Packed Gauze Infection in Damage Control for Uncontrollable Massive Rapid Hemorrhage during Abdominal Surgery and Packing Duration

Yoshihiro Moriwaki, Mitsugi Sugiyama, Takayuki Kosuge and Noriyuki Suzuki

Critical Care and Emergency Center, Yokohama City University Medical Center

Background and Objectives: Patients with massive rapid hemorrhage coagulpathic disease easily fall into lethal triad (acidosis, hypothermia and coagulopathy). In these condition damage control (DC) should be adopted, in which strategy we manage multiple bleeding with gauze packing and then control metabolic catastrophe in ICU. Although longer duration of gauze packing is more favorable for hemostasis, packed gauze may be contaminated during the long packing. The aim of this observational study is to clarify the safety and limit of gauze packing. Methods: Twenty-four gastrointestinal and abdominal surgical cases with intraperitoneal hemorrhage and shock were enrolled, who underwent gauze packing as damage control surgery and depacking in the planed reoperation. We examined the relationship between bacterial culture of the removed gauze and the duration of packing. Results: Mean duration of gauze packing is 64.9 hours. All cases presented negative in bacterial smear and 50.0% positive in bacterial culture. Sixteen cases presented infectious complication and in 10 presented intraperitoneal infection. The rate of infectious complication and intraperitoneal infection within 1 month after the surgery tend to be higher and duration of packed gauze was longer in cases who presented positive bacterial culture in packed gauze (P=0.043). The positive rate of bacterial culture in cases in whom the duration of gauze packing was between 36 and 96 hours showed no change, and that within 36 hours tended to be lower and that over 96 hours tended to be higher. The positive rate in 15 cases in whom the duration was between 36 and 96 hours and 5 cases over 96 hours were 46.7% and 80.0%, respectively, the latter of which tended to be higher (P=0.053). The positive rate in 17 cases in whom the duration was between 36 and 120 hours and 3 cases over 120 hours were 47.1% and 100.0%, respectively, the latter of which was higher (P=0.009). The rate of positive bacterial culture tended to be higher in cases in whom gastrointestinal disruption was seen in the first surgery. Conclusions: Under uncontrollable rapid and massive hemorrhage during surgery, we are forced to perform gauze packing as the primary surgical hemostatic procedure in damage control. We should remove the gauze in order to complete hemostasis and to avoid infection of gauze left in the peritoneal cavity from 96 to 120 hours.

Key words
uncontrolled hemorrhagic shock, gauze packing, gauze infection, gastrointestinal-abdominal surgery, gastrointestinal-abdominal trauma

Reprint requests
Yoshihiro Moriwaki Critical Care and Emergency Center, Yokohama City University Medical Center
4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024 JAPAN

Accepted
April 22, 2009

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