Risk of infection to packed gauze in damage control surgery for patients with hemorrhagic shock: safe limit of duration of packing

Introduction

Damage control is one of the useful strategies for trauma patients with hemorrhagic shock and critically ill patients with septic shock. We often perform gauze packing for the first step of damage control (damage control surgery). We are anxious about infection of packed gauze, and some experts said that we should remove the packed gauze within 48 to 72 hours. However, there is no evidence concerning the relation between duration of packing and risk of infection of the packed gauze. The aim of this study is to clarify this relation.

Methods

A prospective observational case-series study. We performed bacterial culture of the removed gauze in patients who underwent gauze packing in damage control surgery and removal of the packed gauze. We examined the relation between the duration of packing and risk of infection of the packed gauze.

Results

Twenty-one patients were enrolled. The duration of packing ranged from 19 to 146 hours. Bacterial culture was negative in 52% of cases and positive in 48% of cases. Bacterial culture was positive in all cases in whom the duration of packing was over 100 hours. The duration of packing was longer in positive bacterial culture cases than in negative (no statistical difference). More cases were positive in bacterial culture in cases with gastrointestinal perforation (GIP) than without GIP (no statistical difference). However, many cases with GIP were obligated to continued packing for a long duration. There was no relation between bacterial culture and preoperative and operative bleeding (Figure 1).

Figure 1

Duration of packing and bacterial culture of packed gauze.

Conclusion

Gauze packing in damage control surgery is thought to be safe within 96 hours from the viewpoint of infection. We cannot determine the relation between bacterial infection and GIP.