PMID- 30906580
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200929
IS  - 2072-1439 (Print)
IS  - 2077-6624 (Electronic)
IS  - 2072-1439 (Linking)
VI  - 11
IP  - Suppl 2
DP  - 2019 Feb
TI  - Thoracic damage control surgery.
PG  - S158-S166
LID - 10.21037/jtd.2018.11.32 [doi]
AB  - Thoracic damage control surgery (TDCS) is a decision making tool and derivate of 
      the damage control concept (DCC), where physiological stabilization has a 
      priority over anatomical reconstruction under the pressure of time. Intrathoracic 
      haemorrhage control and pleural decompression are the two main immediate tasks of 
      TDCS, while definitive procedures follow when the patient is stabilised in 24-48 
      hours. The focus of the thoracic surgeon is on the prevention of the haemorrhage 
      induced coagulopathy, metabolic acidosis and hypothermy formed triad of death. 
      Surgical haemorrhage control and pleural space decompression are to be performed. 
      The individual patients benefit from TDCS procedures whose condition is too 
      severe for a complex immediate reconstruction (polytrauma). Life threatening 
      chest injuries in multiple/mass casualty scenarios in civilian and military 
      environment alike are triaged and treated accordingly. Onset of acute mismatch 
      between the resources (available hands, OP theaters, resources, hardware) and the 
      needs (number and severity of chest trauma cases), a mindset shift should take 
      place, where time and space the two main limiting factors. Airway obstruction, 
      tension haemo/pneumothorax falls into the preventable death category. Chest 
      drainage and emergency thoracotomy are the two main procedures offered by TDCS. 
      An intervention structured organ/injury specific list of procedures is detailed. 
      This is a mix of emergency surgery and cardiothoracic surgery, where less is 
      more. TDSC is not the Holy Grail found to solve all complex thoracic trauma 
      cases, but is a good tool to increase the chance for survival in challenging, and 
      frequently quite hopeless situations.
FAU - Molnar, Tamas F
AU  - Molnar TF
AD  - Department of Operational Medicine, Medical Humanities Unit, University of Pecs, 
      Pecs, Hungary.
AD  - Department Surgery, St Sebastian Thoracic Surgery Unit, Petz A University 
      Teaching Hospital, Gyor, Hungary.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - China
TA  - J Thorac Dis
JT  - Journal of thoracic disease
JID - 101533916
PMC - PMC6389564
OTO - NOTNLM
OT  - Chest trauma
OT  - acute lung injury
OT  - damage control concept
OT  - thoracic surgery
COIS- Conflicts of Interest: The author has no conflicts of interest to declare.
EDAT- 2019/03/25 06:00
MHDA- 2019/03/25 06:01
PMCR- 2019/02/01
CRDT- 2019/03/26 06:00
PHST- 2019/03/26 06:00 [entrez]
PHST- 2019/03/25 06:00 [pubmed]
PHST- 2019/03/25 06:01 [medline]
PHST- 2019/02/01 00:00 [pmc-release]
AID - jtd-11-S2-S158 [pii]
AID - 10.21037/jtd.2018.11.32 [doi]
PST - ppublish
SO  - J Thorac Dis. 2019 Feb;11(Suppl 2):S158-S166. doi: 10.21037/jtd.2018.11.32.