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[Damage control resuscitation in pediatric severe trauma]
1Unidad de Paciente Crítico Pediátrico, Complejo Asistencial Dr. Sótero del Río, Chile, awegnera@gmail.com.
Insights
Damage control resuscitation (DCR) is applicable to severe pediatric trauma, focusing on managing the lethal triad of coagulopathy, acidosis, and hypothermia. Key strategies include limiting crystalloids and employing permissive hypotension for better outcomes.
Area of Science:
- Pediatric Trauma Care
- Resuscitation Medicine
- Emergency Medicine
Background:
- Trauma is a leading cause of death in children, with many fatalities preventable through effective resuscitation.
- Optimal and timely resuscitation can significantly reduce early and late deaths and sequelae from pediatric trauma.
Purpose of the Study:
- To review the applicability of damage control resuscitation (DCR) in severe pediatric trauma.
- To emphasize the medical management aspects of DCR in pediatric patients.
Main Methods:
- Literature search conducted on PubMed, Cochrane Library, and Google Scholar.
- Keywords included trauma, polytrauma, resuscitation, damage-control, fluids, permissive hypotension, coagulopathy, massive transfusion, and children.
Main Results:
- Damage control resuscitation (DCR) principles are adaptable to severe pediatric trauma, considering unique pediatric physiology and anatomy.
- DCR focuses on managing the lethal triad: coagulopathy, acidosis, and hypothermia, often associated with damage control surgery.
- Initial treatment strategies reviewed include limiting crystalloid fluids, applying permissive hypotension, and implementing hemostatic resuscitation.
Conclusions:
- Further research is needed to define the precise role of permissive hypotension in pediatric trauma.
- Optimal ratios of blood products for resuscitation require further investigation.
- Developing strategies to predict and manage massive transfusion protocols in pediatric trauma is crucial.
Introduction:
Trauma is an important cause of morbidity and mortality in the pediatric population. It has the first place in mortality in our country without considering perinatal pathologies and congenital malformations. An important percentage of early and late deaths secondary to this cau se, as well as its sequelae, could be prevented with optimal and timely resuscitation.
Objective:
To review the applicability of damage control resuscitation (DCR) in severe pediatric trauma, with emphasis on medical management.
Material And Methods:
The PubMed, the Cochrane Library and the Google academic database were used. Search terms (MeSH) were: trauma, polytrauma, resuscitation, damage-control, fluids, permissive hypotension, coagulopathy, massive transfusion and children.
Results:
The concept of DCR can be applied to severe pediatric trauma, taking into account their anatomical and physiological characteristics. The principle is based on the management of the lethal triad (coagulopathy, acidosis and hypothermia) associated with damage control surgery. Limitation of crystalloids, permissive hypotension and hemostatic resuscitation are reviewed in the initial treatment of severe pediatric trauma.
Conclusion:
Future studies should establish the true role of permissive hypotension, the optimal relationship between blood products and the best strategy to predict the activation of massive transfusion protocols and their impact on children with severe trauma.
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