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Trauma, sepsis and shock, the physiological basis of therapy

1988; Elsevier BV; Volume: 8; Issue: 4 Linguagem: Inglês

10.1016/0741-5214(88)90128-0

1097-6809

Samir M. Fakhry, George Johnson,

Sepsis Diagnosis and Treatment

Trauma, sepsis and shock, the physiological basis of therapy George H. A. Clowes, Jr., ed. New York, 1988, Marcel Dekker, Inc., 587 pages. $125. This timely work, as Dr. Clowes states in the preface, covers many aspects of the “definitive treatment and supportive management of severe trauma, invasive infection, and the frequently accompanying shock.” Although not intended as a textbook, it offers a broad overview of our current understanding of the physiologic basis of the care of seriously ill and injured patients. It thus covers many topics integral to the relatively new but rapidly expanding subspecialty: surgical critical care. The work is divided into six parts and 18 chapters. The 36 authors are a diverse and scholarly group whose breadth of expertise reflects the complex and sometimes controversial nature of this vast field. Well referenced throughout, it is instructive for those accomplished in the field while allowing the novice to grasp the fundamental principles involved. Dr. Clowes opens with a comprehensive discussion of the biochemical mechanisms and mediators in the organism's response to stress and injury. Part One continues with a discussion of bacterial invasion. A pathologic description of cellular injury illustrated with outstanding electron micrographs follows. Hemorrhage, hemostasis, and the stress-related cardiorespiratory and hemodynamic responses are the subjects of Part Two. Part Three covers the metabolic and nutritional consequences of stress and the pathophysiology of multiple-system organ failure. Part Four devotes two chapters to our expanding knowledge of immunology. The first reviews one institution's extensive experience with skin testing as well as humoral immunity. The second is a thorough review of relevant immunologic principles with special attention to lymphocyte abnormalities. A concise discussion of antibiotics follows. Wound healing is discussed in Part Five. Part Six includes a practical explanation of the principles of nutritional support and the utility and limitations of patient monitoring techniques. Although the authors' preferences in management are evident in some areas, they are generally supported by basic scientific data, and the work remains true to its title. In summary, this well-written volume provides a strong foundation for understanding the physiologic basis of the management of acute injury and would thus be a welcome addition to the libraries of students of surgery at all levels.