Computer simulation of hypothermia during 'damage control' laparotomy

Asher Hirshberg*, Nadav Sheffer, Ofer Barnea

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


'Damage control' is a surgical strategy for the staged repair of severe trauma that aims to avoid an irreversible physiologic insult marked by a self-propagating combination of hypothermia, coagulopathy, and acidosis. The point beyond which the physiologic insult becomes irreversible, however, remains ill-defined. The aim of this study was to address this problem by means of a dynamic computer model of heat loss during laparotomy for exsanguinating hemorrhage. A single compartment model was developed using a graphic modeling tool and was implemented to calculate the time interval from the beginning of laparotomy to a core temperature of 32°C, which is a marker of irreversible physiologic derangement in injured patients. A series of simulation runs showed that the exposed peritoneum is the dominant factor contributing to heat loss; the bleeding rate has a less marked effect. Elevation of the ambient temperature and rapid abdominal closure are effective interventions available to the surgeon to modify the heat loss curve. This study shows that during a 'damage control' laparotomy for exsanguinating hemorrhage the window of opportunity for salvage before the onset of an irreversible physiologic insult is no longer than 60 to 90 minutes.

Original languageEnglish
Pages (from-to)960-965
Number of pages6
JournalWorld Journal of Surgery
Issue number9
StatePublished - Sep 1999


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