Double Blinded Randomized Controlled Trial: Does Hypertonic Saline Resuscitation in Trauma Following Damage Control Laparotomy
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59 MDW San Antonio United States
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Damage control laparotomy DCL has emerged as the standard of care for trauma patients requiring operative control of intra-abdominal and retroperitoneal injury. This advancement, which allows for the management of patients with previously lethal levels of hypothermia, acidosis, and coagulopathy, has also forced physicians to become comfortable with the management of an open abdomen. Despite advances in the recognition of IAHACS and implementation of a multitude of devices for temporary abdominal closure TAC as many as 30 of patients will fail to achieve primary fascial closure PFC.While the morbidity associated with the management of an open abdomen poses one threat, the trauma patient that has received a DCL is also susceptible to the effects of a massive inflammatory reaction and associated multifactorial edema a risk factor for developing multiple organ dysfunction syndrome MODS. A variety of intravascular fluids have been investigated for their therapeutic effects against activation of neutrophils and the inflammatory cascade to improve clinical outcomes. From these investigations it has been shown that HTS is superior to lactated ringers solution LR, and normal saline solution NSS at reducing neutrophil activation, apoptosis, bowel edema, and expression of inflammatory cytokines both in-vitro and in-vivo.
- Medicine and Medical Research