THORACIC TRAUMA AND CRITICAL CARE THORACIC TRAUMA AND CRITICAL CARE edited by Riyad Karmy-Jones, MD Avery Nathens, MD Eric J. Stern, MD Harborview Medical Center University of Washington Seattle, Washington Springer-Science+Business Media, B.V. Library of Congress Cataloging-in-Publication Data Thoracic trauma and critical care / edited by Riyad Karmy-Jones, Avery Nathens, Eric 1. Stem. p.;cm. Includes bibliographical references and index. ISBN 978-1-4613-5407-9 ISBN 978-1-4615-1127-4 (eBook) DOI 10.1007/978-1-4615-1127-4 1. Chest--Wounds and injuries. 2. Chest--Surgery. 3. Respiratory distress syndrome. 4. Critical care medicine. I. Karmy-Jones, Riyad. II. Nathens, Avery III. Stem, Eric 1. [DNLM: 1. Thoracic Injuries--therapy. 2. Critical Care--methods. 3. Infection Control. 4. Respiratory Distress Syndrome, Adult--therapy. 5. Thoracic Surgical Procedures. 6. Ventilators, Mechanical. WF 985 T4873 2002] RD536 .T4825 2002 617.5'4--dc21 2002029044 Copyright © 2002 by Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 2002 Softcover reprint of the Hardcover 1s t edition 2002 All rights reserved. No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without the written permission from the Publisher, with the exception of any material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Permission for books published in Europe: [email protected] Permissions for books published in the United States of America: [email protected] Printed on acid-free paper. The Publisher offers discounts on this book for course use and bulk purchases. For further information, send email [email protected]. To my wife, Lorie, who every day demonstrates concentration, courage and compassion-RKJ To my wife, Jane, whose enduring patience has made this book possible-AN To my colleagues at Harborview who strive daily (and nightly) to care for those less fortunate than ourselves and to my beautiful wife, Karen who supports me in all my endeavors.-EJS CONTRIBUTORS Blaine Achen MD John J. Borsa, MD, FRCPC Resident, Department of Anesthesia Assistant Professor - Interventional University of Alberta Radiology Edmonton, Alberta University of Washington Medical Center Richard K. Albert, M.D. Seattle, WA Professor Pulmonary and Critical Care Edward Boyle, Jr., MD Medicine Attending Cardiothoracic Surgeon Denver Health Medical Center St. Charles Medical Center Denver, CO Heart Institute of the Cascades Bend, OR Scott K. Alpard MD Division of Cardiothoracic Surgery Susan I. Brundage, MD, MPH, University of Texas Medical Branch FACS Galveston, Texas Assistant Professor of Surgery The Michael E. DeBakey Department Gregory J. Bauer, MD of Surgery Assistant Professor of Surgery Baylor College of Medicine Cornell-Weill Medical School Houston, Texas NewYork,NY Eileen M. Bulger, MD Walter L. Bim, MD,FACS Assistant Professor Assistant Professor of Surgery Department of Surgery Chief, Pediatric Trauma Harborview Medical Center Denver Health Medical Center Seattle, WA University of Colorado Health Sciences Center Yvonne M. Carter MD Chief Resident Tyler Black MD Department of Surgery Department of Surgery Harborview Medical Center University of Alberta Seattle, WA Edmonton, AB Carole Cornejo MD Robert D. Bloch MD Assistant Professor Assistant Professor Department of Surgery Section of Interventional Radiology Harborview Medical Center Department of Radiology Seattle, WA University of Washington Seattle, WA Joseph Cuschieri, MD Assistant Professor Michael E. Boczar, DO Department of Surgery Department of Emergency Medicine University of Cincinnati University of Michigan School of Cincinnati, OH Medicine Hurley Medical Center Flint, Michigan Steven Deem MD Adam Goldin MD Associate Professor, Anesthesiology Chief Resident and Medicine (adjunct, Pulmonary Department of Surgery and Critical Care) University of Washington Medical University of Washington, Center Harborview Medical Center, Seattle, Seattle, WA WA Larry M. Gentilello MD, FACS Daniel J. DiBardino MD Associate Professor Surgical Resident Harvard Medical School The Michael E. DeBakey Department Chief, Division of Trauma and of Surgery Critical Care Baylor College of Medicine Beth Israel Deaconess Medical Center Houston, Texas Boston,MA Robert DuBose MD Nicole Gibran MD, FACS Surgical Resident Associate Professor Uni versity of Washington University of Washington Burn Seattle, WA Center Harborview Medical Center Thomas R. Eubanks, DO Seattle, WA Assistant Professor Department of Surgery David Gourlay MD University of Washington Research Fellow, Seattle, WA Division of Trauma University of Washington, Samir M. Fakhry MD, FACS. Seattle, WA Associate Chair for Research and Education Mystan A. Gurkin MD Chief, Trauma Services Department of Surgery Inova Fairfax Hospital Henry Ford Hospital Falls Church, V A Detroit, MI Clinical Professor of Surgery Georgetown University R. Alan Hall MD Washington, DC Attending Surgeon Division Cardiothoracic Surgery Mitchell S. Farber MD, FACS Virginia Mason Medical Center Attending Surgeon Seattle, WA Hurley Medical Center Flint, MI Robert Harrington, MD Assistant Professor Associate Professor Department of Surgery Infectious Diseases Michigan State University University of Washington Harborview Medical Center Seattle, WA viii David M. Heimbach, MD,FACS Riyad Karmy-Jones MD, Professor, Department of Surgery FACS,FRCS(C),FCCP,FAHA University of Washington Chief, Thoracic Surgery Seattle, WA Harborview Medical Center H. Mathilda Horst, MD, FACS, Associate Professor Surgery FCCM Division of Cardiothoracic Surgery Chief, SICU U ni versity of Washington Hemy Ford Hospital Seattle, WA Detroit, MI Lillian S Kao MD James H. Holmes IV, MD Assistant Professor Chief Resident Department of Surgery Virginia Mason Medical Center University of Texas Seattle, WA Houston, TX Eric Hoffer MD Robert R. Kempainen, MD Associate Professor, Department of Assistant Professor Radiology, University of Washington Division of Allergy, Pulmonary and Co-Director, UW AMC Endovascular Critical Care Medicine Services Program University of Minnesota Associate Director of Radiology, Minneapolis, MN Harborview Medical Center Nadeem A. Khan, M.D., M.P.H. F. Frank Isik MD, FACS Clinical Research Fellow Associate Professor, Division of Trauma Services Plastic Surgery Inova Fairfax Hospital Department of Surgery Falls Church, V A University of Washington School of Medicine Andrew W Kirkpatrick MD FRCS(C), FACS Jay A. Johannigman, M.D. FACS Section of Trauma Services Associate Professor Vancouver General Hospital, Chief, Division of Trauma Vancouver, Canada Department of Surgery University of Cincinnati John B. Kortbeek MD, Cincinnati, OH FRCSC,FACS Director Trauma Services Divya Kapoor MD Calgary Health Region Department of Internal Medicine Clinical Associate Professor University of Utah Department of Surgery Salt Lake City, UT University of Calgary Calgary, AB Kurt Kralovich MD, FACS Division of Trauma/SICU Hemy Ford Hospital Detroit, MI ix David H. Lewis MD Michael S. Mulligan MD Associate Professor Chief, Lung Transplant Program Director Nuclear Medicine Division of Cardiothoracic Surgery Harborview Medical Center University of Washington Seattle, WA Seattle, WA Donald E. Low,MD,FACS,FRCS(C) A very Nathens MD, PhD, Section of General, Thoracic Surgery FRCSC,FACS Virginia Mason Medical Center Assistant Professor Seattle, Washington Chief, SICU Harborview Medical Center Ronald V. Maier MD, FACS Seattle. WA Professor and Vice-Chairman Margaret J. NeffMD, MSc Department of Surgery Assistant Professor of Medicine Uni versity of Washington Director, Critical Care Research Surgeon-in-Chief Division of Pulmonary & Critical Harborview Medical Center Care Seattle, WA Harborview Medical Center Seattle, WA Cairen J. McNamee MD, FRCS(C) Consultant, Thoracic Surgery Lindsey A. Nelson MD University of Alberta Department of Surgery Edmonton, Alberta University of Cincinnati Cincinnati, OH Mark H. Meissner, MD, FACS Associate Professor Savvas Nicolaou MD, FRCP(C) Department of Surgery Department of Radiology, Vancouver Harborview Medical Center General Hospital, Vancouver, Canada University of Washington School of Medicine Stephen Nichols, MD, FACS Assistant Professor Ernest E. Moore, MD, FACS Chief, Vascular Surgery Chief, Department of Surgery Harborview Medical Center Denver Health Medical Center Seattle, WA Professor and Vice-Chairman of Surgery Ram Nirula MD, MPH, FACS University of Colorado Health Fellow, Trauma/SICU Sciences Center Department of Surgery Harborview Medical Center Jeffrey Monson MD University of Washington School of Chief Resident Medicine Department of Surgery University of Washington Dinh Nguyen MD Seattle, WA Trauma/SICU Fellow Hurley Medical Center Flint, MI x David P. O'Brien, M.D Matthew Rosengart MD Department of Surgery Chief Resident University of Cincinnati University of Washington Cincinnati, OH Seattle, WA Farouck N. Obeid MD, FACS Scott Sattler MD Chief, Department of Trauma/SICU Chief Resident Hurley Medical Center Department of Surgery Flint, MI University of Washington Professor Seattle, WA Department of Surgery Michigan State University Romualdo J. Segrola, Jr., MD Donald Oxorn MD, CM, FRCPC, Fellow, Cardiothoracic Surgery FACC University of Minnesota Associate Professor of Anesthesiology Minneapolis, MN Adjunct Associate Professor of Medicine David V. Shatz MD, FACS University of Washington School of Associate Professor Medicine Department of Surgery Seattle, Washington University of Miami School of Medicine Manesh Parikshak, MD Miami,FL Trauma/Critical Care Fellow Henry Ford Hospital Scott E. Sinclair, M.D. Detroit, Michigan Acting Clinical Instructor Pulmonary and Critical Care David J. Pierson MD Medicine Proffessor, Pulmonary and Critical University of Washington Care Medicine Seattle, WA Medical Director, Respiratory Care Harborview Medical Center Shawn J. Skerrett MD Seattle, WA Associate Professor Pulmonary and Critical Care Timothy H. Pohlman MD, FACS Medicine Professor University of Washington Department of Surgery Harborview Medical Center Harborview Medical Center Seattle, WA University of Washington School of Medicine Victor J. Sorensen MD, FACS Attending Surgeon Emanuel P. Rivers, MD, MPH, Trauma/SICU FCCM Hurley Medical Center Departments of Emergency Medicine Flint, MI and Surgery Assistant Professor Case Western Reserve University Department of Surgery Henry Ford Hospital Michigan State University Detroit, Michigan xi Eric Stern MD Eric Vallieres, MD, FRCS(C) Professor Associate Professor Chief Thoracic Radiology Division of Cardiothoracic Surgery Harborview Medical Center University of Washington University of Washington Seattle, WA Seattle, WA Curtis F. Veal, Jr., M.D., FACP, Gregory D. Trachiotis, MD, FACS FCCP Associate Professor of Surgery Medical Director, Kindred Hospital Vice-Chief, Division of Seattle Cardiothoracic Surgery Co-director, Critical Care Services, The George Washington University Swedish Health Systems Medical Center Clinical Associate Professor of Medicine, University of Washington Kristin Wagner, MD Chief Resident, Department of Joseph B. Zwischenberger Surgery MD,FACS The George Washington University Professor of Surgery, Medicine and Medical Center Radiology Washington, DC Director General Thoracic Surgery and ECMO program Cheryl A. White MD, PhD University of Texas Medical Branch Senior Resident Galveston, Texas Division of Plastic Surgery Department of Surgery University of Washington School of Medicine Douglas E. Wood, MD, FACS Associate Professor Chief, Section of Thoracic Surgery The UW Endowed Chair in Lung Cancer Research Division of Cardiothoracic Surgery University of Washington Seattle, WA Stewart Worrell MD Department of Surgery University of Washington School of Medicine John D Urschel, MD, FRCSC, FACS, FRCSEd Associate Professor Department of Surgery McMaster University, Hamilton, Ontario Xll