Control De Daño

Por: Juan Rodrigo Moreno Restrepo MD FCCM Cirujano General Medicina Critica y Cuidados Intensivos Clínica Medellín - Hospital San Rafael

Trauma y mortalidad ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Control de daño, perspectiva histórica ,[object Object],[object Object],[object Object],[object Object]

Evolución del concepto control de daño ,[object Object],John B. Holcomb, J Trauma. 2007;62:307–310 .

Sus origenes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Injury, Int. J. Care Injured (2004) 35, 639—641

Círculo mortal British Journal of Surgery 2004; 91: 1095–1101 METABOLISMO ANAEROBIO ACIDOSIS HIPOTERMIA COAGULOPATIA HIPOPERFUSION

Hipotermia ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],M.A. Schreiber / Crit Care Clin 20 (2004) 101–118 Sagraves SG, Toschlog EA, Rotondo MF. Damage control surgery the intensivist’s role. J Intensive Care Med. 2006;21:5-16.

Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],M.A. Schreiber / Crit Care Clin 20 (2004) 101–118

Acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Djaldetti M, Fishman P, Bessler H, Chaimoff C. pH-induced platelet ultrastructural alterations. A possible mechanism for impaired platelet aggregation. Arch Surg. 1979;114:707–710.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Heiko Lier, MD, J Trauma. 2008;65:951–960.

Factores que afectan la hemostasia ,[object Object],[object Object],[object Object],[object Object],[object Object]

Coagulopatia Injury, Int. J. Care Injured (2004) 35, 713—722

Coagulopatia M.A. Schreiber / Crit Care Clin 20 (2004) 101–118

Coagulopatía y laboratorio ,[object Object],[object Object],[object Object]

Factores de riesgo para desarrollo de coagulopatía severa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Reanimación hipotensiva ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Resucitación inicial en control de daño, hipotensión permisiva ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Fluido de elección para resucitación inicial ?? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Terapia trasfusional predeterminada ,[object Object],[object Object],[object Object]

Beth H. Shaz, Anesth Analg 2009;108:1760 –8

Meta trasfusional ?? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Control daño UCI hipotermia Injury, Int. J. Care Injured (2004) 35, 713—722

Recalentamiento M.A. Schreiber / Crit Care Clin 20 (2004) 101–118

Control daño UCI ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sagraves SG, Toschlog EA, Rotondo MF. Damage control surgery the intensivist’s role. J Intensive Care Med. 2006;21:5-16.

Control de daño UCI, metas de oxigenación global ,[object Object],[object Object],[object Object],[object Object],[object Object],British Journal of Surgery 2004; 91: 1095–1101

Administración buffers, control acidosis ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Papel del Factor VIIa ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Critical Care Vol 11 No 1 Spahn et al.

Pacientes que recibieron por lo menos 8 U GR en las primeras 12 horas

Antifibrinolíticos ,[object Object],N Engl J Med 2007;356:2301-11 .

Complicaciones asociadas a los protocolos de control de daño

Síndrome compartimental abdominal Consecuencias en la función de órganos ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Curr Opin Crit Care 11:156—171. 2005

Cuando medir la presión compartimental ? ,[object Object],[object Object],[object Object],[object Object],[object Object],Current Opinion in Critical Care 2005, 11:333—338

Control de daño y su aplicación en otros sistemas

[object Object],[object Object],[object Object],[object Object],[object Object],Injury, Int. J. Care Injured (2004) 35, 649—654

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Injury, Int. J. Care Injured (2004) 35, 671—677

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Injury, Int. J. Care Injured (2004) 35, 655—660

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Injury, Int. J. Care Injured (2004) 35, 661—670

[object Object],[object Object],[object Object],[object Object],Injury, Int. J. Care Injured (2004) 35, 678—689

Control De Daño

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