotic therapy and reversal of the multiple organ dysfunction. After 14 days of internment, the patient was discharged in adequate clinical condition.

Conclusion

'Damage control' therapy has been demonstrated to be a promising therapy for temporary bleeding control under disturbance of coagulation in the presence of hypothermia, acidosis and prolonged hypotension in major surgical procedures. The intensive care unit must be ready for quick treatment of these disturbances, allowing the patient to undergo definitive surgery as soon as possible.

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Guimarães, H., Ricci, M., Schneider, A. et al. 'Damage control' in the intensive care unit. Crit Care 7, P108 (2003). https://doi.org/10.1186/cc2304

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Keywords

  • Intensive Care Unit
  • Hepatic Injury
  • Pulmonary Artery Catheter
  • Exploratory Laparotomy
  • Severe Bleeding