History of the Innovation of Damage Control for Management of Trauma Patients: 1902-2016

Objective: To review the history of the innovation of damage control (DC) for management of trauma patients. Background: DC is an important development in trauma care that provides a valuable case study in surgical innovation. Methods: We searched bibliographic databases (1950-2015), conference abstracts (2009-2013), Web sites, textbooks, and bibliographies for articles relating to trauma DC. The innovation of DC was then classified according to the Innovation, Development, Exploration, Assessment, and Long-term study model of surgical innovation. Results: The innovation\u27\u27 of DC originated from the use of therapeutic liver packing, a practice that had previously been abandoned after World War II because of adverse events. It then developed\u27\u27 into abbreviated laparotomy using rapid conservative operative techniques.\u27\u27 Subsequent exploration\u27\u27 resulted in the application of DC to increasingly complex abdominal injuries and thoracic, peripheral vascular, and orthopedic injuries. Increasing use of DC laparotomy was followed by growing reports of postinjury abdominal compartment syndrome and prophylactic use of the open abdomen to prevent intra-abdominal hypertension after DC laparotomy. By the year 2000, DC surgery had been widely adopted and was recommended for use in surgical journals, textbooks, and teaching courses ( assessment\u27\u27 stage of innovation). Long-term study\u27\u27 of DC is raising questions about whether the procedure should be used more selectively in the context of improving resuscitation practices. Conclusions: The history of the innovation of DC illustrates how a previously abandoned surgical technique was adapted and readopted in response to an increased understanding of trauma patient physiology and changing injury patterns and trauma resuscitation practices

Comparison of Image Restoration Methods for Lunar Epithermal Neutron Emission Mapping

Orbital measurements of neutrons by the Lunar Exploring Neutron Detector (LEND) onboard the Lunar Reconnaissance Orbiter are being used to quantify the spatial distribution of near surface hydrogen (H). Inferred H concentration maps have low signal-to-noise (SN) and image restoration (IR) techniques are being studied to enhance results. A single-blind. two-phase study is described in which four teams of researchers independently developed image restoration techniques optimized for LEND data. Synthetic lunar epithermal neutron emission maps were derived from LEND simulations. These data were used as ground truth to determine the relative quantitative performance of the IR methods vs. a default denoising (smoothing) technique. We review and used factors influencing orbital remote sensing of neutrons emitted from the lunar surface to develop a database of synthetic "true" maps for performance evaluation. A prior independent training phase was implemented for each technique to assure methods were optimized before the blind trial. Method performance was determined using several regional root-mean-square error metrics specific to epithermal signals of interest. Results indicate unbiased IR methods realize only small signal gains in most of the tested metrics. This suggests other physically based modeling assumptions are required to produce appreciable signal gains in similar low SN IR applications

Decompressive laparotomy for abdominal compartment syndrome

Background: The effect of decompressive laparotomy on outcomes in patients with abdominal compartment syndrome has been poorly investigated. The aim of this prospective cohort study was to describe the effect of decompressive laparotomy for abdominal compartment syndrome on organ function and outcomes. Methods: This was a prospective cohort study in adult patients who underwent decompressive laparotomy for abdominal compartment syndrome. The primary endpoints were 28-day and 1-year all-cause mortality. Changes in intra-abdominal pressure (IAP) and organ function, and laparotomy-related morbidity were secondary endpoints. Results: Thirty-three patients were included in the study (20 men). Twenty-seven patients were surgical admissions treated for abdominal conditions. The median (i.q.r.) Acute Physiology And Chronic Health Evaluation (APACHE) II score was 26 (20-32). Median IAP was 23 (21-27) mmHg before decompressive laparotomy, decreasing to 12 (9-15), 13 (8-17), 12 (9-15) and 12 (9-14) mmHg after 2, 6, 24 and 72 h. Decompressive laparotomy significantly improved oxygenation and urinary output. Survivors showed improvement in organ function scores, but non-survivors did not. Fourteen complications related to the procedure developed in eight of the 33 patients. The abdomen could be closed primarily in 18 patients. The overall 28-day mortality rate was 36 per cent (12 of 33), which increased to 55 per cent (18 patients) at 1 year. Non-survivors were no different from survivors, except that they tended to be older and on mechanical ventilation. Conclusion: Decompressive laparotomy reduced IAP and had an immediate effect on organ function. It should be considered in patients with abdominal compartment syndrome

Intra-abdominal pressure in patients with abdominal trauma

Objetivos: Pacientes com trauma abdominal tratados cirurgicamente são muito suscetíveis ao desenvolvimento de hipertensão intra-abdominal e síndrome do compartimento abdominal, cujo diagnóstico é baseado na medição da pressão intraabdominal associada a parâmetros clínicos. Este estudo teve por objetivos avaliar prospectivamente o comportamento da pressão intra-abdominal de pacientes com trauma abdominal cirurgicamente tratados e identificar se há relação entre tal comportamento e parâmetros clínicos destes pacientes. Método: A técnica de Kron foi utilizada para medir a pressão intra-abdominal. A casuística foi composta por 17 homens e três mulheres com média de idade de 36,9 anos (D.P. 12,943). O mecanismo de trauma mais freqüente foi contusão abdominal 12 (60%) contra oito (40%) pacientes com ferimentos penetrantes. Os dados foram coletados em 6 e 18 horas de pós-operatório. Resultados: As médias de pressão intra-abdominal foram 10,4 cmH2O (D.P. 3,939) em 6 horas e 10,263 cmH2O (D.P. 3,445) em 18 horas de pós operatório. A análise dos resultados mostrou correlação estatisticamente significante entre o volume de colóides infundidos e a pressão intra-abdominal em 6 e 18 horas pós-operatórias (p = 0,0380 e p = 0,0033 respectivamente). É provável que tal correlação se deva ao edema visceral causado pelo extravasamento capilar de soluções, aumentando a pressão intra-abdominal. Conclusões: Os achados deste estudo ratificam a idéia de relação entre grandes volumes de infusão venosa, sobretudo colóides, e o aumento da pressão intra-abdominal e destacam a importância da avaliação da pressão intra-abdominal em pacientes com trauma abdominal submetidos a grandes reposições volêmicas, sobretudo as soluções coloidais. _________________________________________________________________________________________ ABSTRACT: Bacjground: Patients with significant abdominal traumatism submitted to surgical treatment are susceptible to develop intra-abdominal hypertension and abdominal compartment syndrome. Those diagnosis are based on intra-abdominal pressure measurement associated with clinical parameters. The aims of this study were: to study prospectively the behavior of intra-abdominal pressure in patients with abdominal trauma submitted to surgical treatment; to identify if there is association between that behavior and clinical parameters. Methods: There were 17 males and three females with an average age of 36.9 years (S.D. 12.9). The data was collected in two times, six and 18 hours in the immediate postoperative period. The averages of intra-abdominal pressures found were 10.4 cmH2O (S.D. 3.9) in the first six hours and 10.3 cmH2O (S.D. 3.5) in 18 hours of postoperative period. Results: There was significant statistical correlation between the volume of infused colloids and intra-abdominal pressure at six and 18 hours of postoperative period (p = 0.0380 and p = 0.0033, respectively). These correlations are probably explained by visceral edema caused by the capillary leak of solutions, increasing intra-abdominal pressure. Conclusions: Our findings confirm the relationship between large volumes of fluid infusion, mainly colloid solutions, and the increase of intra-abdominal pressure and detach the importance of intraabdominal pressure monitorization in patients with abdominal trauma submitted to massive replacement of liquids, mainly when this replacement was done with colloids solutions

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines

2016 WSES guidelines on acute calculous cholecystitis (vol 11, 25, 2016)

Non peer reviewe