Abstract
Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock. These conditions require rapid actions (diagnosis and management) and a strong interplay between surgeons and anesthesiologists. Effective airway management often makes the difference between life and death in severe maxillofacial and neck trauma and takes initial precedence over all other clinical considerations. Damage control strategies focus on physiological and biochemical stabilization prior to the comprehensive anatomical and functional repair of all injuries. Damage control surgery (DCS) can be defined as the rapid initial control of hemorrhage and contamination, temporary wound closure, resuscitation to normal physiology in the intensive care unit (ICU) and subsequent reexploration and definitive repair following restoration of normal physiology. Damage control resuscitation (DCR) consists mainly of hypotensive (permissive hypotension) and hemostatic (minimal use of crystalloid fluids and utilization of blood and blood products) resuscitation. Both strategies should be administered simultaneously in all of these patients.
Highlights
Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock [1, 2]
Damage control surgery (DCS) can be defined as the rapid initial control of hemorrhage and
SBP: 80 to 90 mmHg until hemorrhage control if severe TBI (GCS ≤ 8) MAP ≥ 80 mmHg consider rFVIIa if major bleeding and traumatic coagulopathy persist despite maximal attempts to stop bleeding in case of pre-trauma therapeutic anticoagulation or antiplatelets drugs consider specific treatment
Summary
Severe maxillofacial and neck trauma exposes patients to life threatening complications such as airway compromise and hemorrhagic shock [1, 2] These conditions require a rapid recognition and management and a strong interplay between surgeons, anesthesiologists and other relevant medical personnel. Recognition of patients that may benefit from a MT is a fundamental step in improving outcome; in certain situations it is unclear which bleeding patient will require MT [21] In this regard, several scores such as Trauma Associated Severe Hemorrhage (TASH) score [22] and ABC score [23] have been validated and utilized (Table 1). Damage control resuscitation Massive transfusion Massive transfusion (MT) may be defined as the rapid transfusion of a large volume of blood products to a patient with severe hemorrhage [21]. Recent guidelines [24] suggest the maintenance of different SBP values (for TBI and non-TBI patients) until
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