Damage control resuscitation in pediatric trauma

Current Opinion in Pediatrics
Meghan Gilley, Suzanne Beno

Abstract

Damage control resuscitation is an overall management strategy used in trauma patients to rapidly restore physiologic stability, while mitigating hypothermia, coagulopathy and acidosis. We review the evidence and current practice of damage control resuscitation in pediatric trauma patients with a specific focus on fluid management. There have been a number of studies over the last several years examining crystalloid fluid resuscitation, balanced blood product transfusion practice and hemostatic agents in pediatric trauma. Excessive fluid resuscitation has been linked to increased number of ICU days, ventilator days and mortality. Balanced massive transfusion (1 : 1 : 1 product ratio) has not yet been demonstrated to have the same mortality benefits in pediatric trauma patients as in adults. Similarly, tranexamic acid (TXA) has strong evidence to support its use in adult trauma and some evidence in pediatric trauma. Attention to establishing rapid vascular access and correcting hypothermia and acidosis is essential. A judicious approach to crystalloid resuscitation in the bleeding pediatric trauma patient with early use of blood products in keeping with an organized approach to massive hemorrhage is recommended. The ideal crysta...Continue Reading

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Citations

Jun 2, 2020·Transfusion·Abigail R WheelerSteven G Schauer
Feb 9, 2021·The Journal of Surgical Research·Nina MbadiweAlisa McQueen
Jan 26, 2021·Frontiers in Pediatrics·Alison B Nair, Robert I Parker
Dec 9, 2020·The Journal of Surgical Research·Samer AsmarBellal Joseph
Nov 5, 2019·The Journal of Surgical Research·Adel ElkbuliDessy Boneva

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