Damage Control Resuscitation in Surgical Critical Care

  • Asanthi Ratnasekera
  • Patrick Reilly
  • Paula FerradaEmail author


Damage control surgery was born out of the need to adapt surgical procedures to fit the physiological state of the patient. Although today leaving an open abdomen and performing a trauma procedure in stages are widely practiced, this was not the case decades ago [1]. Other procedures beyond laparotomy have also been employed, prioritizing trauma patient survival by using a damage control philosophy [2].

Supplementary material

Video 15.1

Empty IVC. Notice the diameter and also the change of the vessel during the respiratory cycle (MP4 1522 kb)

Video 15.2

Full IVC. Notice the lack of change during the respiratory cycle (MP4 302 kb)


  1. 1.
    Rotondo MF, Schwab CW, McGonigal MD, Phillips GR 3rd, Fruchterman TM, Kauder DR, et al. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35(3):375–82; discussion 2–3.CrossRefPubMedGoogle Scholar
  2. 2.
    Waibel BH, Rotondo MM. Damage control surgery: it’s evolution over the last 20 years. Rev Col Bras Cir. 2012;39(4):314–21.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Holcomb JB, del Junco DJ, Fox EE, Wade CE, Cohen MJ, Schreiber MA, et al. The prospective, observational, multicenter, major trauma transfusion (PROMMTT) study: comparative effectiveness of a time-varying treatment with competing risks. JAMA Surg. 2013;148(2):127–36.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Baraniuk S, Tilley BC, del Junco DJ, Fox EE, van Belle G, Wade CE, et al. Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) Trial: design, rationale and implementation. Injury. 2014;45(9):1287–95.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Chang R, Cardenas JC, Wade CE, Holcomb JB. Advances in the understanding of trauma-induced coagulopathy. Blood. 2016;128(8):1043–9.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Engels PT, Rezende-Neto JB, Al Mahroos M, Scarpelini S, Rizoli SB, Tien HC. The natural history of trauma-related coagulopathy: implications for treatment. J Trauma. 2011;71(5 Suppl 1):S448–55.CrossRefPubMedGoogle Scholar
  7. 7.
    Edwards MR, Mythen MG. Fluid therapy in critical illness. Extreme Physiol Med. 2014;3:16.CrossRefGoogle Scholar
  8. 8.
    Funk D, Bohn J, Mutch W, Hayakawa T, Buchel EW. Goal-directed fluid therapy for microvascular free flap reconstruction following mastectomy: a pilot study. Plastic Surg. 2015;23(4):231–4.CrossRefGoogle Scholar
  9. 9.
    Dente CJ, Shaz BH, Nicholas JM, Harris RS, Wyrzykowski AD, Patel S, et al. Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center. J Trauma. 2009;66(6):1616–24.CrossRefPubMedGoogle Scholar
  10. 10.
    Teixeira PG, Inaba K, Shulman I, Salim A, Demetriades D, Brown C, et al. Impact of plasma transfusion in massively transfused trauma patients. J Trauma. 2009;66(3):693–7.CrossRefPubMedGoogle Scholar
  11. 11.
    Cantle PM, Cotton BA. Prediction of massive transfusion in trauma. Crit Care Clin. 2017;33(1):71–84.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Lee CW, Kory PD, Arntfield RT. Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound. J Crit Care. 2016;31(1):96–100.CrossRefPubMedGoogle Scholar
  13. 13.
    Duchesne JC, Heaney J, Guidry C, McSwain N Jr, Meade P, Cohen M, et al. Diluting the benefits of hemostatic resuscitation: a multi-institutional analysis. J Trauma Acute Care Surg. 2013;75(1):76–82.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Carrico CJ, Coln CD, Lightfoot SA, Allsman A, Shires GT. Extracellular fluid volume replacement in hemorrhagic shock. Surg Forum. 1963;14:10–2.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Ferrada P. Image-based resuscitation of the hypotensive patient with cardiac ultrasound: an evidence-based review. J Trauma Acute Care Surg. 2016;80(3):511–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Ferrada P, Anand RJ, Whelan J, Aboutanos MA, Duane T, Malhotra A, et al. Qualitative assessment of the inferior vena cava: useful tool for the evaluation of fluid status in critically ill patients. Am Surg. 2012;78(4):468–70.PubMedGoogle Scholar
  17. 17.
    Ferrada P, Wolfe L, Anand RJ, Whelan J, Vanguri P, Malhotra A, et al. Use of limited transthoracic echocardiography in patients with traumatic cardiac arrest decreases the rate of nontherapeutic thoracotomy and hospital costs. J Ultrasound Med. 2014;33(10):1829–32.CrossRefPubMedGoogle Scholar
  18. 18.
    Wesson HK, Khan S, Ferrada P. Ultrasound as a tool for fluid status assessment in the trauma and critically ill patient. Int J Surg. 2016;33(Pt B):190–5.CrossRefPubMedGoogle Scholar
  19. 19.
    Ferrada P, Murthi S, Anand RJ, Bochicchio GV, Scalea T. Transthoracic focused rapid echocardiographic examination: real-time evaluation of fluid status in critically ill trauma patients. J Trauma. 2011;70(1):56–62; discussion 4CrossRefPubMedGoogle Scholar
  20. 20.
    Krige A, Bland M, Fanshawe T. Fluid responsiveness prediction using Vigileo FloTrac measured cardiac output changes during passive leg raise test. J Intensive Care. 2016;4:63.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Rajaram SS, Desai NK, Kalra A, Gajera M, Cavanaugh SK, Brampton W, et al. Pulmonary artery catheters for adult patients in intensive care. Cochrane Database Syst Rev. 2013;2:CD003408.Google Scholar
  22. 22.
    Warnakulasuriya SR, Davies SJ, Wilson RJ, Yates DR. Comparison of esophageal Doppler and plethysmographic variability index to guide intraoperative fluid therapy for low-risk patients undergoing colorectal surgery. J Clin Anesth. 2016;34:600–8.CrossRefPubMedGoogle Scholar
  23. 23.
    Bickell WH, Wall MJ Jr, Pepe PE, Martin RR, Ginger VF, Allen MK, et al. Immediate versus delayed fluid resuscitation for hypotensive patients with penetrating torso injuries. N Engl J Med. 1994;331(17):1105–9.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Cosnett JE. The origins of intravenous fluid therapy. Lancet. 1989;1(8641):768–71.CrossRefPubMedGoogle Scholar
  25. 25.
    Duchesne JC, Guidry C, Hoffman JR, Park TS, Bock J, Lawson S, et al. Low-volume resuscitation for severe intraoperative hemorrhage: a step in the right direction. Am Surg. 2012;78(9):936–41.PubMedGoogle Scholar
  26. 26.
    Dutton RP, Mackenzie CF, Scalea TM. Hypotensive resuscitation during active hemorrhage: impact on in-hospital mortality. J Trauma. 2002;52(6):1141–6.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ferrada P, Evans D, Wolfe L, Anand RJ, Vanguri P, Mayglothling J, et al. Findings of a randomized controlled trial using limited transthoracic echocardiogram (LTTE) as a hemodynamic monitoring tool in the trauma bay. J Trauma Acute Care Surg. 2014;76(1):31–7; discussion 7–8CrossRefPubMedGoogle Scholar
  28. 28.
    Mitchell JR, Wang JJ. Expanding application of the Wiggers diagram to teach cardiovascular physiology. Adv Physiol Educ. 2014;38(2):170–5.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Asanthi Ratnasekera
    • 1
  • Patrick Reilly
    • 2
  • Paula Ferrada
    • 1
    • 3
    Email author
  1. 1.Department of SurgeryVirginia Commonwealth UniversityRichmondUSA
  2. 2.Department of SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.West HospitalRichmondUSA

Personalised recommendations