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Prompt correction of these abnormalities is vital in order to minimize blood loss, an independent risk factor for postinjury multiple organ failure, and to allow early definitive repair of injuries. However, this shifts the primary burden of addressing the triad of hypothermia, coagulopathy, and acidosis from the anesthesiologist to the critical care physician. The patient is then rapidly transported to the intensive care unit for resuscitation in order to restore sufficient physiologic reserve to allow return to the operating room for definitive repair and reconstruction ( 1-3).Īlthough retrospective in nature, studies have documented a nearly 50% decrease in operative times for the most severely injured patients treated by this approach, and salvage rates of 20–60% in patients who formerly died in the operating room ( 2, 4). Techniques for abbreviating operations include ligation of intestinal injuries without anastomoses, leaving retained clamps on injured vascular structures or placement of temporary intralumenal shunts, packing diffusely bleeding surfaces with multiple laparotomy pads, and using towel clips to quickly close the skin, leaving the underlying fascia open. A minimal operation is initially performed solely to reduce or control surgical bleeding and enteric spillage.

It can be defined as a series of operations performed during several trips to the operating room at intervals of several hours to days, in order to accomplish definitive repair in a staged manner in accordance with the patient's physiologic tolerance. Staged laparotomy, also known as abbreviated laparotomy, or “damage control,” is a new, important, rapidly expanding surgical approach to treating unstable patients. This triad presented as a vicious cycle that often could not be interrupted, and patients frequently died in the operating room due to “irreparable injuries.” In many of these patients progressive intraoperative deterioration in physiology occurred, typically manifested as hypothermia, coagulopathy, and acidosis. The burden was on the anesthesiologist to provide sufficient intraoperative critical care so that the surgeon had sufficient time to definitively repair all injuries. If the patient returned to the operating room for postoperative bleeding the surgeon was considered to have performed an inadequate operation. Prolonged operative times were common in patients with multiple injuries such as massive liver trauma, abdominal vascular trauma, retroperitoneal injuries, multiple intestinal disruptions, chest trauma, and open fractures.

The historical objective of laparotomy was to provide definitive hemostasis, repair of all injuries, and control of enteric contamination by resection of bowel injuries, followed by anastomosomes or ostomy formation. This has presented a new challenge for critical care physicians, who must now address problems that previously burdened anesthesiologists during lengthy operations on unstable patients. New agents targeting this are therefore suggested.Operative goals for trauma patients with severe multisystem injuries have changed in recent years.

Nevertheless, the presence of severe coagulopathy is linked with higher risk than the extremes of the other two in a “triad of death” presentation. However, when all three occur together, one can additionally worsen the effect of the others causing what is referred to as a “vicious cycle resulting in death”. All three components appear to increase the likelihood of death individually. It was found that the mortality rates for this presentation are still high, despite a general decrease in patient fatality following major trauma. This article aimed to look closer at these presentations, their outcomes and management. It is very difficult to reverse and is consequently associated with a high fatality, making it a dreaded presentation which requires high vigilance and swift action. The ‘triad of death’ consists of the presence of acidosis, coagulopathy and hypothermia in an injured patient.