Damage control surgery is defined as rapid termination of an operation after control of life threatening bleeding and contamination in severely injured and unstable patients, followed by correction of physiologic abnormalities and de-finitive management. Emphasis then shifts from the operating theater to the intensive care unit, where the patient’s physiologic deficits are corrected. These patients present many challenges for the intensive care team and emphasize the need for a multidisciplinary approach to optimize trauma patient management. This modern strategy involves a staged approach to multiply injured patients designed to avoid or correct the lethal triad of hypothermia, acidosis and coagu-lopathy before definitive management of injuries. During the first stage of damage control, hemorrhage is stopped and contamination is controlled using the simplest and most rapid means available. Temporary wound closure methods are em-ployed. The second stage is characterized by correction of physiologic abnor-malities in the ICU. Multiple issues need to be addressed simultaneously, while the overall aim is to rapidly achieve a physiological environment that allows the best possible recovery. The “lethal trial” of hypothermia, acidosis and coagulo-pathy due initial hypovolaemia require aggressive correction. From the outset ICU management must also attempt to minimize the complications of these inju-ries and the resuscitation process. In the final phase of damage control, definitive operative management is completed in a stable patient.