The immune system is complex, with numerous mechanisms to confront a myriad of both foreign pathogens and even nonforeign neoplasms. The immune response to injury is mediated by the innate and adaptive arms of the immune system. The innate response…
Since the publication of the last edition of Current Therapy in Trauma and Surgical Critical Care , there have been many changes regarding the diagnosis of sepsis, the most accurate definition to capture its true incidence, and its overall burden…
Multiple organ failure (MOF) has plagued surgical intensive care units (ICUs) for nearly 5 decades. MOF was first described as a syndrome of progressive organ failure leading to early death that most often occurred after sepsis (principally from intra-abdominal infections…
Since the advent of the mechanical ventilator and the modern era of critical care medicine, many topics have been the subject of intense debate and investigation. The acute respiratory distress syndrome (ARDS), first described over half a century ago by…
Hemorrhage continues to be the leading cause of death for traumatically injured patients despite all the advances that have been made in the past 20 years. Time to hemorrhage control is one of the most, if not the most, critical…
Approximately 15% of all blood transfusions in the United States are used in the care of patients who have sustained traumatic injury. Blood transfusion in trauma is lifesaving for those patients in hemorrhagic shock, as the median time to hemorrhagic…
The neuroendocrine axis The endocrine system is a complex system allowing communication between the nervous system and the end organs. It consists of the neuroendocrine axis (hypothalamus, pituitary, and glands), all of which influence the response to stress and critical…
Surgeons commonly encounter coagulation disorders in the course of caring for patients, especially those with serious injury and those undergoing or recovering from surgery. Whereas bleeding is a condition that has been well known throughout human history, understanding the pathophysiology…
Acute kidney injury (AKI) refers to an acute decrease in the glomerular filtration rate (GFR). AKI develops in approximately 20% of patients admitted to the hospital and in 50% of patients admitted to the ICU. Short- and long-term mortality is…
Key points ■ Mechanical ventilation (MV) must support gas exchange and promote patient comfort while minimizing lung injury due to elevated airway pressures. ■ Protective, low tidal volume ventilation reduces morbidity and mortality rates in patients following acute respiratory distress…