{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T04:44:14Z","timestamp":1769921054555,"version":"3.49.0"},"reference-count":49,"publisher":"Universidad del Valle","issue":"2","license":[{"start":{"date-parts":[[2021,8,18]],"date-time":"2021-08-18T00:00:00Z","timestamp":1629244800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":["colombiamedica.univalle.edu.co"],"crossmark-restriction":true},"short-container-title":["Colomb Med"],"abstract":"<jats:p>When trauma patients are admitted into the intensive care unit after undergoing damage control surgery, they generally present some degree of bleeding, hypoperfusion, and injuries that require definitive repair. Trauma patients admitted into the intensive care unit after undergoing damage control surgery can present injuries that require a definite repair, which can cause bleeding and hypoperfusion. The intensive care team must evaluate the severity and systemic repercussions in the patient. This will allow them to establish the need for resuscitation, anticipate potential complications, and adjust the treatment to minimize trauma-associated morbidity and mortality. This article aims to describe the alterations present in patients with severe trauma who undergo damage control surgery and considerations in their therapeutic approach. The intensivist must detect the different physiological alterations presented in trauma patients undergoing damage control surgery, mainly caused by massive hemorrhage. Monitor and support strategies are defined by the evaluation of bleeding and shock severity and resuscitation phase in ICU admission. The correction of hypothermia, acidosis, and coagulopathy is fundamental in the management of severe trauma patients.<\/jats:p>","DOI":"10.25100\/cm.v52i2.4810","type":"journal-article","created":{"date-parts":[[2021,11,22]],"date-time":"2021-11-22T16:17:47Z","timestamp":1637597867000},"page":"e4174810","update-policy":"https:\/\/doi.org\/10.25100\/cm.crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Damage control in the intensive care unit: what should the intensive care physician know and do?"],"prefix":"10.25100","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2552-8958","authenticated-orcid":false,"given":"Monica","family":"Vargas","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4096-1434","authenticated-orcid":false,"given":"Alberto","family":"Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6128-0128","authenticated-orcid":false,"given":"Yaset","family":"Caicedo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6496-6275","authenticated-orcid":false,"given":"Michael","family":"Parra","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4495-7405","authenticated-orcid":false,"given":"Carlos Alberto","family":"Ordo\u00f1ez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10728","published-online":{"date-parts":[[2021,8,18]]},"reference":[{"key":"51937","doi-asserted-by":"crossref","unstructured":"Rotondo MF, Schwab CW, McGonigal MD, Phillips GR 3rd, Fruchterman TM, Kauder DR, Latenser BA, Angood PA: 'Damage control': an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993, 35:375-382. discussion 382-3. https:\/\/doi.org\/10.1097\/00005373-199309000-00008","DOI":"10.1097\/00005373-199309000-00008"},{"key":"51939","doi-asserted-by":"crossref","unstructured":"Shapiro MB, Jenkins DH, Schwab CW, Rotondo MF: Damage control: collective review. J Trauma 2000, 49:969-978. https:\/\/doi.org\/10.1097\/00005373-200011000-00033","DOI":"10.1097\/00005373-200011000-00033"},{"key":"51941","doi-asserted-by":"crossref","unstructured":"Scalea TM, Boswell SA, Scott JD, Mitchell KA, Kramer ME, Pollak AN: External fixation as a bridge to intramedullary nailing for patients with multiple injuries and with femur fractures: damage control orthopedics. J Trauma 2000, 48:613-621. discussion 621-3. https:\/\/doi.org\/10.1097\/00005373-200004000-00006","DOI":"10.1097\/00005373-200004000-00006"},{"key":"51943","doi-asserted-by":"crossref","unstructured":"Rotondo MF, Bard MR: Damage control surgery for thoracic injuries. Injury 2004, 35:649-654. https:\/\/doi.org\/10.1016\/j.injury.2004.03.002","DOI":"10.1016\/j.injury.2004.03.002"},{"key":"51945","doi-asserted-by":"crossref","unstructured":"Tien HC, Spencer F, Tremblay LN, Rizoli SB, Brenneman FD: Preventable deaths from hemorrhage at a level I Canadian trauma center. J Trauma 2007, 62(1):142-146. https:\/\/doi.org\/10.1097\/01.ta.0000251558.38388.47","DOI":"10.1097\/01.ta.0000251558.38388.47"},{"key":"51947","doi-asserted-by":"crossref","unstructured":"Brohi K, Singh J, Heron M, Coats T: Acute traumatic coagulopathy. J Trauma 2003, 54(6):1127-1130. https:\/\/doi.org\/10.1097\/01.TA.0000069184.82147.06","DOI":"10.1097\/01.TA.0000069184.82147.06"},{"key":"51949","doi-asserted-by":"crossref","unstructured":"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. https:\/\/doi.org\/10.1001\/archsurg.1979.01370300061009","DOI":"10.1001\/archsurg.1979.01370300061009"},{"key":"51951","doi-asserted-by":"crossref","unstructured":"Thorsen K, Ringdal KG, Strand K, Soreide E, Hagemo J, Soreide K: Clinical and cellular effects of hypothermia, acidosis and coagulopathy in major injury. Br J Surg 2011, 98:894-907. https:\/\/doi.org\/10.1002\/bjs.7497","DOI":"10.1002\/bjs.7497"},{"key":"51953","doi-asserted-by":"crossref","unstructured":"Lier H, Krep H, Schroeder S, Stuber F. Preconditions of hemostasis in trauma: a review. The influence of acidosis, hypocalcemia, anemia, and hypothermia on functional hemostasis in trauma. J Trauma. 2008;65(4):951-960. https:\/\/doi.org\/10.1097\/TA.0b013e318187e15b","DOI":"10.1097\/TA.0b013e318187e15b"},{"key":"51955","doi-asserted-by":"crossref","unstructured":"Rutherford EJ, Morris JA Jr, Reed GW, Hall KS. Base deficit stratifies mortality and determines therapy. J Trauma. 1992;33:417-423. https:\/\/doi.org\/10.1097\/00005373-199209000-00014","DOI":"10.1097\/00005373-199209000-00014"},{"key":"51957","doi-asserted-by":"crossref","unstructured":"Jurkovich GJ, Greiser WB, Luterman A, Curreri PW. Hypothermia in trauma victims: an ominous predictor of survival. J Trauma. 1987;27:1019 -1024. https:\/\/doi.org\/10.1097\/00005373-198709000-00011","DOI":"10.1097\/00005373-198709000-00011"},{"key":"51959","doi-asserted-by":"crossref","unstructured":"Johnston TD, Chen Y, Reed RL. Functional equivalence of hypothermia to specific clotting factor deficiencies. J Trauma. 1994; 37:413- 417 https:\/\/doi.org\/10.1097\/00005373-199409000-00014","DOI":"10.1097\/00005373-199409000-00014"},{"key":"51961","unstructured":"Kempainen RR, Brunette DD: The evaluation and management of accidental hypothermia. Respir Care 2004, 49:192-205."},{"key":"51963","doi-asserted-by":"crossref","unstructured":"Kurz A, Sessler DI, Lenhardt R: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996, 334:1209-1215. https:\/\/doi.org\/10.1056\/NEJM199605093341901","DOI":"10.1056\/NEJM199605093341901"},{"key":"51965","doi-asserted-by":"crossref","unstructured":"Seamon MJ, Wobb J, Gaughan JP, Kulp H, Kamel I, Dempsey DT: The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies. Ann Surg 2012, 255:789-795. https:\/\/doi.org\/10.1097\/SLA.0b013e31824b7e35","DOI":"10.1097\/SLA.0b013e31824b7e35"},{"key":"51967","doi-asserted-by":"crossref","unstructured":"Hoffman M, Monroe DM. Coagulation 2006: a modern view of hemostasis. Hematol Oncol Clin North Am. 2007;21:1-11. https:\/\/doi.org\/10.1016\/j.hoc.2006.11.004","DOI":"10.1016\/j.hoc.2006.11.004"},{"key":"51969","doi-asserted-by":"crossref","unstructured":"Eberst ME, Berkowitz LR. Hemostasis in renal disease: pathophysiology and management. Am J Med. 1994;96:168 -179. https:\/\/doi.org\/10.1016\/0002-9343(94)90138-4","DOI":"10.1016\/0002-9343(94)90138-4"},{"key":"51971","doi-asserted-by":"crossref","unstructured":"Varon D, Dardik R, Shenkman B, et al. A new method for quantitative analysis of whole blood platelet interaction with extracellular matrix under flow conditions. Thromb Res. 1997;85:283-294. https:\/\/doi.org\/10.1016\/S0049-3848(97)00014-5","DOI":"10.1016\/S0049-3848(97)00014-5"},{"key":"51973","doi-asserted-by":"crossref","unstructured":"McLoughlin TM, Fontana JL, Alving B, Mongan PD, Bu\u00a8nger R. Profound normovolemic hemodilution: hemostatic effects in patients and in a porcine model. Anesth Analg. 1996;83:459-465. https:\/\/doi.org\/10.1213\/00000539-199609000-00003","DOI":"10.1213\/00000539-199609000-00003"},{"key":"51975","doi-asserted-by":"crossref","unstructured":"Hardy JF, de Moerloose P, Samama M. Massive transfusion and coagulopathy: pathophysiology and implications for clinical management. Can J Anesth. 2004;51:293-310. https:\/\/doi.org\/10.1007\/BF03018233","DOI":"10.1007\/BF03018233"},{"key":"51977","doi-asserted-by":"crossref","unstructured":"Spahn DR. Hypocalcemia in trauma: frequent but frequently undetected and underestimated. Editorial. Crit Care Med. 2005; 33:2124 -2125. https:\/\/doi.org\/10.1097\/01.CCM.0000174479.32054.3D","DOI":"10.1097\/01.CCM.0000174479.32054.3D"},{"key":"51979","doi-asserted-by":"crossref","unstructured":"Fukuda T, Nakashima Y, Harada M, et al. Effect of whole blood clotting time in rats with ionized hypocalcemia induced by rapid intravenous citrate infusion. J Toxicol Sci. 2006;31:229 -234. https:\/\/doi.org\/10.2131\/jts.31.229","DOI":"10.2131\/jts.31.229"},{"key":"51981","doi-asserted-by":"crossref","unstructured":"Vivien B, Langeron O, Morell E, et al. Early hypocalcemia in severe trauma. Crit Care Med. 2005;33:1946 -1952. https:\/\/doi.org\/10.1097\/01.CCM.0000171840.01892.36","DOI":"10.1097\/01.CCM.0000171840.01892.36"},{"key":"51983","doi-asserted-by":"crossref","unstructured":"Barry GD. Plasma calcium concentration changes in hemorrhagic shock. Am J Physiol. 1971;220:874-879. https:\/\/doi.org\/10.1152\/ajplegacy.1971.220.4.874","DOI":"10.1152\/ajplegacy.1971.220.4.874"},{"key":"51985","doi-asserted-by":"crossref","unstructured":"Hastbacka J, Pettila V. Prevalence and predictive value of ionized hypocalcemia among critically ill patients. Acta Anaesthesiol Scand. 2003;47:1264 -1269 https:\/\/doi.org\/10.1046\/j.1399-6576.2003.00236.x","DOI":"10.1046\/j.1399-6576.2003.00236.x"},{"key":"51987","doi-asserted-by":"crossref","unstructured":"Barbee RW, Reynolds PS, Ward KR: Assessing shock resuscitation strategies by oxygen debt repayment. Shock 2010, 33:113-122. https:\/\/doi.org\/10.1097\/SHK.0b013e3181b8569d","DOI":"10.1097\/SHK.0b013e3181b8569d"},{"key":"51989","doi-asserted-by":"crossref","unstructured":"Wang CH, HsiehWH, Chou HC, et al. Liberal versus restricted fluid resuscitation strategies in trauma patients: a systematic review and meta-analysis of randomized controlled trials and observational studies. Crit Care Med 2014;42(04):954-961 https:\/\/doi.org\/10.1097\/CCM.0000000000000050","DOI":"10.1097\/CCM.0000000000000050"},{"key":"51991","doi-asserted-by":"crossref","unstructured":"Guly HR, Bouamra O, Spiers M, Dark P, Coats T, Lecky FE; Trauma Audit and Research Network. Vital signs and estimated blood loss in patients with major trauma: testing the validity of the ATLS classification of hypovolaemic shock. Resuscitation 2011;82(05):556-559 https:\/\/doi.org\/10.1016\/j.resuscitation.2011.01.013","DOI":"10.1016\/j.resuscitation.2011.01.013"},{"key":"51993","doi-asserted-by":"crossref","unstructured":"Abou-Khalil B, Scalea TM, Trooskin SZ, Henry SM, Hitchcock R: Hemodynamic esponses to shock in young trauma patients: need for invasive monitoring. Crit Care Med 1994, 2: 633-639. https:\/\/doi.org\/10.1097\/00003246-199404000-00020","DOI":"10.1097\/00003246-199404000-00020"},{"key":"51995","doi-asserted-by":"crossref","unstructured":"Scalea TM, Maltz S, Yelon J, Trooskin SZ, Duncan AO, Sclafani SJ: Resuscitation of multiple trauma and head injury: role of crystalloid fluids and inotropes. Crit Care Med 1994, 22:1610-1615. https:\/\/doi.org\/10.1097\/00003246-199410000-00017","DOI":"10.1097\/00003246-199422100-00017"},{"key":"51997","doi-asserted-by":"crossref","unstructured":"Meregalli A, Oliveira RP, Friedman G: Occult hypoperfusion is associated with increased mortality in hemodynamically stable, high-risk, surgical patients. Crit Care 2004, 8:R60-R65. https:\/\/doi.org\/10.1186\/cc2423","DOI":"10.1186\/cc2423"},{"key":"51999","doi-asserted-by":"crossref","unstructured":"Blow O, Magliore L, Claridge JA, Butler K, Young JS: The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma. J Trauma 1999, 47:964-969. https:\/\/doi.org\/10.1097\/00005373-199911000-00028","DOI":"10.1097\/00005373-199911000-00028"},{"key":"52001","doi-asserted-by":"crossref","unstructured":"Davis JW, Shackford SR, Mackersie RC, Hoyt DB: Base deficit as a guide to volume resuscitation. J Trauma 1988, 28:1464-1467. https:\/\/doi.org\/10.1097\/00005373-198810000-00010","DOI":"10.1097\/00005373-198810000-00010"},{"key":"52003","doi-asserted-by":"crossref","unstructured":"Abramson D, Scalea TM, Hitchcock R, Trooskin SZ, Henry SM, Greenspan J: Lactate clearance and survival following injury. J Trauma 1993, 35:584-588. discussion 588-9. https:\/\/doi.org\/10.1097\/00005373-199310000-00014","DOI":"10.1097\/00005373-199310000-00014"},{"key":"52005","doi-asserted-by":"crossref","unstructured":"McNelis J, Marini CP, Jurkiewicz A, Szomstein S, Simms HH, Ritter G, Nathan IM: Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit. Am J Surg 2001, 182:481-485. https:\/\/doi.org\/10.1016\/S0002-9610(01)00755-3","DOI":"10.1016\/S0002-9610(01)00755-3"},{"key":"52007","doi-asserted-by":"crossref","unstructured":"Stensballe J, Henriksen HH, Johansson PI. Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy. Curr Opin Crit Care. 2017 Dec;23(6):503-510. https:\/\/doi.org\/10.1097\/MCC.0000000000000466","DOI":"10.1097\/MCC.0000000000000466"},{"key":"52009","doi-asserted-by":"crossref","unstructured":"Ostrowski SR, Henriksen HH, Stensballe J, et al. Sympathoadrenal activation and endotheliopathy are drivers of hypocoagulability and hyperfibrinolysis in trauma: a prospective observational study of 404 severely injured patients. J Trauma Acute Care Surg 2017; 82:293-301. https:\/\/doi.org\/10.1097\/TA.0000000000001304","DOI":"10.1097\/TA.0000000000001304"},{"key":"52011","doi-asserted-by":"crossref","unstructured":"Johansson PI, Henriksen HH, Stensballe J, et al. Traumatic endotheliopathy: a prospective observational study of 424 severely injured patients. Ann Surg 2017; 265:597-603. https:\/\/doi.org\/10.1097\/SLA.0000000000001751","DOI":"10.1097\/SLA.0000000000001751"},{"key":"52013","doi-asserted-by":"crossref","unstructured":"Shaz BH, Winkler AM, James AB, et al. Pathophysiology of early traumainduced coagulopathy: emerging evidence for hemodilution and coagulation factor depletion. J Trauma 2011; 70:1401-1407 https:\/\/doi.org\/10.1097\/TA.0b013e31821266e0","DOI":"10.1097\/TA.0b013e31821266e0"},{"key":"52015","doi-asserted-by":"crossref","unstructured":"Fries D, Innerhofer P, Schobersberger W: Time for changing coagulation management in trauma-related massive bleeding. Curr Opin Anaesthesiol 2009, 22:267-274. https:\/\/doi.org\/10.1097\/ACO.0b013e32832678d9","DOI":"10.1097\/ACO.0b013e32832678d9"},{"key":"52017","doi-asserted-by":"crossref","unstructured":"Shere-Wolfe RF, Galvagno SM Jr, Grissom TE. Critical care considerations in the management of the trauma patient following initial resuscitation. Scand J Trauma Resusc Emerg Med. 2012 Sep 18;20:68. https:\/\/doi.org\/10.1186\/1757-7241-20-68","DOI":"10.1186\/1757-7241-20-68"},{"key":"52019","doi-asserted-by":"crossref","unstructured":"Schochl H, Maegele M, Solomon C, Gorlinger K, Voelckel W: Early and individualized goal-directed therapy for trauma-induced coagulopathy. Scand J Trauma Resusc Emerg Med 2012, 20:15. https:\/\/doi.org\/10.1186\/1757-7241-20-15","DOI":"10.1186\/1757-7241-20-15"},{"key":"52021","doi-asserted-by":"crossref","unstructured":"Wray JP, Bridwell RE, Schauer SG, Shackelford SA, Bebarta VS, Wright FL, Bynum J, Long B. The diamond of death: Hypocalcemia in trauma and resuscitation. Am J Emerg Med. 2021 Mar;41:104-109 https:\/\/doi.org\/10.1016\/j.ajem.2020.12.065","DOI":"10.1016\/j.ajem.2020.12.065"},{"key":"52023","doi-asserted-by":"crossref","unstructured":"Cannon JW. Hemorrhagic Shock. N Engl J Med. 2018 Jan 25;378(4):370-379. https:\/\/doi.org\/10.1056\/NEJMra1705649","DOI":"10.1056\/NEJMra1705649"},{"key":"52025","doi-asserted-by":"crossref","unstructured":"Curry N, Brohi K. Surgery in Traumatic Injury and Perioperative Considerations. Semin Thromb Hemost. 2020 Feb;46(1):73-82. https:\/\/doi.org\/10.1055\/s-0039-1697932","DOI":"10.1055\/s-0039-1697932"},{"key":"52027","doi-asserted-by":"crossref","unstructured":"Schafer N, Driessen A, Frohlich M, et al. ; TACTIC partners. Diversity in clinical management and protocols for the management of major bleeding of trauma patients across European level 1 Trauma Centres. Scand J Trauma Resusc EmergMed 2015;23:74 https:\/\/doi.org\/10.1186\/s13049-015-0147-6","DOI":"10.1186\/s13049-015-0147-6"},{"key":"52029","doi-asserted-by":"crossref","unstructured":"Holcomb JB, Tilley BC, Baraniuk S, et al; PROPPR Study Group. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA 2015;313(05):471-482 https:\/\/doi.org\/10.1001\/jama.2015.12","DOI":"10.1001\/jama.2015.12"},{"key":"52031","doi-asserted-by":"crossref","unstructured":"Abou-Khalil B, Scalea TM, Trooskin SZ, Henry SM, Hitchcock R: Hemodynamic responses to shock in young trauma patients: need for invasive monitoring. Crit Care Med 1994, 22:633-639. https:\/\/doi.org\/10.1097\/00003246-199404000-00020","DOI":"10.1097\/00003246-199404000-00020"},{"key":"52033","doi-asserted-by":"crossref","unstructured":"Sperry JL, Minei JP, Frankel HL, West MA, Harbrecht BG, Moore EE, Maier RV, Nirula R: Early use of vasopressors after injury: caution before constriction. J Trauma 2008, 64:9-14. https:\/\/doi.org\/10.1097\/TA.0b013e31815dd029","DOI":"10.1097\/TA.0b013e31815dd029"}],"container-title":["Colombia Medica"],"original-title":[],"link":[{"URL":"https:\/\/colombiamedica.univalle.edu.co\/index.php\/comedica\/article\/download\/4810\/5038","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/colombiamedica.univalle.edu.co\/index.php\/comedica\/article\/download\/4810\/5012","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/colombiamedica.univalle.edu.co\/index.php\/comedica\/article\/download\/4810\/5037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T17:59:01Z","timestamp":1722967141000},"score":1,"resource":{"primary":{"URL":"https:\/\/colombiamedica.univalle.edu.co\/index.php\/comedica\/article\/view\/4810"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,18]]},"references-count":49,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,4,13]]}},"URL":"https:\/\/doi.org\/10.25100\/cm.v52i2.4810","relation":{},"ISSN":["1657-9534","0120-8322"],"issn-type":[{"value":"1657-9534","type":"electronic"},{"value":"0120-8322","type":"print"}],"subject":[],"published":{"date-parts":[[2021,8,18]]},"assertion":[{"value":"Yes","name":"crosschecked","label":"CrossChecked"},{"value":"Yes","name":"peer_reviewed","label":"Peer Reviewed"}]}}