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Paul Ellis Marik Evidence-Based Critical Care Third Edition 123 Evidence-Based Critical Care Paul Ellis Marik Evidence-Based Critical Care Third Edition Paul Ellis Marik Division of Pulmonary and Critical Care Medicine Eastern Virginia Medical School Norfolk, VA, USA ISBN 978-3-319-11019-6 ISBN 978-3-319-11020-2 (eBook) DOI 10.1007/978-3-319-11020-2 Springer Cham Heidelberg New York Dordrecht London Library of Congress Control Number: 2014956872 © Springer International Publishing Switzerland 2015 This work is subject to copyright All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer Permissions for use may be obtained through RightsLink at the Copyright Clearance Center Violations are liable to prosecution under the respective Copyright Law The use of general descriptive names, registered names, trademarks, service marks, etc in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made The publisher makes no warranty, express or implied, with respect to the material contained herein Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Learning without thinking is useless Thinking without learning is dangerous —Confucius, Chinese Philosopher (551–479 BC) To cure sometimes, to relieve often, to comfort always —Hippocrates, Greek Physician, Father of Western Medicine (460–370 BC) This book is dedicated to the memory of my father, Colin Sigmund Marik, a man of great intellect and wit Preface to Third Edition After completing the Second Edition of The Handbook of Evidence Based Critical Care in 2009, I swore that I would rather stick needles in both my eyes than author another updated version of the book But here we are in 2015 with the Third Edition of Evidence-Based Critical Care (no longer a handbook) So what made me change my mind? Most importantly, you, my dedicated readers, have implored me to update the book; I was told, “Medicine as we know it would be incomplete without an updated version.” Your enthusiastic and positive feedback was the driving factors which led me to consider writing this revision In addition, in the last years we have witnessed a remarkable refinement in the management strategies of critically ill patients best characterized as “Less is More” (see Chap 2) At the same time we have realized that while many of our patients survive their ICU stay, many have significant residual functional and cognitive disabilities These changes in our approach and understanding of critical illness have necessitated the updated Third Edition of Evidence-Based Critical Care However, the basic guiding principles of Critical Care Medicine have not changed; compassionate, dedicated and thoughtful clinicians, who evaluate the functioning of the “whole” patient, ponder their disease processes and pathophysiology and provide the highest level of Evidence-Based interventions with the goal of restoring the patient to a quality of life which he/she values Due to the vast number of therapeutic interventions that ICU physicians make daily, the topics are presented as narrative summaries of the best available evidence rather than as systematic reviews of each and every intervention In keeping with the goal of providing an evidence-based approach to critical care, references are provided to support the evidence presented In writing this book my goal has been to take issues that appear complex and make them as simple as possible ix x Preface to Third Edition It appears to me that those who really don’t have a good understanding of the complexities of physiology, pathophysiology and patient care make things so complicated that they themselves don’t understand what they are trying to convey This concept is exemplified by the following quotes: Make everything as simple as possible, but not simpler If you can’t explain it simply, you don’t understand it well enough Albert Einstein, Theoretical Physicist, 1879–1955 Evidence-Based Critical Care is not a reference text but presents a practical evidence-based approach to the management of critically ill ICU patients The focus of this book is on issues that pertain specifically to the ICU As such, the reader is referred to standard medical and surgical texts as well as online resources for more complete information on the wide spectrum of conditions and diseases from which ICU patients may suffer While all attempts have been made to be current, due to the exponential growth of medical knowledge some of the information presented may already be outdated when this book comes to print The reader should therefore keep up-to-date with the current medical literature The guidelines presented in the book are not meant to replace clinical judgment, but rather to provide a framework for patient management Individual clinical situations can be highly complex and the judgment and wisdom of an experienced and knowledgeable intensivist with all available information about a specific patient is essential for optimal clinical management Norfolk, VA, USA Paul Ellis Marik Acknowledgements This book recognizes my mentors and students who have taught me everything I know and inspired me to learn even more xi A Note to the Reader The author and publisher have made every attempt to check information and dosages for accuracy Because information and the science of pharmacology is continually advancing, our knowledge base continues to expand Therefore, we recommend that the reader check all information and all product information for changes, especially changes in dosages or administration before administering any medication xiii 820 Early warning scoring systems (EWS), 191 Eclampsia, 764 See also Pre-eclampsia ECMO See Extracorporeal membrane oxygenation (ECMO) Egi, M., 154 Ekelund, 699 Electrolyte disturbances calcium homeostasis disorders, 645 hypercalcemia, 648–650 hypernatremia, 640–641 hypocalcemia cause of, 646 definition, 646 intracellular calcium, 646–647 treatment, 647–648 vitamin D deficiency, 646 hypokalemia, 641–642 hypomagnesemia, 643–645 hyponatremia AVP, 639 cerebral/renal salt wasting syndrome, 637, 638 conivaptan, 639 definition, 635 diagnostic approach and management, 636 FEurate, 637–638 optimal rate of correction, 639–640 plasma Na+ concentration, 640 SIADH, 637–639 hypophosphatemia, 642–643 sodium and water, 635 El-Sohl, A.A., 268 Elwany, S., 246, 248 End-of-life issues dying patient admission, 806 palliative care goal, 806–807 principles, 807–808 scope of, 806 prevalance, 805 terminal/incurable illnesses, 806 unrealistic expectations, 805 Endometritis, 768 Endothelin, 700 Epidural hematoma, 703 Erstad, B.L., 514 Etomidate, 622, 629 European Cooperative Acute Stroke Study (ECASS), 672 European Society for Clinical Nutrition and Metabolism (ESPEN), 529 Evidence based critical care clinical outcomes, Index clinical practice guidelines, iatrogenic complications, randomized controlled clinical trials, scientific evidence, treatment effect, Expiratory positive airway pressure (EPAP), 311, 792–793 External ventricular drain (EVD), 692 Extracorporeal membrane oxygenation (ECMO) ARDS, 363 β2-agonist, 365 corticosteroids, 363 glucocorticoid treatment, 364 H1N1 infection, 363 nitric oxide, 365 omega-3 fatty acids, 366 prostacyclin, 365 surfactant dysfunction, 365 Extra vascular lung water (EVLW), 59, 320, 350–351 F Fann, F.A., 625 Febrile non-hemolytic transfusion reactions (FNHTR), 589, 593 Feeding tubes, 36, 519, 801 Fegler, G., 90 Feissel, M., 66 Fever acute ischemic stroke, 678 antibiotics, impact on, 275 axillary measurements, 276 blood cultures, impact on, 275 body temperature, 275 C difficile toxin, 288 chest radiograph, 286 CT scan, 288 cytokines, 276 health care costs, 275 infectious causes, 279 infrared ear thermometry, 276 intravascular thermistor, 276 management algorithm, 286–287 mechanisms and etiology, 275 non-infections causes, 282–283 alcohol and drug withdrawal, 281 blood transfusions, 282 drug fever, 279–281 malignant hyperthermia, 279, 283 neuroleptic malignant syndrome, 279, 283–284 postoperative period, 281–282 Index serotonin syndrome, 279, 284–286 thromboembolic disease, 282 patients’ status re-evaluation, 288 physical examination, 286 procalcitonin and lactate levels, 286 pro-inflammatory cytokines, 278 radiologic imaging, impact on, 275 rectal temperatures, 276 subarachnoid hemorrhage, 694 treatment, 276–278 ultrasound examination, 288 venous Doppler’s, 288 Fever of unknown origin (FUO), 803 FFP See Fresh frozen plasma (FFP) FHF See Fulminant hepatic failure (FHF) Fick, A., 90 Fisher, N.C., 603 Fluid and catheter treatment trial (FACTT) trial, 121 Fluid boluses, 70–71 Fluid expansion as supportive therapy (FEAST), 122 Forel, J.M., 16 Forkhead box O (FOXO), 500 Forrest, E.H., 540 Foster, P.F., 603 Fractional excretion of sodium (FENa), 654–655 Fractional excretion of urate (FEurate), 637–638 Francoz, C., 536, 537 Fresh frozen plasma (FFP) indications, 601 invasive procedure central venous catheterization, 602–603 coagulation tests, 601–602 coagulopathy, 601–603 thoracentesis and chest tube placement, 604 paracentesis, 604–606 risks, 600 stable clotting factors, 600 TRALI, 601 Fuchs, B.D., 14 Fuid responsiveness and resuscitation aggressive fluid strategy, 58 albumin, 76–77 burns, 80 conservative fluid srategy, 57 crystalloid bolus, 58 CVP, 63, 64 definition, 59 dehydration, 79 echocardiographic assessment, 67 dynamic echocardiographic parameters, 66–67 821 dynamic techniques, 67 static echocardiographic parameters, 66 static pressure and volume parameters, 67 elective non-cardiac surgery, 57 endothelial glycocalyx, 60, 61 EVLW curves, 59 fluid boluses, 70–71 fluid challenge, 69–70 Frank-Starling principle, 59 heart lung interaction, 64 hemodynamic instability, 57 hemodynamic management, 58 hemorrhage, 78–79 hetastarches, 77–78 hypoperfusion, 58 hypovolemia, 58 iatrogenic salt water drowning, 57 lactated Ringers (LR) solution coagulopathy, 75 HCO3, 73–74 hyperchloremic metabolic acidosis, 73 and kidney disease, 74–75 and liver disease, 75 metabolic fuel, 75–76 vs NaCl, 72–73 renal failure, 73 Marik-Phillips curves, 60 morbidity and mortality, 57 oliguria, 80–81 passive leg raising maneuver echocardiographic/Doppler techniques, 69 heart-lung interactions, 68 hemodynamic effects, 68 reversible auto-transfusion, 68 PPV, 65 sepsis and SIRS, 80 stroke volume, 59 SV, 62 traumatic brain injury, 79 Fulminant hepatic failure (FHF), 540 causes of, 541 cerebral edema, 542–543 clinical picture of, 541 ICP management, 543–544 intra-cranial pressure management, 543–545 Kings criteria, 546 liver transplantation, 545 patients presenting, 541–542 supportive measures, 545 Functional Risk Stratification Score (FUNC), 685 Furosemide, 437, 451–452, 654, 664, 703 Futier, E., 13 822 G Gacouin, A., 16 Gallstone-induced pancreatitis, 565, 570 Gamma-amino-butyric acid type A receptor (GABA-A), 751 Gandhi, G.Y., 157 Ganz, W., 63 Garcia-Pagan, J.C., 555 Gastric residual volume, 497, 507 Gastrointestinal bleeding (GIB), 514–515 Blatchford risk severity score, 552, 553 bleeding peptic ulcers, 557–559 esophageal varices, 559–560 hemodynamic assessment, 551, 552 history and examination, 551–552 laboratory tests, 552 lower GI bleeding, 560–562 nasogastric aspiration, 552 rate of bleeding, 551 rebleeding, 555 resuscitation, 553–555 UGIB, 555 Gault, M.H., 775 Gazzaneo, M.C., 504 Geriatric AGS, 781–782 body composition and muscle mass diaphragmatic function, 776 elderly patient outcomes, 776–778 cardiovascular changes, 774–775 delirium, 779–780 immune system changes, 776 physiology, 773–774 renal function, 775–776 respiratory function, 775 surgery ADRs, 780–781 CGA, 779 coronary artery bypass, 779 delirium, 779–780 elective, 778–779 traumatic injuries, 778 Girard, T.D., 14, 202, 204 Glasgow alcoholic hepatitis score (GAHS), 538 Glasgow Coma Scale (GCS), 201 Global registry of acute coronary events (GRACE) risk model, 474 Glomerulosclerosis, 790 Goldfarb, G., 603 Golestanian, E., 670 Graduated compression stockings (GCS), 403 Grap, M.J., 237 Greif, R., 188 Grief, 188 Index Guerin, C., 16 Guerrero, J., 628 Guglielmi, G., 698 Gulley, D., 535 Guly, H.R., 189 Gusmao-Flores, D., 203 Gu, W.J., 578 Guyton, A.C., 131 H HAI See Hospital acquired infection (HAI) Hall, J.E., 131 Haloperidol, 197, 204–205, 208, 755 Hamel, J.F., 15 Hamzaoui, O., 125 Harris, A.D., 217, 218 Havstad, S E., 15 Healthcare associated pneumonia (HCAP), 261 Heart failure (HF) ADHF (see Acute decompensated heart failure (ADHF)) systolic heart failure ACE inhibitors, 457 AICD, 459 aldactone, 458 beta-blocker therapy, 457–458 calcium channel blocking drugs, 459 CRT, 459–460 digoxin, 459 HFpEF, 461–462 hydralazine/isosorbide dinitrate, 458–459 LVAD, 460–461 revascularization, 460 surgical options, 460 Takotsubo cardiomyopathy ACE inhibitors, 464–465 β-blockers, 464–465 clinical symptoms, 463 diffuse T wave inversion, 463–464 emotional stress, 462–463 features, 463 octopus trapping pot, 462 physical stress, 463 post-menopausal women, 463 QT interval prolongation, 463–464 Heart failure with preserved ejection fraction (HFpEF), 461–462 Hebert, C.A, 589 Hebert, P.C., 14 Helicobacter pylori, 556 Heme oxygenase-1 (HO-1), 591 Index Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome clinical presentation, 765 hepatic dysfunction, 764 hepatic injury, 765 microangiopathic hemolytic anemia, 764 SIRS, 765, 767 thrombocytopenia, 764 Hemolytic-uremic syndrome (HUS), 612 Hemorrhage, 78–79 Heparin-induced thrombocytopenia (HIT), 610–612 Hepatic encephalopathy (HE) aggressive protein restriction, 529 colonic bacteria, 528 MARS, 529 neuropsychiatric syndrome, 527 nonabsorbable antibiotics, 528–529 West Haven criteria, 527–528 Hepato-adrenal syndrome, 532 Hepatorenal syndrome (HRS) diagnostic approach, 529–531 diagnostic criteria, 529–530 pathophysiological, 529 treatment, 531 Herridge, M.S., 48, 499 Herzig, S.J., 516 Hetastarches (HES), 77–78 HF See Heart failure (HF) Hibbert, R.M., 604 Hickey, M., 605 Hickson, M., 577 High-frequency oscillatory ventilation (HFOV), 354–355 High resolution computed tomography (HRCT), 800 Hilbert, G., 246 Hillary, 182 Hill, G.E., 592 Histamine-2 receptor blockers (H2RB), 517 Holland, L.L., 602 Homsi, E., 665 Horvath, K.A., 593 Hospital acquired infection (HAI) CAUTI (see Catheter Associated Urinary Tract Infections (CAUTI)) CDI (see Clostridium difficile infection (CDI)) CLABSI (see Central Line Associated Blood Stream Infection (CLABSI)) control measures chlorhexidine bathing, 216–217 gloves and gowns, 217 hand antisepsis, 216 823 healthcare provider apparel, 217 oropharyngeal and gastrointestinal decolonization, 218–219 private rooms and environmental control, 219–220 counter-productive approach, 214 ICU death, 214 MDR colonization, 215–216 MRSA isolation, 217–218 risk factors, 231 mediastinitis infection rates, 215 nosocomial rhinosinusitis, 246–248 in US, 213, 214 VAP (see Ventilator associated pneumonia (VAP)) Hospital acquired pneumonia (HAP), 214, 261 Hotchkiss, R.S., 134 H2 Receptor Antagonists (H2RA), 517–518 HRS See Hepatorenal syndrome (HRS) Huang, S.S., 218 Hughes, R.E., 62 Hu, H., 205 Hunt and Hess Classification system, 693 Hunt, W.E., 699 Huskins, W.C., 217 Hydrocortisone, 16, 627–628, 630 Hypercalcemia, 648–650 Hypernatremia, 640–641 Hypertensive crises blood pressure management ACE inhibitors, 436 antihypertensive agents, 435 APH, 439–440 autoregulatory range, 433, 434 clevidipine, 438, 439 clonidine, 436 esmolol, 438, 439 furosemide, 437 hydralazine, 436 labetalol, 437, 438 management principles, 436 nicardipine, 438, 439 nitroglycerin, 437 preoperative hypertension, 440–441 resident/hospitalist, 434–435 sodium nitroprusside, 437 sublingual and intranasal nifedipine, 436 definitions, 429–430 medical history, 432 objective evaluation, 433 pathophysiology, 430–431 physical examination, 432 824 Hypertensive crises (cont.) PRES characteristics, 441 clinico-neuro-radiological entity, 441 CT and MRI, 441 drugs, 442 pathogenetic theory, 441 pregnancy-induced PRES, 441 signs and symptoms, 431–432 Hypertonic saline, 706, 707 Hypervolemia, 699 Hypokalemia, 641–642 Hypomagnesemia, 643–645 Hyponatremia AVP, 639 cerebral/renal salt wasting syndrome, 637, 638 conivaptan, 639 definition, 635 diagnostic approach and management, 636 FEurate, 637–638 optimal rate of correction, 639–640 plasma Na+ concentration, 640 SIADH, 637–639 Hypophosphatemia, 642–643 Hypothermia, 102 I Ibrahim, G.M., 699 Ibsen, B., Increased intracranial pressure (ICP) CBF, 703 corticosteroids, 707 FHF patient, 543 hyperosmotic agents, 706–707 hyperventilation, 706 indications for, 704–705 management of, 543–545 measurement of, 704 mechanical ventilation, 708 narcotics, 705 prophylactic hypothermia, 707 TBI, 703 volume resuscitation, 706 Infection related ventilator associated complication (IVAC), 233 Infectious Diseases Society of America (IDSA), 243–244, 275 Inhaled nitric oxide (iNO), 365, 418 Inspiratory positive airway pressure (IPAP), 311 Inspiratory to expiratory (I:E) ratio, 298–299, 305, 378 Index Institute for Healthcare Improvement (IHI), 214, 236, 237 Intensive Care Delirium Screening Checklist (ICDSC), 203 Intensive care unit (ICU) admission criteria, 39–40 admission history and physical examination, 23 cardiovascular system, 41–42 clinical pearls, 28 daily examination abdomen, 25 additional observations, 24 chest, 25 CNS, 26 daily neurological examination, 26 heart, 25 ventilator, 25 vital signs, 24 discharge criteria, 44–45 drug ingestion and drug overdose, 42 endocrine, 43 follow up patients, 28 gastrointestinal disorders, 43 imaging, 27 laboratory tests, 26–27 neurological disorders, 42 new admissions, 27–28 patient’s status, 27 physiologic indication, 44 postoperative care, 44 prioritization, 40–41 pulmonary system, 42 renal disorders, 43 INTERACT2 trial, 689 Intermittent hemodialysis (IHD), 14, 658 International Ascites Club, 529, 530 International Cooperative Pulmonary Embolism Registry (ICOPER), 399 International Stroke Trial (IST), 672, 676 Intracerebral hemorrhage (ICH) blood pressure control, 689–690 Clot volume, 685 common sites of, 685, 686 incidence, 685 medical management, 687–689 prognostic score, 685, 686 risk factors, 685–686 STITCH trail randomized, 690–692 warfarin-associated, 685 Intravenous Nimodipine West European Trial, 679 Intraventricular hemorrhage (IVH), 685, 691–692 825 Index J Janda, S., 271 Janz, D.R., 186, 591 Jawaheer, G., 505 Jehovah Witness literature, 596 Jepson, M.M., 134 Johnson, D.J., 779 Joseph, 699 Juffermans, N.P., 593 Juttler, E., 677 K Kaarlola, A., 777 Kaasch, A.J., 224 Kalisvaart, K.J., 205 Kanji, S., 484 Kansagara, D., 597 Kantorova, I., 515 Karl, I.E., 134 Katsanos, C.S., 503, 626 Kcentra, 605 Keh, D., 16 Khan, H., 601 Khuri, S.F., 99 Kiguli, S., 16 Kilgannon, J.H., 186 Koo, H.L., 243 Kosnik, E.J., 699 Krag, M., 517 Kress, J.P., 13, 14 L Lactate See Stress hyperlactemia Lactated ringers (LR) solution coagulopathy, 75 HCO3, 73–74 hyperchloremic metabolic acidosis, 73 and kidney disease, 74–75 and liver disease, 75 metabolic fuel, 75–76 vs NaCl, 72–73 renal failure, 73 Lambert, M.L., 213 Lansdorp, B., 65 Late Ventilator Associated Pneumonia (L-VAP), 262 Latta, Thomas, 71 Lautrette, A., 808 Lawrence, V.A., 779 Lee, P., 646 Lees, K.R., 673 Left ven-tricular assist device (LVAD), 460–461 Left ventricular stroke work index, 120 Legrand, M., 131 Lehman, L.W., 175 Leppick, I.E , 726 Levetiracetam, 72, 726, 727 Levine, S., 50, 500 Liberation classic weaning method, 319 cuff leak test, 326 EVLW, 320–321 extubation failure, 325 factors, 319–320 failure causes, 324 NIV, 324–325 noradrenaline group, 321 oxygen consumption and cardiac function, 320 process, 322 readiness testing, 322–323 SBT, 323–324 standard care, 319 vasoactive drug treatment, 321 Lim, H.Y., 627 Lin, P.C., 517 Liu, L.L., 779 Liu, L.Y., 628 Long term acute care associated pneumonia (LTAC-P), 262 Long term acute care (LTAC) hospital, 47 Lorazepam, 205–206 Lowenstein, D.H., 720 Lowey, 244 Low molecular weight heparin (LMWH), 401, 403, 676, 780 Luca, A., 536 Lundy, J.S., 585 Lung parenchyma, 798–800 Lutterman, A.C., 800 Lyon, J.E., 755 M Maas, M.B., 691 Macdonald, R.L., 720 MacLaren, R., 517 Maddrey’s discriminant function (mDF), 538, 539 Maesaka, J.K., 637 Magee, L.A., 767 Magovern, G.J., 62 Mahjoub, Y., 65 Maitland, K., 16 Maki, D.G., 221, 227, 228 Malcolm, D.S., 647 826 Malignant obesity hypoventilation syndrome (MOHS) chronic hypercapnic respiratory failure, 792 criteria, 792 pathophysiology, 792 treatment of, 792–793 Mannitol, 705–707 Mannucci, P.M., 534 Marcantonio, E.R., 780 Marik, P.E., 221 Martini, R.P., 699 Masko, 505 Matevosyan, K., 602 Maurya, I., 507 McNicoll, L., 779 McVay, P.A., 604 Mean arterial pressure (MAP), 700 Mean perfusion pressure (MPP), 175 Mechanical ventilation ABG analysis, 306–307 acute cardiogenic pulmonary edema, 291 acute severe asthma, 386–387 ALI, 291 ALI/ARDS, 293 APRV, 296, 301–303 auto-PEEP, 305–306 clinical judgment, 291 CMV, 300 COPD, 291, 377–378 CPAP breaths, 295 hypercarbic respiratory failure, 291 IMV and SIMV, 299–300 indications, 291–292 initial settings, 293, 295 liberation (see Liberation) NIV, 291 PBW, 292 PC-CMV, 299 PC-CSV, 300 PEEP, 303–305 phase variables, 293, 295 PSV and CPAP, 295, 296 SIMV, 295, 296 standard ventilator terminology and variables, 293–294 tracheostomy, 307–308 variables cycling method, 297 I:E ratio, 298–299 inspiratory flow patterns, 297–298 trigger variables, 298 VC-CMV mode, 299 Meduri, G.U., 628 Melsen, W.G., 230 Index Meperidine, 208 Messori, A., 514 Methicillin resistant staphylococcus aureus (MRSA), 216 Methylprednisolone, 613, 629, 630 Metlay, J.P., 227 Meziani, F., 15 Micek, S.C., 121 Midazolam, 206 Mixed venous oxygen saturation (SmvO2), 343–344 Model for end-stage liver disease (MELD), 523 Molecular adsorbent recirculating system (MARS), 529 Moller, J.T., 179 Morphine, 197, 208 Mueller, S.W., 755 Muench, E., 699 Muizelaar, J.P., 706 Mullens, W., 131 Muller, L., 69 Multidrug resistant organisms (MDR) colonization, 215–216 MRSA isolation, 217–218 risk factors, 231 Multifocal atrial tachycardia (MAT), 485 Multi-sensitive organisms (MSO), 262 Multi-system organ failure (MSOF), 353 Mumtaz, H., 603 Murphy’s laws of procedures, 29–30 Murphy, T., 639 Mutoh, T., 702 Myocardial infarction without ST-segment elevation (NSTEMI) See Unstable angina (UA) N Naloxone, 745 National Early Warning Score (NEWS), 191 National Health and Nutrition Examination Survey, 787 National Healthcare Safety Network (NHSN), 227 National High Blood Pressure Education Program Working Group on High Blood Pressure in Pregnancy, 761 National Institute of Neurological Disorders and Stroke (NINDS), 672 Nava, S., 777 Near-fatal asthma (NFA), 381 Needham, D.M., 500 Nelson, J.E., 808 Nesiritide, 453 827 Index Neuroleptic malignant syndrome, 279, 283–284 Neuromuscular abnormalities critical illness myopathy body composition, 51 definition, 49 diaphragm, 49 diaphragmatic atrophy, 51 implications, 51 respiration, 49 respiratory muscles, 50 ventilatory support, 50 critical illness polyneuropathy, 49 Neuromuscular blockers, 16 Neuromuscular blocking agents (NMBA), 362 Ng, T., 595 Nguile-Makao, M., 230 Nguyen, B., 15 Nguyen, H.B., 158 Nielsen, N., 17 Nieuwenhoven, C.A., 237 Nimodopine, 693–694 Nitroglycerin, 452–453 N-methyl- D-aspartate (NMDA) receptor, 751 Nohria, A., 132 Non-alcoholic steatohepatitis (NASH), 790 Non-cardiac pulmonary edema, 799 Non-contrast enhanced CT scans (NECT), 671–672 Nonconvulsive status epilepticus, 727–728 Noninvasive positive pressure ventilation (NPPV), 384–385 Non-invasive ventilation (NIV), 291, 792 BiPAP ventilators, 311–312 COPD, 312 CPAP, 311 EPAP cycle, 311–312 face-mask, 311 hypercapnic respiratory failure, 315 hypoxemic respiratory failure, 315 indications acute cardiogenic pulmonary edema, 313 COPD exacerbations, 313 facilitating extubation, 313 immunocompromised patients, 314 post-operative patients, 314 initial settings, 312 NIPPV, 315–316 Norfloxacin, 526–527 Nosocomial rhinosinusitis (NS), 246–248 Nosotti, M., 595 Novel oral anti-coagulants (NOAC’s), 412–414 N-terminal pro-brain natriuretic peptide (NT-proBNP), 447 Nursing-home acquired pneumonia (NHP), 262 Nussenblatt, V., 229 Nutrition bolus vs continuous feeding, 504–506 composition, 493–494 digest, 495–497 EDEN trial, 498 enteral nutrition (EN), 493 feed critically ill patients, 506–507 mTOR Pathway, 502–504 muscle wasting anabolic and catabolic pathways, 500, 501 CIM, 499 CPK levels, 499 FOXO, 500, 502 myostatin, 500 protein synthesis, 501 proteolysis, 500 steroids, 502 myths of, 494 obese patient, 507 quantity, 493 refeeding syndrome, 507–508 starvation, 498–499 time intervals, 493 TPN, 494–495 O Oba, Y., 798 Obesity cardiovascular effects, 789–790 critical care outcomes, 787–788 drug toxicity, 790 hepatic and renal effects, 790 ideal body weight, 789 MOHS chronic hypercapnic respiratory failure, 792 criteria, 792 pathophysiology, 792 treatment of, 792–793 nutritional requirements, 790–791 prevalence, 787 radiological procedures, 791 respiratory effects, 788–789 vascular access, 791 Obstetrical hemorrhage, 760–761 O’Connor, M.F., 13 Octogenarians, 779 Oliguria, 80–81 O’Malley, C.M., 75 Ong, J.P., 527 Oostdijk, E.A., 219 828 Opelz, G., 588 Opoka, R.O., 16 Orogastrictube, 35 Osler, W., 3, 261, 269 Oxytocin, 761 P Pabinger, I., 605 Page, V.J., 204 Pain, agitation and delirium pathway (PAD), 199 Pain management anxiety, 197 BPS, 200 CPOT, 200 delirium (see Delirium) GCS, 201 neuromuscular blockade, 209–210 non-pharmacologic interventions, 202 sedation ABC trial, 202 analgesia protocol, 197–199 bolus doses, lorazepam, 199 complications, 199–200 daily awakening trial, 202 dexmedetomidine infusion, 199, 207 fentanyl, 208 haloperidol, 208 lorazepam, 205–206 meperidine, 208 midazolam, 206 morphine, 197, 208 nonbenzodiazepine, 199 propofol, 199, 206–207 Ramsey Sedation Scale, 201 RASS, 201–202 treatable causes, 200 Palliative care, 806–808 Pancreatitis abdominal pain, 565–566 causes of, 565 complications, 568–569 diagnosis, 566–567 patient management, 569–571 prevalence, 565 risk stratification, 567–568 Pandharipande, P., 199 Panwar, R., 175 Papazian, L., 16, 209 Paracentesis, 36 Paradoxical vocal cord motion disorder (PVCM), 388 Pareznik, R., 134 Index Parienti, J.J., 222 Park, H.Y., 626 Paroxysmal supraventricular tachycardia (PSVT), 485–487 Partial pressures of carbon dioxide (PaCO2), 329 Partial pressures of oxygen (PaO2), 329 Passive leg raising maneuver (PLR), 67 Patanwala, A.E., 579 Paugam-Burtz, C., 13 Pedestrian- motor vehicle injuries, 778 Perfusion Index (PI), 189 Peri-operative fluid optimization goal-directed hemodynamic therapy, 99–100 hypothermia, 102 interventions, 99 intraoperative oxygen debt theory, 101 long-term survival, 99 and postoperative complications, 101 postoperative morbidity and mortality, 99 SmvO2/ScvO2, 103 technologies and treatment algorithms, 100 traditional fluid management, 99 Petrov, M.S., 578 Phelan, H.A., 592 Phillips, R.A., 91 Plain abdominal radiography, 801 Platelet transfusion See Thrombocytopenia Platelet Transfusion in Cerebral Hemorrhage trial, 609, 689 Platt, R., 227 Pleth Variability Index (PVI), 189 Pleural effusions hepatic hydrothorax, 393 pathophysiology, 391–392 Pneumonia appropriate initial antimicrobial therapy, 261 aspiration ACE, 269 antimicrobial therapy, 268–269 diagnosis, 268 dysphagia, 267 NG tube, 269 risk factors, 267–268 SLP, 269 CA-MRSA, 266–267 CAP (see Community-acquired pneumonia (CAP)) classification, 261–262 co-existent/influenza pneumonia, 264 complicated pleural effusion/empyema, 271 C pneumoniae, 265 criterias, 264–265 diagnostic testing, 265 829 Index DRP, 261, 262 HAP, 261, 262 HCAP, 261, 262 inappropriate initial antimicrobial therapy, 261 non-infectious diseases masquerade, 265 nursing home-acquired pneumonia, 269 persistent temperature/failure, 269–270 unusual pathogens, 270 Pohlman, A.S., 13 Polymorphic ventricular tachycardia (PVT), 489 management, 489–490 normal QT interval, 489 prolonged QT interval, 489 QRS morphology, 489 Polypharmacy, 780 Pongruangporn, M., 221 Portal vein thrombosis (PVT), 535–537 Portopulmonary hypertension (POPH), 532 Positive end-expiratory pressure (PEEP), 359–360, 788–789 Posterior reversible encephalopathy syndrome (PRES), 765 characteristics, 441 clinico-neuro-radiological entity, 441 CT and MRI, 441 drugs, 442 pathogenetic theory, 441 pregnancy-induced PRES, 441 Postpartum hemorrhage (PPH), 760 Predicted body weight (PBW), 23, 292 Pre-eclampsia diagnosis central nervous system, 763 coagulation system, 764 fetal, 764 HELLP syndrome, 764–765 hepatic, 764 PRES, 765 signs, 762–763 symptoms, 762 hepatic, 763 multiorgan disease process, 761 risk of, 762 treatment anti-hypertensive agents, 766–767 corticosteroids and plasmapheresis, 767–768 hypertension, 765–766 Pregnancy, 339–340, 441 acute fatty liver, 768 amniotic fluid embolus syndrome, 768 cardio-respiratory changes, 759, 760 hypertension, 761 obstetrical hemorrhage antepartum, 760 patient management, 760–761 postpartum, 760 pre-eclampsia (see Pre-eclampsia) respiratory failure, 769–770 sepsis, 768–769 Pre-renal azotemia, 654–655 Press, M.J., 227 Pressure controlled intermittent mandatory ventilation (PC-IMV), 299–300 Pressure controlled ventilation (PCV), 354–357 Pressure support ventilation (PSV), 295 Propofol, 199, 206–207 Proton pump inhibitors (PPIs), 518 PROXI trial, 188 Pryor, K.O., 188 Puerperal sepsis, 768 Pulmonary artery catheter (PAC), 7, 343–344 Pulmonary artery occlusion pressure (PAOP), 63 Pulmonary embolism absolute contraindications, 419 catheter directed clot fragmentation and aspiration, 418 diagnosis of algorithm, 410, 411 CTPA, 410 CUS, 408–409 DD-US-CT strategy, 410 revised Geneva score, 408, 409 scoring systems, 408 V/Q scan, 410 Wells score, 408, 409 hypoxemic respiratory failure, 408 iNO, 418 thrombolytic therapy, 413, 415–416 treatment NOAC’s, 412–414 pulmonary embolism severity index, 411–412 vena caval interruption, 419 Puthucheary, Z.A., 50, 500, 502, 505 R Raad, I., 224 Radiology chest radiograph antero-posterior, 797 cardiogenic pulmonary edema, 799 diaphragm, 800 non-cardiac pulmonary edema, 799 pneumothoraces., 800 pulmonary pathology, 797 830 Radiology (cont.) radion exposure, 800, 801 supine, 797 tubes and catheters position, 798, 799 computed tomographic (CT), 801–802 indium labeled leukocye scans, 802–803 plain abdominal radiography, 801 Rady, M.Y., 779 Rafanan, A.L., 802 Raff, T., 515 Rahman, N.M., 271 Ramsey, M.A., 201 Ramsey Sedation Scale, 201 Ranson’s Criteria, 567 Rao, S.V., 598 Rapid response team (RRT), 191–192 Reactive oxygen species (ROS), 185, 186, 188 Red blood cell transfusions anemia, 585, 596 benefit/harm of, 596 complications, 588 FNHTR, 593 infectious, 587 noninfectious, 588 oxygen delivery equation, 586 packed red blood cells, 586, 587 postoperative and nosocomial infections, 592–593 randomized clinical trial, 597–598 storage lesion, 590–591 TACO, 594 TRALI, 594 transfusion-associated thrombosis, 594–595 10/30 transfusion trigger, 585 TRIM, 588–589 tumor recurrence, 595 Red Cell Storage Duration Study (RECESS), 592 Refeeding syndrome, 507–508 Refractory status epilepticus, 720–721, 726–727 Regueira, T., 134 Reignier, J., 16 Renal replacement therapy (RRT), AKI criteria for, 657–658 CRRT, 658–659 dosing of, 659 recommendations for, 659 Renal salt wasting syndrome, 637, 638 Reperfusion therapy, 475–476 Respiratory function, 775 Rhabdomyolysis acute renal failure mechanisms, 663 clinical manifestations, 663–664 creatine kinase, 659–660 Index dialysis, 665–666 epidemiology, 660 laboratory findings, 664 muscular trauma, 660 non physical causes, 661–662 pathophysiology, 663 physical causes, 660–661 risk factors, 662 treatment of, 664–665 Rice, T.W., 498 Richard, J.C., 16 Richmond Agitation-Sedation Scale (RASS), 201–202 Rifaximin, 528 Right ventricular infarction (RVI), 478 Rincon, F., 186, 708 Rivers, E., 15, 57, 58 Rodriguez, A., 266 Rohde, J.M., 593 Ronco, J.J., 134, 176 Rose, L., 237 S Saccharomyces boulardii, 578 Safar, P., Safdar, N., 221 SAH See Subarachnoid Hemorrhage (SAH) Salerno, D., 802 Salerno, F., 526 Salgado, C.D., 219 Salicylates, 738–739 Saline-adenine-glucose- mannitol (SAG-M), 590 Saline versus Albumin Fluid Evaluation (SAFE) study, 77 Salman, S.S., 609 Sarcopenia, 776, 790 Schuetz, P., 223 Schmidt, J.M., 700 Schmidt, M.G., 219 Schreiber, M.P., 630 Schweickert, W.D., 202 Sebille, V., 16 Segal, R., 602 Seizures complication, 718 hypoglycemia, 717 management, 719 primary neurological disease, 719 therapy, 719–720 tonic-clonic convulsions, 717 Selective decolonization of the digestive tract (SDD), 218–219 Index Selinger, C.P., 577 Semmelweis, I., 216 Sepsis, 80 antibiotic therapy, 118 bacteriologic data, 108 B-blockers and phenylephrine, 128–129 blood-pressure, 15 CVP, 117 detrimental effect, 131 ESCAPE trial, 132 lung protective strategy, 133 mean capillary pressure, 132 mean systemic filling pressure, 131 microcirculatory flow and organ function, 131 natriuretic peptides, 132 normal venous pressures, 130 renal replacement therapy, 132 definition, 107 diagnosis, 115 EGDT, 116 epidemiological data, 107 fluid therapy aggressive fluid resuscitation, 119 EGDT, 122–123 endothelial injury, 120 endotoxin, 119 FACTT trial, 121 FEAST study, 122 fluids and vasopressor, 123 Frank-Starling curve, 119–120 iatrogenic injury, 119 iatrogenic salt water drowning, 119 left ventricular stroke work index, 120 mean arterial pressure, 123 myocardial edema, 120 natriuretic peptides, 119 pneumonia, 121 tissue edema, 120 vasodilatation, 119 vasopressin in septic shock trial, 121 vasopressor agent, 123 ICU, 107 incidence, 107 mortality, 108 organ dysfunction blood cultures, 113 manifestation, 113 polymerase chain reaction, 113 procalcitonin, 113–114 systemic inflammation, 113 pathophysiology cardiomyopathy, 109–111 complications, 111 831 resuscitation end-points, 129–130 and septic shock, 15, 107 tissue hypoxia and mitochondrial dysfunction animal models and patients, 134 in animal models and patients, 134 blood transfusion, 135 corticosteroids, 135–136 hemodynamic profile over time, 137 hypoxic hypoxia, 134 nitric oxide and glutathione, 135 oxygen delivery, 134 source control, 136 tissue oxygen saturation, 134 vasopressors and inotropic agents central venous catheterization, 126 dobutamine, 126 extravasation injuries, 127 global biventricular dysfunction, 126 mean perfusion pressure, 125 mortality and organ failures, 125 norepinephrine, 125 SEPSISPAM, 124 terlipressin, 127 VASST trial, 127 ventricular function, 126 SEPSISPAM trial, 175 Sequential compression devices (SCDs), 401, 676 Serotonin syndrome, 279, 284–286 Seshadri, N., 803 Severe acute respiratory distress syndrome, 16 Severe Community Acquired Pneumonia (S-CAP), 261 Sharma, B.C., 528 Shehabi, Y., 199 Shindo, Y., 262 Shoemaker, W.C., 100, 102, 103 Shulman, R.J., 505 Sick-sinus syndrome, 487 Siebig, S., 628 Sildenafil, 793 Sinus bradycardia, 487 3-SITES Multicenter Randomized Controlled Trial, 222 Skillman, J.J., 513 Skippen, P., 706 Sleeswijk, M.E, 484 Sligl, W.I., 266 Smith, D.T., 268 Smith, G.I., 503 Smith, I.J., 500 Society for Healthcare Epidemiology (SHEA) of America, 217, 243–244 832 Society of Critical Care Medicine, 805 Society of Critical Care Medicine, 275 Sort, P., 526 Stoutenbeek, C.P., 219, 514 Speech and language pathologist (SLP), 269 Speroff, T., 14 Spontaneous bacterial empyema (SBEM), 393 Spontaneous bacterial peritonitis (SBP), 525–527 Spontaneous breathing trials (SBT), 319, 323–324 Sprung, C.L., 16 Stark, R.P., 227 Status asthmaticus See Acute severe asthma Status epilepticus causes of, 721 complications, 722 definition, 720 diagnosis, 722–723 epilepticus, 728 etiology, 721 general measures, 723–724 nonconvulsive, 727–728 pathophysiology, 722 pharmacotherapy, 724–726 prevalence, 720 refractory classification, 721 definition, 720–721 management of, 726–727 treatment, 723 Stoll, B., 505 Strand, S., 765 Stress hyperglycemia acute hyperglycemia, 154, 155 chronic hyperglycemia, 155 clinical outcomes, 154 epinephrine and norepinephrine, 153 glucose, 153 glucose control and steroids, 158 iatrogenic normalization, 154 insulin, 153 observational data, 154 skeletal muscles, 153 thermal injury and sepsis, 153 treatment, 155–157 Stress hyperlactemia brain metabolism, 163–164 heart metabolism, 163 illness severity, 160 metabolic fuel, 162 metabolic stress, 161–162 Stress response activation, 150 Index cardiovascular effects, 152 chronic stress syndrome, 152 dysfunction, 151 immune effects, 152–153 metabolic effects, 153 modulators, 151–152 Stress ulcer prophylaxis (SUP) acid suppressive therapy, 516 complications H2RA, 517–518 PPIs, 518 sucralfate, 518–519 enteral nutrition, 515–516 GIB, 514–515 H2RB’s, 517 pathogenesis, 514 “ventilator bundles”, 513 Stroke intensive care units, 670 Strom, T., 197 Study of Prevention of Postoperative Atrial Fibrillation (SPPAF), 482 Subarachnoid Hemorrhage (SAH) antifibrinolytic therapy, 698 cerebral vasospasm management (see Cerebral vasospasm) diagnosis and evaluation, 693 initial management agitation/delirium, 694 anemia, 696 bed rest, 693 blood pressure control, 696 brain tissue oxygen monitoring, 697 cerebral microdialysis, 697 corticosteroids, 697 DVT prophylaxis, 696–697 ECHO and ECG screening, 697 fluid management, 694–695 glucose control, 695–696 laxatives, 696 magnesium, 695 mechanical ventilation, 697 mild sedation/anxiolysis, 694 nimodopine, 693–694 nutrition, 697 pain, 694 sodium, 695 statins, 697 stress ulcer prophylaxis, 697 temperature/fever, 694 surgical and endovascular methods, treatment, 698 TPTD, 701–702 Subdural hematoma (SDH), 702–703 Sucralfate, 518–519 Index SUP See Stress ulcer prophylaxis (SUP) Supraventricular tachycardia (SVT), 486 Surgical site infection (SSI), 187–188 Swan H.J., 7, 63 Swiston, J., 271 Sympathoadrenal system (SAS), 149 Symptomatic vasospasm, 701 Synchronized intermittent mandatory ventilation (SIMV), 295, 296, 387 Syrjala, M.T., 803 Systemic inflammatory response syndrome (SIRS), 765 Systemic lupus erythematosus (SLE), 763 Systolic blood pressure (SBP), 171 Systolic heart failure ACE inhibitors, 457 AICD, 459 aldactone, 458 beta-blocker therapy, 457–458 calcium channel blocking drugs, 459 CRT, 459–460 digoxin, 459 HFpEF, 461–462 hydralazine/isosorbide dinitrate, 458–459 LVAD, 460–461 revascularization, 460 surgical options, 460 T Tachycardia-bradycardia syndrome, 487 Takotsubo cardiomyopathy ACE inhibitors, 464–465 β-blockers, 464–465 clinical symptoms, 463 diffuse T wave inversion, 463–464 emotional stress, 462–463 features, 463 octopus trapping pot, 462 physical stress, 463 post-menopausal women, 463 QT interval prolongation, 463–464 Tambyah, P.A., 228 Tavernier, B., 66 Technetium-labeled red blood cell (Tc-RBC), 561 Teltsch, D.Y., 219 Tenzing, 182 Thoracentesis, 36 Thrombocytopenia anticonvulsants, 607 antimicrobials, 607 causes, 607 complications, 608 833 definition, 606 DIT, 608 diuretics, 608 etiology, 607 HITT, 610–612 indications of, 608, 609 platelet product contents, 608, 609 TTP, 612–613 Thromboembolic disease (TED) DVT diagnosis, 405–406 diagnostic algorithm, 410–411 distal lower extremity, 406 pregnancy, 399–400 prophylaxis protocols, 405 UEDVT, 406–408 venous thrombosis (see Venous thrombosis) Wells score, 409 pulmonary embolism (see Pulmonary embolism) Thrombolysis in myocardial infarction (TIMI) risk score, 473–474 Thrombotic thrombocytopenic purpura (TTP), 612–613 Timset, J.F, 222, 226 Torsades De Pointes, 489–490 Total parenteral nutrition (TPN), 494–495 Towne, A.R., 723 Toxicology activated charcoal, 732–733 anticholinergic syndrome, 735 cholinergic syndrome, 735 depressed level of consciousness, 734 ethylene glycol and methanol poisoning cocaine (see Cocaine) digitalis, 743 isopropyl alcohol, 742–743 lithium, 744 opiates, 745 osmolar gap, 741 phenytoin, 743–744 extrapyramidal, 735 flumazenil, 731 gastric lavage, 731–732 hallucinations, 735 hemodialysis, 733–734 hemoperfusion, 733 intoxications acetaminophen, 735–738 acute ethanol, 739–740 antidotes, 731, 732 carbon monoxide poisoning, 748–749 834 Toxicology (cont.) salicylates, 738 tricyclic antidepressants, 738–739 ipecac, 731 isopropyl alcohol, 742–743 methanol poisoning, 741–742 nystagmus, 735 seizures, 734–735 serotonin syndrome, 735 sympathetic syndrome, 735 toxidromes, 734 Toxidromes, 734 Transcranial Doppler (TCD) technology, 700–701 Transfusion associated circulatory overload (TACO), 594 Transfusion associated graft-versus-host disease (TA-GvHD), 589 Transfusion related acute lung injury (TRALI), 594 Transfusion related immunomodulation (TRIM), 588–589 Transpulmonary thermodilution, 91–92 Trauma, 778 Traumatic brain injury (TBI), 79, 703 Treggiari-Venzi, M., 197 Tricyclic antidepressants, 738–739 Tripodi, A., 534Tsai, M.H., 530, 532 U Undersea and Hyperbaric Medical Society, 749 Unfractionated heparin (UFH), 401 Unstable angina (UA) Canadian cardiovascular classification, 472 class II recommendation, 475 class I recommendation, 474–475 differential diagnosis, 472 electrocardiography, 472–473 GRACE risk model, 474 risk stratification, 473 TIMI risk score, 473–474 tropinins, 473 types, 472 Upper extremity deep venous thrombosis (UEDVT), 406–408 Upper gastrointestinal bleeding (UGIB) causes of, 556 definition, 555 endoscopy, 556–558 peptic ulcer disease, 555 Index V Vancomycin, 224, 243–244 Vancomycin resistant enterococci (VRE), 216 van den Akker, 628 van den Berghe, G., 15, 155, 157 Van Santvoort, H.C., 571 Vargas, F., 246 Varpula, M., 124, 175 Venous blood gas analysis (VBGs), 342–343 Venous thrombosis bleeding risk score, 403–404 Caprini DVT risk assessment score, 401, 403 distal lower limb leg, 400 GCS, 403 IVC filter, 401 LMWH, 401, 403 lower leg, 401, 402 SCDs, 401, 403 UFH, 401, 402 Ventilation/perfusion scanning (V/Q), 410 Ventilator associated condition (VAC), 233 Ventilator associated pneumonia (VAP), 516 annual costs, 213 APACHE II Score, 230 clinical signs, 229 diagnosis, 229, 232–233 empiric antibiotic choice, 235 incidence rate, 229 individual patient data, 230 mortality, 214 pathogenesis, 230–232 prevention acid suppressive therapy, 238 chlorhexidine mouth wash, 237–238 endotracheal tube remove, 235 head of bed elevation, 237 probiotics, 239 recommended measures, 239 subglottic suctioning, 238 ventilator bundle, 236 SAPS II score, 230 surveillance definitions, 229 treatment, 234–235 Ventricular fibrillation, 486 Ventricular premature complexes, 487 Ventricular tachycardia nonsustained, 488 PVT (see Polymorphic ventricular tachycardia (PVT)) sustained, 488–489 Villa, E., 537 Villanueva, C., 554, 597 ... systematically © Springer International Publishing Switzerland 2015 P.E Marik, Evidence-Based Critical Care, DOI 10. 1007/978-3-319- 1102 0-2_1 ... Eastern Virginia Medical School Norfolk, VA, USA ISBN 978-3-319- 1101 9-6 ISBN 978-3-319- 1102 0-2 (eBook) DOI 10. 1007/978-3-319- 1102 0-2 Springer Cham Heidelberg New York Dordrecht London Library.. .Evidence-Based Critical Care Paul Ellis Marik Evidence-Based Critical Care Third Edition Paul Ellis Marik Division of Pulmonary and Critical Care Medicine Eastern

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  • Preface to Third Edition

  • Acknowledgements

  • A Note to the Reader

  • Contents

  • Part I: General ICU Topics

    • Chapter 1: Evidence Based Critical Care

      • References

    • Chapter 2: “Less Is More”: The New Paradigm in Critical Care

      • References

    • Chapter 3: “Classic” Papers

    • Chapter 4: Critical Care Medicine 101

      • Factors to Consider When a Patient is Admitted to the ICU

      • Initial “Generic” Treatment Orders

      • Reference

    • Chapter 5House Offi cers Guidelines 1: Housekeeping

      • Admission History and Physical Examination

      • Daily Examination

        • General

        • Vital Signs (24 h Min and Max and Current)

        • Additional Observations

        • The Ventilator

        • Heart

        • Chest

        • Abdomen

        • CNS

        • Importance of the Daily Neurological Examination

      • Laboratory Tests

      • Imaging

      • Presenting on Daily Rounds

        • New Admissions

        • Table 5.1 Comparison of the traditional H&P and proposed ICU presentation format

        • Follow Up Patients

      • Clinical Pearls

      • References

    • Chapter 6: House Officers Guidelines 2: Procedures

      • Murphy’s Laws of Procedures

      • Central Venous Access

        • Subclavian Vein Catheterization

        • Internal Jugular Vein Catheterization

        • Femoral Vein Catheterization

        • Complications of Central Venous Access

      • Arterial Catheters

      • Naso/Oro Gastric Tubes

      • Feeding Tubes

      • Thoracentesis and Paracentesis

        • Clinical Pearls

      • References

    • Chapter 7: Admission-Discharge Criteria

      • ICU Admission Criteria [1]

      • Prioritization of Potential ICU Admissions

        • Priority 1

        • Priority 2

        • Priority 3

        • Priority 4

        • Transfer from Another Hospital: Variable Priority

      • Disease Specific Indications for ICU Admission

        • Cardiovascular System

        • Pulmonary System

        • Neurological Disorders

        • Drug Ingestion and Drug Overdose

        • Gastrointestinal Disorders

        • Endocrine

        • Renal Disorders

        • Postoperative Care

        • Miscellaneous

      • Physiologic Indication for ICU Admission

      • Discharge Criteria

      • Reference

    • Chapter 8: Chronic Critical Illness and the Long Term Sequela of Critical Care

      • Neuromuscular Abnormalities

        • Critical Illness Polyneuropathy

        • Critical Illness Myopathy (See also Chap. 32 on Nutrition)

        • Brain Dysfunction

      • “Prevention” of CCI

      • Management of CCI

        • Testing

        • General Management

        • Stress Hyperglycemia

        • Metabolic Bone Disease

        • Anabolic Steroids

        • Exercise Program

      • References

    • Chapter 9: Fluid Responsiveness and Fluid Resuscitation

      • Echocardiographic Assessment of Fluid Responsiveness

        • Static Echocardiographic Parameters

        • Dynamic Echocardiographic Parameters

      • Passive Leg Raising (PLR)

      • The Fluid Challenge

      • Fluid Boluses in Volume Responsive Patients

      • What Type of Fluid?

        • Lactated Ringer’s (Hartmann’s Solution) vs. 0.9 % NaCl (Ab-Normal Saline)

      • Complications Associated with 0.9 % NaCl vs. Lactate Ringers Solution

        • Renal Failure

        • Hyperchloremic Metabolic Acidosis and DEATH

        • Lactate Generates HCO3−

        • Ringer’s Lactate and Kidney Disease

        • Ringers Lactate and Liver Disease

        • Coagulopathy

        • Lactate as a Metabolic Fuel

      • Albumin

      • Hetastarches (HES)

      • So, Which Fluid?

      • Resuscitation in Specific Disease States

        • Hemorrhage

        • Traumatic Brain Injury

        • Dehydration

        • Sepsis (and SIRS)

        • Burns

      • Management of Oliguria

        • Management of Volume Overload/Acute Pulmonary Edema

      • References

    • Chapter 10: Assessment of Cardiac Function and Cardiac Output

      • Echocardiographic Assessment of Cardiac Function

      • Methods of Measuring Cardiac Output

        • Pulmonary Artery Catheter

        • Transpulmonary Thermodilution

        • Pulse Contour Analysis

        • Esophageal Doppler

        • USCOM

        • Bioreactance

      • Utility of Cardiac Output monitoring

        • Determining Fluid and Inotrope Responsiveness

        • Driving up CI to Supranormal Values

      • References

    • Chapter 11: Peri-operative Fluid Optimization

      • References

    • Chapter 12: Sepsis

      • Bacteriology and Sites of Infection

      • Pathophysiology of Sepsis

        • Septic “Cardiomyopathy”

        • Complications Associated with Sepsis

      • Clinical Features and Diagnosis of Sepsis

        • Organ Dysfunction in Severe Sepsis/Septic Shock

      • Management of Sepsis

        • Antibiotic Therapy

        • Fluid Therapy (See also Chap. 9)

        • Vasopressors and Inotropic Agents

        • B-Blockers and Phenylephrine in Septic Shock

        • Resuscitation End-Points

        • The Dangers of a HIGH CVP

        • Does Tissue Hypoxia and Mitochondrial Dysfunction Exist in Sepsis?

          • Blood Transfusion

          • Corticosteroids

          • Source Control

      • Case Example

      • References

    • Chapter 13: The Stress Response, Stress Hyperglycemia and Stress Hyperlactemia

      • The Stress Response

        • Cardiovascular Effects of the Stress Response

        • Immune Effects of the Stress Response

        • Metabolic Effects of the Stress Response

      • Stress Hyperglycemia

        • Treatment of “Stress Hyperglycemia”

        • So What to Do!

        • How to Achieve These Goals?

        • Glucose Control and Steroids

      • Stress Hyperlactemia

        • Lactate Metabolism

        • Lactate as a Marker of Illness Severity

        • Lactate as a Marker of Metabolic Stress

        • Lactate as a Metabolic Fuel

        • Heart Metabolism and Lactate

        • Brain Metabolism and Lactate

      • References

    • Chapter 14: Understanding the Vital Signs: BP, HR, RR, TEMP, SaO2 … and SV

      • Blood Pressure

        • The Brain-Heart Distance and the Giraffe Theory of Blood Pressure Determination in Humans

        • What’s a Normal Blood Pressure?

        • BP Thresholds for the Intensivist/Anesthesiologist

        • Non-Invasive Blood Pressure (NIBP) vs Arterial Line Blood Pressure (IAP) and Systolic Blood Pressure (SBP) vs Mean Arterial Pressure (MAP)

        • Central vs Peripheral Blood Pressure Measurement

        • Blood Pressure Autoregulation

        • MAP, Organ Failure and Death

      • Circulatory Shock

      • Pulse Rate

      • Respiratory Rate (& Pattern)

      • Temperature

      • Pulse Oximetry

      • Too Much Oxygen Kills

        • Analysis of the Oximetric Waveform

      • Stroke Volume: The 6th Vital Sign

      • Putting the Vital Signs Together

        • Early Warning Scoring Systems and Rapid Response Teams

      • References

    • Chapter 15: Management of Pain, Agitation and Delirium

      • Assessing the Level of Pain and Sedation

        • The Ramsey Sedation Scale

        • The Richmond Agitation-Sedation Scale (RASS)

      • Sedation Vacations

      • Non-pharmacologic Interventions

      • Delirium

      • Sedative and Analgesics Agents

        • Lorazepam

        • Midazolam

        • Propofol

        • Dexmedetomidine

        • Haloperidol

        • Fentanyl

        • Morphine

        • Meperidine

      • Neuromuscular Blockade

        • Neuromuscular Blocking Agents

      • References

    • Chapter 16: Hospital Acquired Infections and Their Prevention

      • Colonization with Multidrug Resistant Organisms

      • Handwashing and Infection Control Measures

        • Handwashing

        • Chlorhexidine Bathing

        • Gloves and Gowns and Healthcare Provider Apparel

        • Universal Screening for MDR’s and “Protective Isolation”

        • Oropharyngeal and Gastrointestinal Decolonization

        • Private Rooms and Environmental Control

      • Central Line Associated Blood Stream Infection

        • Management of CLABSI’s

        • Antibiotics Lock Therapy

        • Prevention of CLABSI

      • Catheter Associated Urinary Tract Infection

      • Ventilator Associated Pneumonia

        • Pathogenesis of VAP

        • Diagnosis of VAP

        • Treatment

        • General Concepts for the Antimicrobial Treatment of VAP

        • Empiric Antibiotic Choices

        • “Specific” Interventions for Prevention of VAP

          • Elevation of Head of Bed

          • Chlorhexidine Mouth Wash

          • Subglottic Suctioning

          • Acid Suppressive Therapy

          • Probiotics

          • Recommended Measures to Limit the Development of VAP

        • Clostridium difficile Infection

        • Laboratory Diagnosis

          • Enzyme Immunoassays for Toxin A/B

          • Enzyme Immunoassay for Glutamine Dehydrogenase

          • Nucleic Acid Amplification for Toxin A/B Gene

        • Sigmoidoscopy

        • Treatment

        • Fidaxomicin

        • Adjunctive Treatment Options

        • Probiotics

        • Surgical Intervention

      • Nosocomial Rhinosinusitus

      • References

  • Part II: Pulmonary

    • Chapter 17: The Bacterial Pneumonias: A New Treatment Paradigm

      • Unified Treatment Algorithm

        • No Risk Factors for a CAP-DRP

        • Risk Factors for CAP-DRPs

        • Influenza (Co-Existent or Influenza Pneumonia)

          • Major Criteria

          • Minor Criteria (3 or More)

        • Diagnostic Testing of Hospitalized Patients with Pneumonia

        • Non-Infectious Diseases Masquerading as Pneumonia

      • Special Considerations

        • Severe CAP with no MDR Risk Factors

        • Community-Acquired MRSA Pneumonia (CA-MRSA)

        • Aspiration Pneumonia

        • Nursing Home-Acquired Pneumonia

        • Persistent Temperature/Failure to Respond to Rx

        • Unusual Pathogens

        • Complicated Pleural Effusion/Empyema

      • References

    • Chapter 18: Fever

      • Common Misconception and Fables [1]

      • Pathogenesis of Fever

        • Treatment of Fever

      • Causes of Fever in the ICU

        • Infectious Causes of Fever in the ICU

        • Non-Infections Causes of Fever in the ICU

        • Non-Infectious Causes of Fever

          • Drug Fever

          • Alcohol and Drug Withdrawal

          • Postoperative Fever

          • Blood Transfusions

          • Thromboembolic Disease

          • Acalculous Cholecystitis

          • Malignant Hyperthermia

          • Neuroleptic Malignant Syndrome

          • Serotonin Syndrome

            • Diagnosis

            • Sternbach’s Criteria [45]

            • Hunter Serotonin Toxicity Criteria [46]

            • Treatment

      • An Approach to the Febrile ICU Patient

      • Clinical Pearls

      • References

    • Chapter 19: Mechanical Ventilation 101

      • Alveolar Overdistension Damages Normal Lungs

      • Ventilator Variables and Modes of Ventilation

        • Ventilator Variables (See Table 19.1)

          • Cycling

          • Inspiratory Wave Forms

          • Ventilator Trigger Variables

          • Inspiratory to Expiratory Ratio (I:E)

      • Common Modes of Mechanical Ventilation

        • Volume Control Continuous Mandatory Ventilation (VC-CMV)

          • Pressure Controlled Continuous Mandatory Ventilation (PC-CMV)

          • Volume Controlled and Pressure Controlled Intermittent Mandatory Ventilation (VC-IMV and PC-IMV) (Also Termed IMV, SIMV)

          • Continuous Mandatory Ventilation (CMV)

          • Continuous Spontaneous Ventilation (CSV) with Pressure Support Ventilation (PSV) (PC-CSV)

          • Airway Pressure Release Ventilation (APRV)

        • Positive End-Expiratory Pressure (PEEP)

      • Auto-PEEP

        • Monitoring Patients Undergoing Mechanical Ventilation

        • Sudden Increase in Airway Pressure and/or Fall in Arterial Saturation

      • When to Perform a Tracheostomy

        • Timing of Tracheostomy in the Critically Ill

      • References

    • Chapter 20: Non-invasive Ventilation

      • Set Up

      • Initial Settings

      • Indications of NIV

        • COPD Exacerbations

        • Acute Cardiogenic Pulmonary Edema

        • Facilitating Extubation in COPD Patients

        • Immunocompromised Patients

        • Post-operative Patients

      • When to Use NIV

        • Hypercapnic Respiratory Failure

        • Hypoxemic Respiratory Failure

        • Contraindications to NIPPV

        • Success and Failure Criteria for NIPPV

      • References

    • Chapter 21: Liberation (Weaning from Mechanical Ventilation)

      • General Concepts

        • Effect of Liberation on Oxygen Consumption and Cardiac Function

        • Fluid Overload and Liberation Failure

        • Vasopressors and Inotropic Agents and Weaning

      • Mechanical Ventilation Liberation Process

        • “Readiness” Testing

        • Spontaneous Breathing Trials

        • Causes of Liberation Failure

        • Early Extubation Followed by NIV in COPD

        • NIV for Persistent Liberation Failure

        • Extubation Failure

        • Patients at High Risk of Extubation Failure

      • The Cuff Leak Test

        • Corticosteroids for the Prevention of Post-extubation Stridor

      • References

    • Chapter 22: Arterial Blood Gas Analysis

      • Indications for ABG Sampling

      • ABG Sampling

      • ABG Analysis

        • Alveolar Ventilation

        • Oxygenation

          • Relation Between PaO2 and FiO2

          • PaO2 and Age

          • Respiratory Failure

        • Acid-Base Balance

          • The Anion Gap

      • A Step Wise Approach to Acid-Base Disorders

      • Common Acid Base Disturbances in the ICU

        • Metabolic Acidosis

          • Does Lactic Acidosis Exist?

          • d-Lactic Acidosis

        • Metabolic Alkalosis

      • Venous Blood Gas Analysis (VBGs)

      • Mixed Venous/Central Venous Oxygen Saturation

      • References

    • Chapter 23: ARDS

      • Definition, Causes and Assessment of Severity

        • Definition of ALI According the American European Consensus [2]

        • Acute Lung Injury (ALI)

        • Acute Respiratory Distress Syndrome (ARDS)

        • Pathophysiological Definition of ARDS

        • Causes of ALI [8, 9]

      • Management of the Acute Phase of ARDS

        • Ventilatory Strategy

        • Pressure Controlled Ventilation

        • Airway Pressure Release Ventilation

        • Permissive Hypercapnia

        • Best PEEP

        • Recruitment Maneuvers

      • Non-Ventilatory Adjuncts to Gas Exchange

        • Prone Positioning

        • Neuromuscular Blocking Agents

      • ECMO

        • Corticosteroids

          • Myths About Complications of Glucocorticoid Treatment

          • Glucocorticoids to Prevent ALI/ARDS

        • Inhaled Nitric Oxide

        • Nebulized Prostacyclin

        • β2-Adrenergic Receptor Agonists

        • Surfactant

        • Omega-3 Enteral Nutrition

      • “Our” Approach to Refractory Hypoxemia

      • References

    • Chapter 24: COPD Exacerbation

      • Common Precipitating Events

      • Indications for Hospitalization

      • Indications for ICU Admission

      • Treatment

      • Indications for NPPV

      • Indications for Endotracheal Intubation

      • Mechanical Ventilation in COPD

      • Suggested Initial Settings

      • References

    • Chapter 25: Acute Severe Asthma

      • Indications for Admission to the ICU

      • Initial Treatment

        • Other Therapeutic Options

      • Complications of Acute Asthma

      • Noninvasive Positive-Pressure Ventilation in Status Asthmaticus

      • Indications for Intubation

      • Sedation Post-intubation

      • Mechanical Ventilation

      • Initial Ventilator Settings [18]

      • References

    • Chapter 26: Pleural Effusions and Atelectasis

      • Pleural Effusions

        • Pathophysiology

        • Drainage of Pleural Effusion

      • Hepatic Hydrothorax

      • Alelectasis

        • Respiratory Therapy

        • Mucolytics

        • Bronchoscopy

        • Bilevel/APRV

      • References

    • Chapter 27: Venous Thromboembolic Disease: DVT and PE

      • Pregnancy, Venous Thromboembolism and Thrombophilias

      • Site of Venous Thrombosis

        • The Veins of the Lower Limb

      • Suggested DVT Prophylaxis Protocols

      • Diagnosis of DVT

      • Distal Lower Extremity DVT

      • Upper Extremity DVT

        • Superficial Phlebitis

      • Pulmonary Embolism

        • Diagnosis of Pulmonary Embolism

        • Treatment of Thromboembolic Disease

        • Thrombolytic Therapy

        • Catheter Directed Clot Fragmentation and Aspiration

        • Inhaled Nitric Oxide

        • Vena Caval Interruption

        • “Absolute Contraindications” for Anticoagulation with Heparin

      • References

  • Part III: Cardiac

    • Chapter 28: Hypertensive Crises

      • Definitions

      • Pathophysiology

      • Clinical Presentation

        • Initial Evaluation

      • Initial Management of Blood Pressure

        • Resident (or Hospitalist) Called to the Floor for High Blood Pressure: What to Do?

          • Management Principles of Hypertensive Emergency

        • Drugs to AVOID

        • Recommended Antihypertensive Agents

        • Acute Postoperative Hypertension

        • Pre-operative Hypertension

      • Posterior Reversible Encephalopathy Syndrome (PRES)

        • Pregnancy-Induced PRES

        • Drugs Associated with PRES

          • Management

      • References

    • Chapter 29: Acute Decompensated Cardiac Failure

      • Confirm the Diagnosis of Cardiac Failure

      • Evaluation of the Patient with Cardiac Failure

        • B-Type Natriuretic Peptides

        • Echocardiography

        • Laboratory Testing

        • Hemodynamic Monitoring

        • Precipitating Factors

      • Treatment

        • Acute Phase of Treatment

          • Oxygen

          • Morphine

          • Diuretics

          • Vasodilators

          • Beta-Blockers

          • Inotropic Agents

          • Vasopressin Antagonists

          • Ultrafiltration

          • Management of Atrial Fibrillation (AF)

          • Management of Hypertension

          • Anticoagulation

          • Anemia

        • Treatment of ADHF: Summary

      • Long-Term Management

        • Systolic Heart Failure

          • ACE Inhibitors

          • Beta Blockers

          • Aldactone

          • Hydralazine + Isosorbide-dinitrate

          • Digoxin

          • Calcium Channel Blocking Drugs

          • AICD’s and Resynchronization Therapy

          • Evaluation of Patients for Revascularization

          • Surgical Options

          • Mechanical Support Devices

        • Management of Patients with Heart Failure with Preserved Ejection Fraction (HFpEF)

      • Takotsubo Cardiomyopathy

        • Stressors Reported to Trigger Takotsubo Cardiomyopathy [105, 107]

        • Mayo Clinic Criteria for Takotsubo Cardiomyopathy [107]

      • References

    • Chapter 30: Acute Coronary Syndromes

      • Unstable Angina/NSTEMI

      • Canadian Cardiovascular Classification of Angina

      • Types of Presentations of Unstable Angina

      • Differential Diagnosis

      • Electrocardiography

      • Tropinins

      • Management of UA/NSTEMI

        • Risk Stratification

        • Thrombolysis in Myocardial Infarction (TIMI) Risk Score [5]

        • Global Registry of Acute Coronary Events (GRACE) Risk Model [6]

      • Treatment Approach for UA and NSTEMI (PER AHA Guidelines) [7]

        • Class I Recommendations

        • Class II Recommendations

      • Treatment Approach to STEMI (PER AHA Guidelines) [8]

        • Class I Recommendations

        • Class II Recommendations

      • Complications Following STEMI

        • Recurrent Chest Pain Post-AMI

          • Pericarditis

          • Ischemia

        • Mitral Regurgitation

        • Left Ventricular Failure and Low Output States

        • Right Ventricular Infarction

        • Atrial Fibrillation

      • References

    • Chapter 31: Arrhythmias

      • Arrhythmias and Electrolyte Disturbances

      • Acute Atrial Fibrillation/Flutter

        • Urgent Cardioversion

        • Rate Control

        • Pharmacologic Cardioversion

        • Anticoagulation

      • Multifocal Atrial Tachycardia (MAT)

      • Paroxysmal Supraventricular Tachycardia (PSVT)

        • Management

        • SVT Mediated by Accessory Pathways

      • Sinus Bradycardia

      • Sick-Sinus Syndrome

      • Accelerated Idioventricular Rhythm

      • Ventricular Premature Complexes and Bigeminy

      • Nonsustained Ventricular Tachycardia

      • Sustained Ventricular Tachycardia

      • Polymorphic Ventricular Tachycardia (Torsades De Pointes)

        • Management

      • References

  • Part IV: Gastrointestinal

    • Chapter 32: Nutrition in the ICU: It’s Whey Cool

      • Myths of Nutritional Support [2]

      • Important Points to Digest

      • How Many Calories and How Much Protein to Give?

        • Muscle Wasting in Critical Illness

        • Factors That Activate Muscle Synthesis by the mTOR Pathway

        • Bolus vs. Continuous Feeding

          • Metabolic Abnormities and Complications Associated with Continuous Enteral Feeding

      • So! What is the Best Way to Feed Critically Ill Patients?

      • The Obese Patient

      • The Refeeding Syndrome

      • References

    • Chapter 33: Stress Ulcer Prophylaxis

      • Does SUP Reduce GI Bleeding?

      • Enteral Nutrition and Stress-ulcer Prophylaxis

      • Complications Associated with Acid Suppressive Therapy

      • So! What to Do?

      • Complications Associated with Specific Drugs

        • H2 Receptor Antagonists (H2RA)

        • Proton Pump Inhibitors (PPIs)

        • Sucralfate

      • References

    • Chapter 34: Acute and Chronic Liver Disease

      • Chronic Liver Failure

        • Causes of Cirrhosis

        • Metabolic/Hematologic Derangements in Cirrhosis

      • Spontaneous Bacterial Peritonitis

      • Hepatic Encephalopathy

        • Grades of Hepatic Encephalopathy

      • Hepatorenal Syndrome

        • Hepatorenal Syndrome: Diagnostic Criteria

        • Diagnostic Approach

        • Treatment of HRS

          • Combination Therapy for HRS

      • Hepato-adrenal Syndrome

      • Pulmonary Consequences of Portal Hypertension

      • Infection and Cirrhosis

        • Supportive Care of the Hospitalized Cirrhotic

      • The Coagulopathy of Chronic Liver Disease

      • Portal Vein Thrombosis

      • Acute-on-chronic Liver Failure

      • Alcoholic Hepatitis

        • Differential Diagnosis [72]

        • Management

      • Fulminant Hepatic Failure

        • Causes of Fulminant Hepatic Failure

        • Workup of Patients Presenting with FHF

        • Cerebral Edema in FHF

        • Management of Increased ICP

        • Supportive Measures

        • Indications for Liver Transplantation

        • Kings Criteria

      • References

    • Chapter 35: GI Bleeding

      • Initial Assessment

      • Initial Resuscitation

      • Triage of Patients. Who to Admit to the ICU?

      • Upper GI Bleeding

        • The Major Causes of UGIB Include

      • Further Management of Upper GI Bleeding (See Fig. 35.1)

      • Further Management of Bleeding Peptic Ulcers

        • Recurrent Hemorrhage

      • Further Management of Esophageal Varices

      • Management of Patients with Lower GI Bleeding

      • References

    • Chapter 36: Pancreatitis

      • Diagnosis

      • Risk Stratification

      • Complications

      • Management

      • References

    • Chapter 37: Diarrhea & Constipation

      • Diarrhea

      • Infectious Diarrhea

      • “Non-Infectious” Diarrhea

        • Antibiotic Associated Diarrhea (AAD)

        • Enteral Feeding-Associated Diarrhoea

        • Management of “Non-Infectious” Diarrhoea

      • The Use of Probiotics and Prebiotics

      • Constipation

      • References

  • Part V: Miscellaneous

    • Chapter 38: Transfusion of Blood and Blood Products

      • Red Blood Cell Transfusions

        • Why Transfuse?

      • Risks Associated with Blood Transfusion (See Fig. 38.1)

        • Risks Associated with Blood Transfusion

        • Transfusion-Associated Immunomodulation

        • “Age” of Transfused Red Blood Cells

          • RBC Storage Lesion [25]

          • Increased Risk of Postoperative and Nosocomial Infections

          • Febrile Non-hemolytic Transfusion Reactions (FNHTR)

          • Transfusion Related Acute Lung Injury (TRALI)

          • Transfusion Associated Circulatory Overload (TACO)

          • Transfusion-Associated Thrombosis

          • Decreased Survival and Tumor Recurrence Following Surgery

        • Tolerance to Anemia

        • Weighing the Risks and Benefits of Blood Transfusion

        • So, When Should Patients’ Be Transfused?

      • Coagulation Disorders in the ICU

      • Fresh Frozen Plasma

        • FFP Prior to Invasive Bedside Procedures or Surgery

          • Coagulopathy and Central Venous Catheterization

          • Thoracentesis and Chest Tube Placement

        • Paracentesis

        • Management of Non-therapeutic INRs With or Without Bleeding (Due to Coumadin Therapy)

      • Platelet Transfusion

      • Heparin Associated Thrombocytopenia

      • Thrombotic Thrombocytopenic Purpura (TTP)

      • Cryprecipitate

      • References

    • Chapter 39: Adrenal Insufficiency

      • Causes of Adrenal Insufficient/Circi

      • Clinical Features of Adrenal Insufficiency/Circi

      • Diagnosis of Adrenal Insufficiency/Circi

      • Factors Affecting the Response to Corticosteroid Treatment

        • The Immune Status of the Host

        • Timing of Corticosteroids

        • Dose and Dosing Strategy

        • Acute Rebound After Discontinuation of Corticosteroids

        • Genetic Polymorphisms

        • Abnormalities of the Glucocorticoid Receptor

      • Treatment of Adrenal Insufficiency/CIRCI

        • Who to Treat with Steroids?

        • Adverse Effects of Corticosteroids

      • References

    • Chapter 40: Electrolyte Disturbances

      • Sodium and Water

        • Rules of the Game

      • Hyponatremia

      • Hypernatremia

      • Hypokalemia

      • Hyperkalemia

      • Hypophosphatemia

        • Management

      • Hypomagnesemia

        • Management of Hypomagnesemia

      • Disorders of Calcium Homeostasis

      • Hypocalcemia

        • Should Hypocalcemia Be Corrected in Critically Ill Patients?

        • Treatment

      • Hypercalcemia

        • Treatment

        • Second Line

        • Additional Therapies

      • References

    • Chapter 41: Acute Kidney Injury

      • Pre-Renal Azotemia

      • Contrast Agents and the Kidney

      • Prevention of Contrast Induced AKI

      • “Common” Nephrotoxic Agents

      • Management of Established Acute Renal Failure

      • When to Initiate Renal Replacement Therapy (RRT)

        • Mode of Renal Replacement Therapy

        • Advantages of CRRT Therapy Include

        • Dosing of RRT

        • Summary of Recommendations for RRT in Patients with AKI [35]

      • Rhabdomyolysis

        • Epidemiology

        • Etiology

          • Physical Causes

          • Non Physical Causes

        • Pathophysiology

        • Mechanisms of Acute Renal Failure in Rhabdomyolysis Patients

        • Clinical Manifestations

        • Laboratory Findings

        • Management

        • Dialysis

      • References

    • Chapter 42: Acute Ischemic Stroke

      • Stroke ICU’s, Medical ICU’s or Stroke Units

      • Profiles Predictive of Futility After Devastating Stroke [15]

      • Acute Ischemic Stroke (AIS)

        • Imaging

        • Thrombolytic Therapy

        • Treatment of Acute Ischemic Stroke With Intravenous rtPA [16]

      • Endovascular Interventions

        • Antiplatelet Therapy and Anti-Coagulation

        • Anticoagulation in Cardio-Embolic Stroke

        • Raised ICP and Decompressive Surgery

        • Treatment of Hyperglycemia

        • Treatment of Fever

        • Treatment of Post Stroke Hypertension

        • Supportive Medical Therapy

      • References

    • Chapter 43: Intracerebral and Subarachnoid Hemorrhage

      • Intracerebral Hemorrhage

        • Medical Management

        • Blood Pressure Control

        • Surgical Interventions

      • Subarachnoid Hemorrhage

        • Diagnosis and Evaluation

        • Initial Management

      • Specific Therapeutic Issues

        • Antifibrinolytic Therapy

        • Surgical and Endovascular Methods of Treatment

        • Management of Cerebral Vasospasm

          • TCD Monitoring

        • Transpulmonary Thermodilution (TPTD) Hemodynamic Assessment

      • Subdural Hematoma

      • Epidural Hematoma

      • Increased Intracranial Pressure (ICP)

        • Measurement of ICP

        • Indications for ICP Monitoring

        • Management of Raised ICP

          • Hyperventilation

          • Volume Resuscitation

          • Hyperosmotic Agents

          • Other Interventions

          • Prophylactic Hypothermia

          • Mechanical Ventilation

      • References

    • Chapter 44: Seizures & Status Epilepticus

      • Seizures in the ICU

        • Seizures Occurring as a Complication of Critical Illness

        • Seizures from Primary Neurological Disease

        • Management

        • Seizure Therapy

      • Status Epilepticus

        • Etiology

        • Common Causes of Status Epilepticus Include

        • Pathophysiology

        • Complications of Generalized Status Epilepticus

        • Diagnosis

        • Treatment

        • General Measures

        • Pharmacotherapy

        • Management of Refractory Status Epilepticus

        • The Management of Nonconvulsive Status Epilepticus

        • Prevention of Seizure Recurrence Once Status Epilepticus is Terminated

      • References

    • Chapter 45: Toxicology

      • General Measures

        • Technique for Performing Gastric Lavage

        • Activated Charcoal

        • Hemodialysis/Hemoperfusion

        • Common Agents Responsible for

      • Common Intoxications

        • Acetaminophen

          • Signs and Symptoms

          • Management

        • Salicylates

          • Signs and Symptoms

          • Management

        • Tricyclic Antidepressants

          • Signs and Symptoms

          • Management

        • Acute Ethanol Intoxication

      • Ethylene Glycol and Methanol Poisoning

        • Ethylene Glycol

        • Methanol

          • Management

        • Isopropyl Alcohol

          • Signs and Symptoms

          • Management

        • Digitalis

          • Signs and Symptoms

          • Management

        • Phenytoin

          • Signs and Symptoms

          • Management

        • Lithium

          • Signs and symptoms

          • Predisposing Factors to Lithium Toxicity

          • Management

        • Opiates

          • Signs and Symptoms

          • Management

        • Cocaine

          • Complications Associated with the Use of Cocaine

          • The Management of Cocaine Toxicity

      • Carbon Monoxide Poisoning

      • References

    • Chapter 46: Alcohol Withdrawal Syndrome

      • The Clinical Institute Withdrawal Assessment Scale for Alcohol (CIWA-Ar)

      • Differential Diagnosis

      • Treatment

        • Other Treatment Considerations

        • Prevention of Post-operative DT’s

      • References

    • Chapter 47: Pregnancy Related Disorders

      • Obstetrical Hemorrhage

        • Antepartum Hemorrhage

        • Postpartum Hemorrhage

        • Management

      • Hypertension

      • Pre-eclampsia

        • Diagnosis of Pre-eclampsia

          • Symptoms

          • Signs

          • Central Nervous System

          • Hepatic

          • HELLP Syndrome

          • Coagulation System

          • Other

          • Fetal

        • HELLP Syndrome

        • Posterior Reversible Encephalopathy Syndrome (PRES)

      • Treatment of Pre-eclampsia

        • Anti-hypertensive Agents for the Treatment of Pre-eclampsia

        • Corticosteroids and Plasmapheresis as Adjunctive Treatment of HELLP

      • Acute Fatty Liver of Pregnancy

      • Amniotic Fluid Embolus Syndrome

      • Sepsis in Pregnancy

      • Respiratory Failure in Pregnancy

      • References

    • Chapter 48: The Geriatric ICU Patient

      • The Physiology of Aging

      • Cardiovascular Changes

      • Changes in Respiratory Function

      • Changes in Renal Function

      • Immune System Changes

      • Body Composition and Muscle Mass

        • The Outcome of Elderly Patients Admitted to the ICU

      • Trauma and the Elderly Patient

      • Surgery and the Elderly

        • Delirium in the Elderly

        • Drug Dosing and Polypharmacy in the Elderly

      • American Geriatric Society Beers Criteria

        • Drugs to Avoid in the Elderly

      • References

    • Chapter 49: Obesity in the ICU

      • Effect of Obesity on Critical Care Outcomes

      • Respiratory Effects of Obesity

      • Ideal Body Weight

      • Cardiovascular Effects of Obesity

      • Hepatic and Renal Effects of Obesity

      • Drug Dosing in Obese Patients

      • Nutritional Requirements

      • Gaining Vascular Access

      • Radiological Procedures

      • Malignant Obesity Hypoventilation Syndrome (MOHS)

        • Major Criteria

        • Minor Criteria

        • Treatment of MOHS

      • References

    • Chapter 50: Radiology

      • The Chest Radiograph

        • Position of Tubes and Catheters

        • Lung Parenchyma, Pleura and Mediastinum

      • Plain Abdominal Radiography

      • Computed Tomography (CT)

      • Indium Labeled Leukocye Scans

      • References

    • Chapter 51: End-of-Life Issues

      • Palliative Care

        • “Principles” of Palliative Care [14]

      • References

    • Chapter 52: Words of Wisdom

      • References

  • Index

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