Damage control surgery: it's evolution over the last 20 years.

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics. A host of new resuscitation strategies and technologies have been developed over the past two decades, from permissive hypotension and damage control resuscitation to advanced ventilators and hemostatic agents, which have allowed for a more focused resuscitation, allowing some of the morbidity of this model to be reduced. The combination of the simple, malleable paradigm along with better understanding of resuscitation has proven to be a potent blend. As such, what was once an almost lethal injury (combined vascular and visceral injury) has become a survivable one.

Damage control surgery: it's evolution over the last 20 years / Cirurgia para o controle de danos: sua evolução durante os últimos 20 anos

In less than twenty years, what began as a concept for the treatment of exsanguinating truncal trauma patients has become the primary treatment model for numerous emergent, life threatening surgical conditions incapable of tolerating traditional methods. Its core concepts are relative straightforward and simple in nature: first, proper identification of the patient who is in need of following this paradigm; second, truncation of the initial surgical procedure to the minimal necessary operation; third, aggressive, focused resuscitation in the intensive care unit; fourth, definitive care only once the patient is optimized to tolerate the procedure. These simple underlying principles can be molded to a variety of emergencies, from its original application in combined major vascular and visceral trauma to the septic abdomen and orthopedics. A host of new resuscitation strategies and technologies have been developed over the past two decades, from permissive hypotension and damage control resuscitation to advanced ventilators and hemostatic agents, which have allowed for a more focused resuscitation, allowing some of the morbidity of this model to be reduced. The combination of the simple, malleable paradigm along with better understanding of resuscitation has proven to be a potent blend. As such, what was once an almost lethal injury (combined vascular and visceral injury) has become a survivable one.

Em menos de vinte anos, o que começou como um conceito para o tratamento de pacientes com trauma grave do tronco e acentuada perda sanguínea tornou-se o modelo de tratamento primário para numerosos pacientes da emergência, com lesões que ameaçam à vida, incapazes de tolerar os tradicionais métodos cirúrgicos. Seus principais conceitos são de natureza simples: em primeiro lugar, adequada identificação do paciente que necessita deste modelo de tratamento; segundo, substituição do procedimento cirúrgico convencional para a operação mínima necessária; terceira, agressiva reanimação na unidade de cuidados intensivos; em quarto lugar, tratamento definitivo apenas quando o paciente estiver apto à suportá-lo. Estes princípios fundamentais podem ser empregados para uma variedade de situações de emergência, de sua aplicação original na associação de injúrias viscerais e vasculares complexas à sepse de origem abdominal e ao trauma ortopédico. Uma série de novas estratégias de reanimação e tecnologias têm sido desenvolvidas ao longo das duas últimas décadas, da hipotensão permissiva e controle de dano da reanimação à modernos ventiladores e agentes hemostáticos, que permitiram uma reanimação adequada a este modelo, com redução da morbidade. A combinação deste simples conceito com à melhor compreensão da reanimação, tem provado ser uma potente associação. Como tal, o que era considerado uma lesão quase fatal (lesão vascular e visceral combinadas) tem possibilitado a sobrevida de doentes.