Surgical Critical Care and Emergency Surgery

Ryan Malcom, MDDivision of Trauma and Acute Care Surgery New York Medical College Westchester Medical Center Valhalla, NY, USA

Toni Manougian MD, MBADepartment of Critical Care Anesthesiology New York Medical College Westchester Medical Center Valhalla, NY, USA

Matthew J. Martin, MDTrauma and Acute Care Surgery Service Scripps Mercy Hospital San Diego, CA, USA

Kazuhide Matsushima, MDDivision of Acute Care Surgery University of Southern California LAC+USC Medical Center Los Angeles, CA, USA

Adrian A. Maung, MD, FCCMYale School of Medicine New Haven, CT, USA

Richard S. Miller, MDDepartment of Surgery TCU & UNTHSC School of Medicine John Peter Smith Health Fort Worth, TX, USA

William Mohr III, MDRegions Hospital Saint Paul, MN, USA

Ida Molavi, MDDepartment of Trauma and Acute Care Surgery Louisiana State University Health Shreveport, LA, USA

Thomas Muse, MDDepartment of Trauma and Acute Care Surgery Department of Surgery University of Alabama at Birmingham Birmingham, AL, USA

Christopher S. Nelson, MDDivision of Acute Care Surgery Department of Surgery University of Missouri Columbia, MO, USA

Omar Obaid, MDDivision of Trauma, Critical Care Burns, and Emergency Surgery Department of Surgery University of Arizona Tucson, AZ, USA

Thomas A. O’Hara, DODwight D. Eisenhower Army Medical Center Fort Gordon, GA, USA

Terence O’Keeffe, MB ChBAugusta University Medical Center Augusta, GA, USA

Kristine Tolentino Parra, MDNaval Medical Center San Diego, CA, USA

Gregory S. Peirce, MDWomack Army Medical Center Fort Bragg, NC, USA

Annalise Penikis, MDUniversity of Maryland Medical Center Baltimore, MD, USA

Herb A. Phelan, MD, MSCSDepartment of Surgery, LSU School of Medicine New Orleans, LA, USA

Kartik Prabhakaran, MDNew York Medical College Westchester Medical Center Valhalla, NY, USA

Theodore Pratt, MDNaval Medical Center San Diego, CA, USA

Eric Raschke, DOMadigan Army Medical Center Tacoma, WA, USA

Shariq Raza, MDTrauma Surgery, Surgical Critical Care & Emergency Surgery Perelman School of Medicine University of Pennsylvania Philadelphia, PA, USA

Peter M. Rhee, MDDivision of Trauma and Acute Care Surgery New York Medical College Westchester Medical Center Valhalla, NY, USA

Daniel Roubik, MDBrooke Army Medical Center San Antonio, TX, USA

Navdeep Samra, MDLSU Health Shreveport, LA, USA

Jaideep Sandhu, MBBS, MPHCity of Hope National Medical Center Duarte, CA, USA

Jarrett Santorelli, MDDivision of Trauma, Acute Care Surgery, Surgical Critical Care and Burns University of California San Diego San Diego, CA, USA

Fariha Sheikh, MDDivision of Trauma and Critical Care Surgery Rutgers New Jersey Medical School University Hospital Newark, NJ, USA

Jared Sheppard, MDDivision of Acute Care Surgery, Department of Surgery University of Missouri Columbia, MO, USA

Ilya Shnaydman, MDDivision of Trauma and Acute Care Surgery New York Medical College Westchester Medical Center Valhalla, NY, USA

Elise Sienicki, MDNaval Medical Center, San Diego, CA, USA

Brandt Sisson, MDNaval Medical Center San Diego, CA, USA

Michael C. Smith, MDDivision of Trauma and Surgical Critical Care Vanderbilt University Medical Center Nashville, TN, USA

Collin Stewart, MDBanner University Medical Center University of Arizona College of Medicine Tucson, AZ, USA

Michelle Strong, MD, PhDTrauma and Acute Care Surgeon Austin, TX, USA

Jonathan Swisher, MDLTC, MC US Army William Beaumont Army Medical Center El Paso, TX, USA

Andrew Tang, MDUniversity of Arizona College of Medicine Banner University Medical Center Tucson, AZ, USA

Anne Warner, MDDepartment of Surgery Christiana Care Health Care System Newark, DE, USA

Cassandra Q. White, MDDepartment of Surgery Augusta University Augusta, GA, USA

Andrew J. Young, MDDivision of Trauma, Critical Care and Burn The Ohio State University Columbus, OH, USA

Bardiya Zangbar, MDDivision of Trauma and Acute Care Surgery New York Medical College Westchester Medical Center Valhalla, NY, USA

This book is accompanied by a companion website

www.wiley.com/go/surgicalcriticalcare3e

The website features:

Interactive multiple choice questions

Anne Warner, MD, Harsh Desai, MD, and Frederick Giberson, MD

Department of Surgery, Christiana Care Health Care System, Newark, DE, USA

1 In a patient who develops ARDS, the addition of PEEP in optimizing ventilatory support has which of the following effects?Maximal alveolar recruitment with inspiration.Decreasing mean airway pressure.Decreased right ventricular afterload.Improvement of functional residual capacity (FRC).Increasing left ventricular afterload.The use of positive end‐expiratory pressure (PEEP) as part of the ARDS ventilatory strategy has been shown to improve the functional residual capacity (FRC) above the closing pressure of alveoli, thereby preventing alveolar collapse. PEEP maximizes alveolar recruitment at end expiration, not inspiration. The addition of PEEP increases inflation pressure, thereby increasing peak alveolar pressure and ultimately mean airway pressure. Increased PEEP increases pulmonary vascular resistance impeding right vascular stroke volume and thereby left ventricular filling. It also decreases the transmural pressure – the pressure needed to be overcome in order to eject stroke volume – thereby decreasing left ventricular afterload.Answer: DBriel M, Meade M, Mercat A, et al. Higher vs lower positive end‐expiratory pressure in patients with acute lung injury and acute respiratory distress syndrome. JAMA. 2010; 303 (9): 865–873.Schmitt JM, Viellard‐Baron A, Augarde R, et al. Positive end‐expiratory pressure titration in acute respiratory distress syndrome patients: impact on right ventricular outflow impedance evaluated by pulmonary artery Doppler flow velocity measurements. Crit Care Med. 2001; 29: 1154–1158.

2 Which of the following is NOT a component of the inflammatory cascade leading to lung injury in ARDS?Injury to type I and type II epithelial cells within the alveoli.Capillary endothelial dysregulation resulting in recruitment of neutrophils.Sequestration of predominantly lymphocytes within the pulmonary microcirculation.Release of cytoplasmic granules from neutrophil degranulation.Exudation of protein‐rich fluid into the distal airspaces.The inflammatory cascade in ARDS is thought to be initiated by activation of circulating neutrophils by the release of IL‐1 and TNF by macrophages and monocytes. Endothelial dysregulation attracts and retains neutrophils with subsequent sequestration within the pulmonary microcirculation. This occurs through adhesion of neutrophils to endothelial cells and neutrophil stiffening. Neutrophils then move into lung parenchyma and degranulate propagating injury to the type I and II epithelial cells within the alveoli allowing for exudation of protein‐rich fluid, erythrocytes, and platelets into the distal airspaces.Answer: CAbraham E. Neutrophils and acute lung injury. Crit Care Med. 2003; 31(supp): S195–S199.