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Maxillofacial and neck trauma: a damage control approach.

Krausz AA, Krausz MM, Picetti E - World J Emerg Surg (2015)

Bottom Line: Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock.These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists.Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral & Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.

ABSTRACT
Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock. These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists. Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries. 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. Damage control resuscitation (DCR) consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation. Both strategies should be administered simultaneously in all of these patients.

No MeSH data available.


Related in: MedlinePlus

Role of damage control strategies (DCS and DCR) in severely injured patients. DCS = damage control surgery. DCR = damage control resuscitation
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Fig1: Role of damage control strategies (DCS and DCR) in severely injured patients. DCS = damage control surgery. DCR = damage control resuscitation

Mentions: Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock [1, 2]. These conditions require not only a rapid recognition and management but also a strong interplay between surgeons, anesthesiologists and other relevant medical personnel. Hemorrhage represents one of the leading causes of death following trauma [3, 4]. After the initial insult, the combined occurrence of coagulopathy, hypothermia, and acidosis (“the lethal triad”) further contributes to the poor prognosis of severely exsanguinating trauma patients [5]. Over the last years, new strategies termed DCS and DCR have gained popularity in the management of injured patients [5–7]. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries [5–7]. DCS can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the ICU and subsequent re-exploration and definitive repair following restoration of normal physiology [5, 8]. DCR, defined as nonsurgical strategies utilized to prevent or reverse the effects and outcomes of “lethal triad”, consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation [5–7]. DCR and DCS should be administered simultaneously with close collaboration between all medical personnel involved in the patient’s treatment (Fig. 1). Damage control strategies have been applied initially to abdominal trauma [9] and subsequently to other fields such as thoracic surgery [10] and orthopedics [11]; relatively high survival rates with these strategies have been reported [5–7, 12]. Case reports demonstrate the benefits of applying damage control principles to maxillofacial and neck trauma patients [13, 14]. Appropriate selection of patients that can benefit from DCS is very important. In severe trauma patients with serious physiological derangement, attempts of primary definitive surgical management can inevitably lead to poor outcome. In contrast, inappropriate use of DCS may expose patients to additional unnecessary procedures which associated costs and complications [6, 15–17]. In addition to injury patterns, indications for the application of a damage control strategy are mainly related to: 1) significant bleeding requiring massive transfusion, 2) severe metabolic acidosis (pH < 7.30), 3) hypothermia (T < 35.8 °C), 4) estimated operating time > 90 min, 5) coagulopathy and 6) lactate > 5 mmol/l [6, 18–20].Fig. 1


Maxillofacial and neck trauma: a damage control approach.

Krausz AA, Krausz MM, Picetti E - World J Emerg Surg (2015)

Role of damage control strategies (DCS and DCR) in severely injured patients. DCS = damage control surgery. DCR = damage control resuscitation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4495937&req=5

Fig1: Role of damage control strategies (DCS and DCR) in severely injured patients. DCS = damage control surgery. DCR = damage control resuscitation
Mentions: Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock [1, 2]. These conditions require not only a rapid recognition and management but also a strong interplay between surgeons, anesthesiologists and other relevant medical personnel. Hemorrhage represents one of the leading causes of death following trauma [3, 4]. After the initial insult, the combined occurrence of coagulopathy, hypothermia, and acidosis (“the lethal triad”) further contributes to the poor prognosis of severely exsanguinating trauma patients [5]. Over the last years, new strategies termed DCS and DCR have gained popularity in the management of injured patients [5–7]. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries [5–7]. DCS can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the ICU and subsequent re-exploration and definitive repair following restoration of normal physiology [5, 8]. DCR, defined as nonsurgical strategies utilized to prevent or reverse the effects and outcomes of “lethal triad”, consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation [5–7]. DCR and DCS should be administered simultaneously with close collaboration between all medical personnel involved in the patient’s treatment (Fig. 1). Damage control strategies have been applied initially to abdominal trauma [9] and subsequently to other fields such as thoracic surgery [10] and orthopedics [11]; relatively high survival rates with these strategies have been reported [5–7, 12]. Case reports demonstrate the benefits of applying damage control principles to maxillofacial and neck trauma patients [13, 14]. Appropriate selection of patients that can benefit from DCS is very important. In severe trauma patients with serious physiological derangement, attempts of primary definitive surgical management can inevitably lead to poor outcome. In contrast, inappropriate use of DCS may expose patients to additional unnecessary procedures which associated costs and complications [6, 15–17]. In addition to injury patterns, indications for the application of a damage control strategy are mainly related to: 1) significant bleeding requiring massive transfusion, 2) severe metabolic acidosis (pH < 7.30), 3) hypothermia (T < 35.8 °C), 4) estimated operating time > 90 min, 5) coagulopathy and 6) lactate > 5 mmol/l [6, 18–20].Fig. 1

Bottom Line: Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock.These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists.Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations.

View Article: PubMed Central - PubMed

Affiliation: Department of Oral & Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel.

ABSTRACT
Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock. These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists. Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries. 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. Damage control resuscitation (DCR) consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation. Both strategies should be administered simultaneously in all of these patients.

No MeSH data available.


Related in: MedlinePlus