Resuscitation beyond the abdominal compartment syndrome.

Abstract:

PURPOSE OF REVIEW:In the 1980s, we witnessed tremendous advances in trauma care including trauma system development, advanced trauma life support, damage control surgery and ICU resuscitation. As a result, patients who used to bleed to death in the operating room survived. However, many went on to develop multiple organ failure (MOF) and in the mid-1990s, an epidemic of abdominal compartment syndrome (ACS) that emerged in these MOF survivors stimulated fundamental changes in early management of patients arriving in shock with severe bleeding. RECENT FINDINGS:In the early 2000s, a massive transfusion protocol (emphasizing aggressive use of fresh frozen plasma) coupled with hypotensive resuscitation and rapid hemorrhage control were implemented and refined at a busy level I trauma center in Houston, Texas, USA. These changes were associated with a 50% reduction in mortality in massive transfusion patients, and ACS virtually disappeared. SUMMARY:ACS is a modifiable link in the MOF cascade to death after severe shock. However, as ACS disappears, MOF is still occurring. Although fewer patients are dying of MOF, it remains the leading cause of prolonged ICU stays and long-term disability. This experience underscores the importance of ongoing epidemiologic characterization of postinjury MOF.

journal_name

Curr Opin Crit Care

authors

Gonzalez EA,Moore FA

doi

10.1097/MCC.0b013e3283409d16

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

570-4

issue

6

eissn

1070-5295

issn

1531-7072

pii

00075198-201012000-00011

journal_volume

16

pub_type

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