Frank Cerra - Academia.edu (original) (raw)
Papers by Frank Cerra
Journal of Surgical Research, Dec 1, 1985
CRC Press eBooks, Aug 12, 2005
Springer eBooks, 1987
Multiple organ failure continues to be the pathway of death after burns, trauma and sepsis. This ... more Multiple organ failure continues to be the pathway of death after burns, trauma and sepsis. This clinical syndrome represents the transition from a hypermetabolic response to injury that has associated respiratory dysfunction, to a setting of clinical organ failures and death. Risk factors include: perfusion deficits, persistent foci of dead or injured tissue, an uncontrolled focus of infection, the presence of the respiratory distress syndrome, persistent hypermetabolism, and preexisting fibrotic liver disease. Once in the organ failure syndrome, most treatment modalities become progressively ineffective, including: ventilation, antibiotics, nutrition, and surgery. The best treatment remains prevention with rapid control of the source and restoration of oxygen transport. To date, no single “magic bullet” has been shown to exist either experimentally or clinically.
Journal of Cardiothoracic and Vascular Anesthesia, Apr 1, 1993
ABSTRACT
Journal of Parenteral and Enteral Nutrition, Nov 1, 1988
Twenty-one dogs underwent instrumentation of the left ventricle with ultrasonic dimension to stud... more Twenty-one dogs underwent instrumentation of the left ventricle with ultrasonic dimension to study the effects of acute protein-calorie malnutrition on the adrenergic responsiveness of the heart. This study allowed a chronic and dynamic measurement of the major cardiac axes and the ventricular wall thickness, which in turn can be used to derive sophisticated measurements of global and intrinsic left ventricular function. Of the 21 dogs, 11 received a protein- and calorie-deficient diet designed to achieve a mean weight loss from a baseline of 20-25% over a 4-week period. The other 10 dogs received a normal diet. Dogs were also randomized to receive either acute propranolol beta-receptor blockade (n = 9) or acute isoproterenol beta-receptor stimulation (n = 12) during their baseline studies. Of the nine dogs given propranolol, five were subsequently malnourished and four served as controls. Of the 12 given isoproterenol, six were rendered malnourished and six were controls. All dogs were studied at both baseline and 4 weeks and received drugs in an identical fashion during both studies. The significant changes with malnutrition consisted of decreases in heart rate, cardiac mass, and left ventricular wall thickness. The degree of change in stroke volume, ejection fraction, cardiac output, dp/dt, and Emax (index of left ventricular contractility), with the administration of propranolol or isoproterenol was unaltered by malnutrition. These data support the contention that moderate protein-calorie malnutrition is well tolerated in instrumented, unstessed dogs and that the left ventricle's capacity to respond to beta-stimulation and to tolerate beta-blockade is largely unimpaired.
World Journal of Surgery, Apr 1, 1987
Update in intensive care and emergency medicine, 1991
Multiple organ failure persists as a major cause of morbidity and mortality in surgical patients ... more Multiple organ failure persists as a major cause of morbidity and mortality in surgical patients with a mortality rate in the 50–60% range and intensive care unit stays of three to four weeks or longer [1]. With the advent of modern Intensive Care Unit (ICU) care, the outcome improved. For the last several years, however, there has been no improvement in spite of better modes of ventilation, antibiotics, nutrition and metabolic support, gut decontamination, and better technology for the care of the critically ill and injured [2].
Springer eBooks, 1993
Liver dysfunction following trauma, infection and major surgical procedures is a relatively commo... more Liver dysfunction following trauma, infection and major surgical procedures is a relatively common occurrence. As a component of the organ failure process its presence is associated with an adverse outcome, particularly when the liver dysfunction becomes progressive and manifests as liver failure. With the exception of a limited number of trauma or hepatic surgical problems, the liver is not usually the site of primary tissue injury; rather, it becomes injured as part of the systemic response and the treatment provided. This indirect liver injury, its clinical manifestations, its pathogenesis, and current therapies are the subjects of this article.
CardioVascular and Interventional Radiology, Jul 1, 1981
A case of blunt liver trauma complicated by delayed upper gastrointestinal bleeding, probably hem... more A case of blunt liver trauma complicated by delayed upper gastrointestinal bleeding, probably hemobilia, was successfully treated by intra-arterial embolization. Laparotomy with liver resection or hepatic artery ligation--procedures that carry a high morbidity and mortality in a critically ill patient--were avoided. Embolization techniques can be a valuable alternative to surgery in the management of hepatic trauma with delayed hemorrhage in selected, high-risk cases.
Critical Care Clinics, 1989
Archives of Surgery, Feb 1, 1985
The etiology of hepatic failure associated with the multiple-system organ failure syndrome is poo... more The etiology of hepatic failure associated with the multiple-system organ failure syndrome is poorly understood. Because of indirect evidence suggesting that macrophages or Kupffer's cells may play a role in this phenomenon, macrophage-rich peritoneal cells were co-cultured with isolated rat hepatocytes. Following co-culture, the rate of hepatocyte protein synthesis, quantitated by counts per minute of tritiated leucine incorporated into protein, was significantly diminished. This modulation of hepatocyte function was not enhanced by prestimulation of macrophage-rich peritoneal cells in vivo by casein, thioglycolate, or Corynebacterium parvum. Addition of the macrophage secretory product lysozyme did not alter hepatocyte protein synthesis. This cell-mediated effect on hepatocytes could not be recreated by a macrophage-rich peritoneal cells supernatant transfer. These results support the idea that cells of macrophage lineage could mediate changes in hepatocyte function that may, in turn, play a role in the etiology of hepatic malfunction associated with the multiple-system organ failure syndrome.
PubMed, Oct 1, 1983
Twenty-two patients with cirrhosis and acute encephalopathy who were refractory to medical therap... more Twenty-two patients with cirrhosis and acute encephalopathy who were refractory to medical therapy were entered into a randomized, double-blind prospective trial. This trial consisted of either neomycin or a modified amino acid solution rich in branched chains and low in aromatic amino acids and methionine (F080) in the presence of isocaloric amounts of dextrose. The groups were indistinguishable from each other by clinical or laboratory criteria; they were primarily patients who had undergone operation and they would tolerate only 30 gm of oral protein or intravenous standard amino acids. The group receiving F080 had a faster and more complete improvement in encephalopathy. This improvement correlated with the plasma molar ratio and occurred with a lower mortality rate. In addition, the patients also tolerated twice the amino acid load without encephalopathy and were in positive nitrogen balance. Modified metabolic support is effective in the setting of acute liver failure in chronic cirrhosis, particularly in patients who have undergone operation.
Journal of Trauma-injury Infection and Critical Care, Mar 1, 1981
Multiple Systems Organ Failure DE EITCH, IN THIS ISSUE of the Annals, has done a very impressive-... more Multiple Systems Organ Failure DE EITCH, IN THIS ISSUE of the Annals, has done a very impressive-bit of work in reviewing and synthesizing a large number of articles related to multiple organ failure (MOF).' It first must be noted that each organ has multiple systems of function. It is highly unlikely that these fail uniformly and much more likely that some are failing while others are hyperactive. Multisystem organ failure (MSOF) is therefore a better term than MOF. Multisystem organ failure has been increasingly recognized as a cause ofdeath. Historically, we have clearly delayed death, but whether we have changed
JAMA, May 17, 2000
The efficacy and safety of the pulmonary artery catheter are under scrutiny because of its associ... more The efficacy and safety of the pulmonary artery catheter are under scrutiny because of its association with increased morbidity and mortality in observational studies. In response, the National Heart, Lung, and Blood Institute (NHLBI) and the US Food and Drug Administration (FDA) conducted the Pulmonary Artery Catheterization and Clinical Outcomes workshop in Alexandria, Va, on August 25 and 26, 1997, to develop recommendations regarding actions to improve pulmonary artery catheter utility and safety. The NHLBI and FDA planning task force selected a workshop chairperson, subcommittee chairs, and participants. Approximately 85 participants were selected for their collective expertise in critical care, pulmonary medicine, cardiovascular medicine and surgery, pediatrics, nursing, biostatistics, and medical economics. The meeting was open to industry representatives and other government and lay observers. This workshop was funded by the NHLBI and the FDA's Division of Devices. Published reports relating to the efficacy and safety of the pulmonary artery catheter, especially consensus documents developed by professional societies. The planning task force disseminated materials, held teleconferences, and developed draft position papers prior to the workshop. These were modified during the workshop and thereafter in the course of several teleconferences, and presented to the entire group for final modifications and approval. A need exists for collaborative education of physicians and nurses in performing, obtaining, and interpreting information from the use of pulmonary artery catheters. This effort should be led by professional societies, in collaboration with federal agencies, with the purpose of developing and disseminating standardized educational programs. Areas given high priority for clinical trials were pulmonary artery catheter use in persistent/refractory congestive heart failure, acute respiratory distress syndrome, severe sepsis and septic shock, and low-risk coronary artery bypass graft surgery. JAMA. 2000;283:2568-2572
Annals of Surgery, Mar 1, 1979
ABSTRACT
Clinical Pharmacology & Therapeutics, Jun 1, 1981
Annals of Surgery, Sep 1, 1991
Journal of Surgical Research, Dec 1, 1985
CRC Press eBooks, Aug 12, 2005
Springer eBooks, 1987
Multiple organ failure continues to be the pathway of death after burns, trauma and sepsis. This ... more Multiple organ failure continues to be the pathway of death after burns, trauma and sepsis. This clinical syndrome represents the transition from a hypermetabolic response to injury that has associated respiratory dysfunction, to a setting of clinical organ failures and death. Risk factors include: perfusion deficits, persistent foci of dead or injured tissue, an uncontrolled focus of infection, the presence of the respiratory distress syndrome, persistent hypermetabolism, and preexisting fibrotic liver disease. Once in the organ failure syndrome, most treatment modalities become progressively ineffective, including: ventilation, antibiotics, nutrition, and surgery. The best treatment remains prevention with rapid control of the source and restoration of oxygen transport. To date, no single “magic bullet” has been shown to exist either experimentally or clinically.
Journal of Cardiothoracic and Vascular Anesthesia, Apr 1, 1993
ABSTRACT
Journal of Parenteral and Enteral Nutrition, Nov 1, 1988
Twenty-one dogs underwent instrumentation of the left ventricle with ultrasonic dimension to stud... more Twenty-one dogs underwent instrumentation of the left ventricle with ultrasonic dimension to study the effects of acute protein-calorie malnutrition on the adrenergic responsiveness of the heart. This study allowed a chronic and dynamic measurement of the major cardiac axes and the ventricular wall thickness, which in turn can be used to derive sophisticated measurements of global and intrinsic left ventricular function. Of the 21 dogs, 11 received a protein- and calorie-deficient diet designed to achieve a mean weight loss from a baseline of 20-25% over a 4-week period. The other 10 dogs received a normal diet. Dogs were also randomized to receive either acute propranolol beta-receptor blockade (n = 9) or acute isoproterenol beta-receptor stimulation (n = 12) during their baseline studies. Of the nine dogs given propranolol, five were subsequently malnourished and four served as controls. Of the 12 given isoproterenol, six were rendered malnourished and six were controls. All dogs were studied at both baseline and 4 weeks and received drugs in an identical fashion during both studies. The significant changes with malnutrition consisted of decreases in heart rate, cardiac mass, and left ventricular wall thickness. The degree of change in stroke volume, ejection fraction, cardiac output, dp/dt, and Emax (index of left ventricular contractility), with the administration of propranolol or isoproterenol was unaltered by malnutrition. These data support the contention that moderate protein-calorie malnutrition is well tolerated in instrumented, unstessed dogs and that the left ventricle's capacity to respond to beta-stimulation and to tolerate beta-blockade is largely unimpaired.
World Journal of Surgery, Apr 1, 1987
Update in intensive care and emergency medicine, 1991
Multiple organ failure persists as a major cause of morbidity and mortality in surgical patients ... more Multiple organ failure persists as a major cause of morbidity and mortality in surgical patients with a mortality rate in the 50–60% range and intensive care unit stays of three to four weeks or longer [1]. With the advent of modern Intensive Care Unit (ICU) care, the outcome improved. For the last several years, however, there has been no improvement in spite of better modes of ventilation, antibiotics, nutrition and metabolic support, gut decontamination, and better technology for the care of the critically ill and injured [2].
Springer eBooks, 1993
Liver dysfunction following trauma, infection and major surgical procedures is a relatively commo... more Liver dysfunction following trauma, infection and major surgical procedures is a relatively common occurrence. As a component of the organ failure process its presence is associated with an adverse outcome, particularly when the liver dysfunction becomes progressive and manifests as liver failure. With the exception of a limited number of trauma or hepatic surgical problems, the liver is not usually the site of primary tissue injury; rather, it becomes injured as part of the systemic response and the treatment provided. This indirect liver injury, its clinical manifestations, its pathogenesis, and current therapies are the subjects of this article.
CardioVascular and Interventional Radiology, Jul 1, 1981
A case of blunt liver trauma complicated by delayed upper gastrointestinal bleeding, probably hem... more A case of blunt liver trauma complicated by delayed upper gastrointestinal bleeding, probably hemobilia, was successfully treated by intra-arterial embolization. Laparotomy with liver resection or hepatic artery ligation--procedures that carry a high morbidity and mortality in a critically ill patient--were avoided. Embolization techniques can be a valuable alternative to surgery in the management of hepatic trauma with delayed hemorrhage in selected, high-risk cases.
Critical Care Clinics, 1989
Archives of Surgery, Feb 1, 1985
The etiology of hepatic failure associated with the multiple-system organ failure syndrome is poo... more The etiology of hepatic failure associated with the multiple-system organ failure syndrome is poorly understood. Because of indirect evidence suggesting that macrophages or Kupffer's cells may play a role in this phenomenon, macrophage-rich peritoneal cells were co-cultured with isolated rat hepatocytes. Following co-culture, the rate of hepatocyte protein synthesis, quantitated by counts per minute of tritiated leucine incorporated into protein, was significantly diminished. This modulation of hepatocyte function was not enhanced by prestimulation of macrophage-rich peritoneal cells in vivo by casein, thioglycolate, or Corynebacterium parvum. Addition of the macrophage secretory product lysozyme did not alter hepatocyte protein synthesis. This cell-mediated effect on hepatocytes could not be recreated by a macrophage-rich peritoneal cells supernatant transfer. These results support the idea that cells of macrophage lineage could mediate changes in hepatocyte function that may, in turn, play a role in the etiology of hepatic malfunction associated with the multiple-system organ failure syndrome.
PubMed, Oct 1, 1983
Twenty-two patients with cirrhosis and acute encephalopathy who were refractory to medical therap... more Twenty-two patients with cirrhosis and acute encephalopathy who were refractory to medical therapy were entered into a randomized, double-blind prospective trial. This trial consisted of either neomycin or a modified amino acid solution rich in branched chains and low in aromatic amino acids and methionine (F080) in the presence of isocaloric amounts of dextrose. The groups were indistinguishable from each other by clinical or laboratory criteria; they were primarily patients who had undergone operation and they would tolerate only 30 gm of oral protein or intravenous standard amino acids. The group receiving F080 had a faster and more complete improvement in encephalopathy. This improvement correlated with the plasma molar ratio and occurred with a lower mortality rate. In addition, the patients also tolerated twice the amino acid load without encephalopathy and were in positive nitrogen balance. Modified metabolic support is effective in the setting of acute liver failure in chronic cirrhosis, particularly in patients who have undergone operation.
Journal of Trauma-injury Infection and Critical Care, Mar 1, 1981
Multiple Systems Organ Failure DE EITCH, IN THIS ISSUE of the Annals, has done a very impressive-... more Multiple Systems Organ Failure DE EITCH, IN THIS ISSUE of the Annals, has done a very impressive-bit of work in reviewing and synthesizing a large number of articles related to multiple organ failure (MOF).' It first must be noted that each organ has multiple systems of function. It is highly unlikely that these fail uniformly and much more likely that some are failing while others are hyperactive. Multisystem organ failure (MSOF) is therefore a better term than MOF. Multisystem organ failure has been increasingly recognized as a cause ofdeath. Historically, we have clearly delayed death, but whether we have changed
JAMA, May 17, 2000
The efficacy and safety of the pulmonary artery catheter are under scrutiny because of its associ... more The efficacy and safety of the pulmonary artery catheter are under scrutiny because of its association with increased morbidity and mortality in observational studies. In response, the National Heart, Lung, and Blood Institute (NHLBI) and the US Food and Drug Administration (FDA) conducted the Pulmonary Artery Catheterization and Clinical Outcomes workshop in Alexandria, Va, on August 25 and 26, 1997, to develop recommendations regarding actions to improve pulmonary artery catheter utility and safety. The NHLBI and FDA planning task force selected a workshop chairperson, subcommittee chairs, and participants. Approximately 85 participants were selected for their collective expertise in critical care, pulmonary medicine, cardiovascular medicine and surgery, pediatrics, nursing, biostatistics, and medical economics. The meeting was open to industry representatives and other government and lay observers. This workshop was funded by the NHLBI and the FDA's Division of Devices. Published reports relating to the efficacy and safety of the pulmonary artery catheter, especially consensus documents developed by professional societies. The planning task force disseminated materials, held teleconferences, and developed draft position papers prior to the workshop. These were modified during the workshop and thereafter in the course of several teleconferences, and presented to the entire group for final modifications and approval. A need exists for collaborative education of physicians and nurses in performing, obtaining, and interpreting information from the use of pulmonary artery catheters. This effort should be led by professional societies, in collaboration with federal agencies, with the purpose of developing and disseminating standardized educational programs. Areas given high priority for clinical trials were pulmonary artery catheter use in persistent/refractory congestive heart failure, acute respiratory distress syndrome, severe sepsis and septic shock, and low-risk coronary artery bypass graft surgery. JAMA. 2000;283:2568-2572
Annals of Surgery, Mar 1, 1979
ABSTRACT
Clinical Pharmacology & Therapeutics, Jun 1, 1981
Annals of Surgery, Sep 1, 1991