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Damage Control in Pediatric Patients

  • R. Todd Maxson
Chapter

Abstract

The concepts of damage control surgery and resuscitation have been known for many years, as have data affirming the advantages for adult patients. There has been no doubt that the application of these damage control resuscitation principles have led to improved success of non-operative management of solid organ injury, decreased multi-system organ failure, and improved mortality [1]. As of this writing, there has been no prospective randomized trial proving the benefit of damage control resuscitation in the pediatric patient. There are several challenges with such trials; primarily, the most common injuries are traumatic brain injury, and overall mortality is low. Death from hemorrhage is rare and precludes effective trials without broad multicenter participation over an extended time frame. It should be said, however, that when a therapy or intervention is proven to have benefit in adult patients, it should be considered applicable to the pediatric population unless there is compelling reason to believe that there are differences in the pediatric anatomy or physiology that would change the efficacy of the therapy or intervention. Such is the case with damage control surgery and resuscitation. The concept of limited crystalloid resuscitation; early, balanced blood component replacement; rapid correction of physiological derangements, including coagulopathy and inflammation; and source control surgery for bleeding and contamination should all be applicable in the pediatric patient based on the developing biology of the child.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Arkansas Children’s HospitalLittle RockUSA
  2. 2.University of Arkansas for Medical SciencesLittle RockUSA

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