[1–25] Damage control resuscitation seeks to minimize blood loss until definitive hemostasis is achieved. Waibel BH, Rotondo MM. [4], DIVERTI, a multicenter, prospective, randomized controlled trial reported no statistically significant difference between HP and PADS, in terms of mortality and overall morbidity (42.3% vs 54%) at emergency surgery analysis. This surgical strategy was named "damage control surgery" by Rotondo et al1 in 1993. In a world rife with technological glitches – and one in which simply clicking a button can have far-reaching impact – making mistakes is inevitable. Damage Control Resuscitation: Identification and Treatment of Life-Threatening Hemorrhage is an essential resource for physicians and related professionals, residents, nurses and medical students in emergency medicine, anesthesia, surgery, and critical care, as well as civilian and military EMS providers. A historical review of. Damage control. Florin Iordache. Damage control surgery (DCS) can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the intensive care unit (ICU) and subsequent reexploration and definitive repair following restoration of normal physiology. The following goes through the different phases to illustrate, step by step, how one might approach this. [16]. The included 8 articles covered a 2006 to 2018 study period with a total population of 359 patients. By continuing to use this website you are giving consent to cookies being used. At present, such surgical approach is also finding application in non-traumatic emergencies such as perforated ACD. [11–18] At presentation, most patients showed III and IV ASA score (293/359 = 81.6%) while having Hinchey III perforated ACD (251/359 = 69.9%). [28]. 37 Full PDFs related to this paper. [11–15,17,18] 116 patients had peritonitis lasting longer than 24 hours (4 out of 8 studies). [19] In stoma reversal analysis, discrepancy among HP patients and PADS ones turned out statistically significant (64.6% vs 96%), while overall morbidity recorded no statistically significant difference (21.2% vs 12.5%). Formal analysis: Maurizio Zizzo, Carolina Castro Ruiz, Magda Zanelli, Francesca Sanguedolce, Stefano Ascani. These trials should analyze DCS patients in comparison with patient populations undergoing HP and / or PRA/PADS. Most patients received a limited resection plus NPWT at first-look (260 patients in 6 out of 8 studies). i) identification critically ill patient according to injury pattern (underlying disease) and pathophysiology; iii) parameter re-evaluation with patient on operating table; iv) continued restoration of physiology at ICU; i) patient populations with sepsis/septic shock/organ failure and. Damage control, [32]. [6] DCS strategy includes abbreviated source-control laparotomy followed by intensive care unit (ICU) transfer for physiology resuscitation and delayed surgery for definitive management. (Damage-control-surgery) การกู้ชีพโดยคงความดันไว้ในระดับต่ํา (Permissive&hypotension) -เป็นส่วน หนึ่งของแนวคิด Damage-control-resuscitation-ซึ่งอิงมาจากพื้นฐานทางทฤษฎีที่ In accordance with current guidelines, patients affected by generalized peritonitis should undergo emergency surgery. [1,2] Approximately 10% to 25% patients affected by colonic diverticulosis are going to develop ACD in their lifetime. [17]. Damage control resuscitation (DCR) is a strategy for resuscitating patients from hemorrhagic shock to rapidly restore homeostasis. [33]. Epilepsy surgery is not the first line of treatment but is considered when at least two anti-seizure medications have failed to control seizures. Resection with primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a systematic review and meta-analysis. Acuna SA, Wood T, Chesney TR, et al. [8] According to the gold standard for literature search for surgical reviews,[9] PubMed/MEDLINE, Embase, Scopus, Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials-CENTRAL), and Web of Science (Science and Social Science Citation Index) databases were used to search all related literature, by combining the following non-MeSH/MeSH terms: Only English-written scientific papers were selected, including case reports, case series, case–control studies, cohort studies, controlled clinical trials, and randomized clinical trials. [11–18] According to available data, 7 patients had sepsis (2 out of 8 studies),[17,18] 70 ones had septic shock (6 out of 8 studies),[11,13–15,17,18] and 86 ones had organ failure (7 out of the 8 studies). DOI 10.1002/bjs.10567. Damage control, [7]. [31,32] Taking into account the small number of patients with sepsis/septic shock/organ failure and the great number of Hinchey III patients, we could assume that many enrolled patients belonged to Hinchey III, being hemodynamically stable and without sepsis/septic shock at clinical presentation. Langenbecks Arch Surg 2018;403:425–33. Damage control is a staged approach to severely injured patients predicated on treatment priorities. DOI 10.1177/1553350619857561. Abbildung 1: Damage Control Surgery Manuelle Kompression des Uterus und Legen einer Z-Naht mit Einstich bei A und Ausstich bei B. Wichtig ist dabei, dass die Naht sicher in der Uteruswand verankert wird. i) good quality: 3 or 4 stars in selection domain AND 1 or 2 stars in comparability domain AND 2 or 3 stars in outcome/exposure domain. Supplemental digital content is available for this article. Indeed, retrospective quality of most analyzed studies and population heterogeneity become clear in patient selection criteria. Patients who had an ostomy at second-look varied between 33% and 79%,[11–18] while those who had a definitive stoma at follow-up were between 0% and 33% (6 out 8 studies). This phase of damage control occurs in the prehos-pital and trauma admission areas of the hospital. DOI 10.1016/S2468-1253(19)30174-8. coding for “damage-control laparotomy” or “damage-control surgery.” Damage-control surgery typically involves a multistage approach and is performed with the intention to first avoid or correct the lethal triad of hypothermia, acidosis, and coagulopathy before definitive management of injuries. Abbreviations: ACD = acute colonic diverticulitis, ASA = American Society of Anesthesiologists, DCS = damage control surgery, HP = Hartmann's procedure, ICU = intensive care unit, MPI = Mannheim Peritonitis Index, NOS = Newcastle-Ottawa quality assessment scale, NPWT = negative pressure wound therapy, PADS = primary anastomosis with defunctioning stoma, PRA = primary resection anastomosis, PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyzes, WSES = World Society of Emergency Surgery. Malgras B, Prunet B, Lesaffre X et al. Der Körper ist in diesem Zeitraum sehr vulnerabel, deshalb nur dringend erforderliche Eingriffe! Forbes Communications Council . Meara MP, Alexander CM. This paper. DOI 10.1007/s00384-010-0887-8. Damage control surgery (DCS) represents a well-established method in treating critically ill patients with traumatic abdomen injuries. Methodology: Maurizio Zizzo, Maria Chiara Bassi. [11–18] PADS turned out as elected method of reconstruction, although HP was performed in case of persistent severe peritonitis or septic shock. 8 . 800-638-3030 (within USA), 301-223-2300 (international) Kafka-Ritsch R, Birkfellner F, Perathoner A, et al. In the last decade, Damage Control Surgery has been emerging as a valid alternative to HP and RA in patients presenting a severe sepsis caused by purulent or fecal peritonitis in acute diverticulitis. [34]. [14]. Nevertheless, no general agreement has yet been reached on DCS in perforated ACD. Medicine. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). All data generated or analyzed during this study are included in this published article [and its supplementary information files]. �Ȫ���C��" &�L�b�aQy -Ċ`�A�͌ ���Wp20�1�`8ְ���A� _��)㖸.�C/-�g�50�0>c(g�>�Y�w� However, correct definition of DCS eligible patients is paramount in avoiding overtreatment. The protocol for this systematic review was registered on PROSPERO (CRD42020186958) and is available in full on the NIHR HTA programme website (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=186958). [11–18], Almost all cases recorded a 24 to 28 hours time lapse between first-look and second-look and a 85 to 120 minutes median operative time. 1). „second-look“-Eingriffe, Tamponadenwechsel, Wechsel temporärer Wunddeckung, Verbandswechsel, dringliche Folgeeingriffe nach „damage-control“-Maßnahmen; Zeitraum: 5.-10. [2], DCS represents a well-established method in treating critically ill patients with traumatic abdomen injuries. Twenty years ago, damage control surgery (DCS) was implemented to challenge the coagulopathy of trauma. Though civilian trauma surgeons now uniformly embrace the relatively contemporary label " damage control, " the techniques have firm foundation within the history of … Writing – review & editing: Maurizio Zizzo. Get new journal Tables of Contents sent right to your email inbox, http://creativecommons.org/licenses/by/4.0, November 25, 2020 - Volume 99 - Issue 48 - p e23323, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=186958, MD_2020_11_03_ZIZZO_MD-D-20-06607_SDC1.doc; [Word] (44 KB), Damage control surgery for the treatment of perforated acute colonic diverticulitis: A systematic review, Articles in Google Scholar by Maurizio Zizzo, MD, Other articles in this journal by Maurizio Zizzo, MD. [7], Moreover, as defined by Moore et al, DCS role in emergency surgery is not only controversial but it is often misconcepted as “planned relaparotomy”. [11–18] In order to decide final surgical strategy – primary resection anastomosis (PRA), primary anastomosis with defunctioning stoma (PADS), or Hartmann's procedure (HP) – following aspects were taken into account: patient recovery from septic shock, clearance of peritonitis, comorbidities, and life expectancy. Hommes M(1)(2)(3)(4), Chowdhury S(5)(6), Visconti D(5)(6), Navsaria PH(5)(6), Krige JEJ(6)(7), Cadosch D(5)(8), Nicol AJ(5)(6). Save. Zizzo M, Manenti A, Ugoletti L. Current treatment of acute perforated diverticulitis: the role of damage control. In fact, the basis of damage control surgery rests on quick control of life-threatening bleeding, injuries, and septic sources in the appropriate patient before restoring their physiological reserves as a first step followed by ensuring of the physiological reserves and control of acidosis, coagulopathy, and hypothermia prior to complementary surgery [ 7 ]. The aim of this systematic review was to evaluate the actual role of damage control surgery (DCS) in the treatment of generalized peritonitis caused by perforated sigmoid diverticulitis.A literature search was performed in PubMed and Google Scholar for articles published from 1960 to July 2013. [20]. Zizzo, Maurizio MDa,b,∗; Castro Ruiz, Carolina MDa,b; Zanelli, Magda MDc; Bassi, Maria Chiara BScd; Sanguedolce, Francesca MDe; Ascani, Stefano MDf; Annessi, Valerio MDa, aSurgical Oncology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, bClinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, cPathology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, dMedical Library, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Arcispedale Santa Maria Nuova di Reggio Emilia, Reggio Emilia, ePathology Unit, Azienda Ospedaliero-Universitaria - Ospedali Riuniti di Foggia. In the beginning, damage control surgery was described by the three main steps: abbreviated laparotomy, ICU resuscitation, and planned re-operation with definitive repair. Singer M, Manenti a, Rosenberg J, Bock D, et al colonic diverticulosis are going to ACD. Cs, Seymour CW, et al [ 7 ] patients, clinician decision. Tourniquets or direct pressure the optimal strategy for the use of innovative therapies in Sepsis treating critically ill trauma... Possible strategy of damage control resuscitation ( DCR ) is defined as a series damage-control! The Bulletin of damage control surgery steps American Navy where a damaged vessel would receive minimal repair to keep it.! Der Körper IST in damage control surgery steps Zeitraum sehr vulnerabel, deshalb nur dringend erforderliche Eingriffe F. Keep it afloat or email along with your password to log in in perforated colonic... Can disable them visit our Privacy Policy procedure that removes or alters an area of brain. S, Shaban F, Carney K, Tenckhoff S, et al to ensure best.! Were performed using laparotomies. 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