By Jerome Abrams, Paul Druck, Frank B. Cerra

ISBN-10: 0824759117

ISBN-13: 9780824759117

Providing present views at the body structure and metabolism of the severely sick, this reference demonstrates useful methods for the preoperative, intraoperative, and postoperative care of the severely ailing sufferer with an abundance of truly laid-out figures, case stories, graphs, and charts.

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Yet clinical trials in “sepsis” patients are by nature beset with extreme selection bias problems. Identification of a statistically identifiable benefit hidden in a sea of patients who will get well without the intervention, and patients who will sicken and die with or without the intervention, poses formidable difficulties. Clearly, identifying the appropriate patient population for trials, as well as for each of the therapies we already possess, will be essential to improving care. A 2001 conference re-examined the definitions of sepsis, and proposed a model of categorizing response to infectious challenge modeled on the TNM staging system used by oncologists (54) and designated as the PIRO model.

These cells produce toxic proteins, peptides, and reactive oxygen species that not only kill pathogenic organisms but also can cause collateral damage to host cells. Activated neutrophils also are trapped in pulmonary capillary beds, as well as in post-capillary venules of other tissues. Damage to these tissues attracts additional immune cells, and the unregulated amplification of this process may lead to organ failure distant from the site of the original infection. The down-regulation of these activated neutrophils is believed to be related to neutrophil apoptosis (33).

Faist E, Baue AE, Dittmer H, Heberer G. Multiple organ failure in polytrauma patients. J Trauma 1983; 23(9):775– 787. Ciesla DJ, Moore EE, Zallen G, Biffl WL, Silliman CC. Hypertonic saline attenuation of polymorphonuclear neutrophil cytotoxicity: timing is everything. J Trauma 2000; 48(3):388 – 395. Moore FA. The role of the gastrointestinal tract in postinjury multiple organ failure. Am J Surg 1999 Dec; 178(6):449– 453. Marshall JC, Christou NV, Meakins JL. The gastrointestinal tract. The “undrained abscess” of multiple organ failure.

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Surgical Critical Care, Second Edition by Jerome Abrams, Paul Druck, Frank B. Cerra


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