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The art and science of pediatric damage control
Anthony Tran1, Brendan T Campbell1
1Pediatric Surgery and Injury Prevention Center, Connecticut Children's Medical Center, Hartford, Connecticut 06106.
Insights
Damage control surgery, initially for severe bleeding, now offers a comprehensive resuscitation and surgical plan for critically injured children. This review details its application in pediatric abdominal, thoracic, and extremity trauma.
Area of Science:
- Surgical Management
- Pediatric Trauma Care
- Emergency Medicine
Background:
- Damage control surgery evolved from a "bail out" for bleeding in severe trauma to a comprehensive strategy.
- It addresses patients with compromised physiologic reserve due to injury.
- The approach has expanded significantly over the last 25 years.
Purpose of the Study:
- To review current damage control concepts relevant to pediatric surgeons.
- To provide evidence-based recommendations for applying damage control in severely injured children.
- To focus on resuscitation and operative treatment for pediatric abdominal, thoracic, and extremity injuries.
Main Methods:
- Review of current literature and evidence-based practices in damage control surgery.
- Focus on pediatric-specific considerations for resuscitation and operative management.
- Application of damage control principles to severe pediatric trauma.
Main Results:
- Damage control is a vital strategy for managing critically injured children with exhausted reserves.
- It encompasses resuscitation and surgical intervention for complex injuries.
- Evidence-based recommendations guide its pragmatic application in pediatric trauma.
Conclusions:
- Damage control surgery is a crucial, evolving strategy in pediatric trauma.
- Its principles are essential for optimizing outcomes in severely injured children.
- This review provides a practical guide for pediatric surgeons utilizing damage control.
Abstract:
Damage control is a surgical strategy that has evolved and expanded considerably over the past 25 years. The approach was initially developed as a "bail out" procedure to control bleeding with severe abdominal injuries in the setting of unmitigated hemorrhagic shock. Damage control is now more broadly applied as a comprehensive management plan for the resuscitation and surgical treatment of injured patients with exhausted physiologic and metabolic reserve. This article reviews the most current concepts in damage control that are important and relevant to the practicing pediatric surgeon. It also provides evidence-based recommendations about how damage control principles can be pragmatically applied to severely injured children. This review focuses specifically on the fundamentals of damage control with respect to resuscitation and the operative treatment of children with severe abdominal, thoracic, and extremity injuries.