Evidence-Based Critical Care: A Case Study Approach

Preface
Contents
Part I: ER-ICU Shock and Resuscitation
	1: Cardiac Arrest Management
		Case Presentation
		Principles of Management and Standard Approach to Resuscitation
			Chest Compressions
			Ventilation and Oxygenation
			Vasopressors During CPR
			Management of Ventricular Fibrillation/Pulseless Ventricular Tachycardia
				Defibrillation
					Antiarrhythmic Therapy
			Management of Pulseless Electrical Activity
			Quality Assurance
		Evidence Contour
			Airway Management During Cardiac Arrest
			Hemodynamic-Directed Resuscitation
			Bedside Ultrasound During CPR
			Mechanical CPR
			Extracorporeal Cardiopulmonary Resuscitation
		References
	2: Post-cardiac Arrest Management
		Case Presentation
			Overview of Post-cardiac Arrest Syndrome (PCAS)
				Post-cardiac Arrest Brain Injury
				Post-cardiac Arrest Myocardial Dysfunction
				Systemic Ischemia/Reperfusion Response
				Persistent Precipitating Pathology
		Principles of Management
			Hemodynamic Optimization
			Mechanical Ventilator Strategy
			Management of Acute Coronary Syndrome (ACS)
			Hypothermic Targeted Temperature Management (HTTM)
			Glycemic Control
			Seizure Management
			Neuroprognostication
			Organ Donation
		Evidence Contour
			Patient Selection for Emergent Coronary Angiography
			Patient Selection for HTTM
			HTTM Optimization
			Mechanical Support for Refractory Cardiac Arrest or Post-cardiac Arrest Cardiogenic Shock
		References
	3: Undifferentiated Shock
		Case Presentation
		Principles of Management
			Shock Types
		Evidence Contour
			Assessment of Volume Responsiveness
			Bedside Echocardiography
			Summary
		References
	4: Hypovolemic Shock and Massive Transfusion
		Case Presentation
		Principles of Management
			Establish Adequate IV Access
			Consider Physiologic Reserve
			Monitor Volume Responsiveness
			Administer the Appropriate Fluid(s)
			Minimize Crystalloid Administration in Setting of Hemorrhage
			Massive Transfusion Protocol
			Ionized Calcium Repletion
			Track Endpoints of Resuscitation
			Hemostatic Resuscitation
			Allow for Permissive Hypotension During Hemorrhage
			Correct and Reverse Augmenting Factors of Coagulopathy and Shock
			Preserve Formed Clot with Antifibrinolytics
		Evidence Contour
			Point-of-Care Monitoring of the Hemostatic System
			Use and Timing of Vasopressors, Traumatic Brain Injury
		References
	5: Acute Respiratory Failure: Non-invasive Ventilation and High Flow Nasal Cannula
		Case Presentation
		Principles of Management
			Definition
			Indications, Contraindications and Settings
			Predictors of Failure of Non-invasive Ventilation
		Use of High-Flow Nasal Cannula as an Alternative to NIV
			Evidence Contour
			Use in Patients with Pneumonia
			Use in Patients with Asthma Exacerbation
			Use in Patients with ARDS
			Use of NIV in Patients with Altered Mental Status
			Use of NIV for Preoxygenation Prior to Intubation
			Use of NIV to Facilitate Weaning from Invasive Ventilation
			Palliative Care Indications
		References
	6: Diagnosis and Management of Tricyclic Antidepressant Ingestion
		Case Presentation
			Case Conclusion
		Principles of Management
			Diagnosis
			Tricyclic Antidepressant Side Effects
			Gastrointestinal Decontamination
			Plasma Alkalinization
			Management of Hypotension and Vasopressor Support
			Extracorporeal Elimination
			Seizure Management
		Evidence Contour
			Intravenous Lipid Emulsion
			Hypertonic Saline
			Antiarrhythmic Drugs
			Physostigmine
		References
	7: Management of Beta Blocker and Calcium Channel Blocker Toxicity
		Case Presentation
			Case Conclusion
		Principles of Management
			Gastrointestinal Decontamination
			Hemodynamic Support
				Calcium Salts
				Glucagon
				Atropine
				Vasopressors
				High-Dose Insulin Euglycemia Therapy
				Invasive Circulatory Support
		Evidence Contour
			Lipid Emulsion Therapy
			Sodium Bicarbonate
			Methylene Blue
			Extracorporeal Removal Strategies
		References
	8: Management of Sympathomimetic Overdose Including Designer Drugs
		Case Presentation
		Principles of Management
			Gastrointestinal Decontamination
				Activated Charcoal
				Special Considerations in the “Body Packer”
			Management of Agitation
				Benzodiazepines
				Antipsychotics
				Dexmedetomidine
			Seizure Management and Choice of Anticonvulsant
				Benzodiazepines
				Barbiturates
				Levetiracetam
				Phenytoin/Fosphenytoin
			Hypertensive Crisis and Tachycardia
				Calcium Channel Blockers
				Nitrates
				Alpha-Adrenergic Blockers
			Chest Pain and Cardiac Ischemia
			Cardiac Arrhythmias and Conduction Disturbances
		Evidence Contour
			Beta-Adrenergic Blockers
			Hyperthermia
				Benzodiazepines
				External Cooling
				Dantrolene
				Carvedilol
				Atypical Antipsychotics
			Lipid Emulsion
		References
	9: Diagnosis and Management of Ethylene Glycol Ingestion
		Case Presentation
		Principles of Management
			Diagnosis
			Ventilator and Circulatory Support
			Gastric Decontamination/Lavage/Charcoal
			Aldehyde Dehydrogenase (ADH) Blockade
			Hemodialysis
		Evidence Contour
			Ethylene Glycol Treatment Threshold
			Fomepizole Vs. Ethanol
			ADH Inhibition Without Hemodialysis
			Serum and Urine Alkalization
			Cofactor Supplementation
			Other Toxic Alcohols
				Methanol
				Isopropyl Alcohol
		References
	10: Accidental Hypothermia
		Case Presentation
		Principles of Management
			Diagnosis
			Patient Monitoring
			Adjunctive Testing
			Rewarming
			Hypothermia Without a Pulse
			Other Supportive Care
			Disposition
			Pediatric Patients
		Evidence Contour
			Withholding CPR
			Degree of Rewarming in Cardiac Arrest
			Extracorporeal Support When Signs of Life Present
			Selection of Extracorporeal Support
			Transcutaneous Pacing
			Endovascular Rewarming
			Esophageal Heat Transfer Device
			Core Afterdrop
		References
Part II: Cardiac Disease
	11: Management of Cardiogenic Shock
		Case Presentation
		Principles of Management
			Diagnosis
			Early Revascularization
			Vasopressors/Inotropes
			Percutaneous Mechanical Circulatory Support
			Intra-Aortic Balloon Pump
			Impella® 2.5, CP, and 5.0
			TandemHeart®
			Venoarterial Extracorporeal Membrane Oxygenation (v-a ECMO)
			Temporary Surgical Mechanical Circulatory Support
		Evidence Contour
			Multivessel Revascularization
			Vasopressors and Inotropes
			Mechanical Circulatory Support
		References
	12: Management of Acute Heart Failure
		Case Presentation
		Principles of Management
			Diagnosis
			Diuretic Therapy
			Intravenous Vasodilators
			Emergent Mechanical Circulatory Support
		Evidence Contour
			Pulmonary Artery (PA) Catheters
			Inotropic Agents
			Diuretic Dosing—Intermittent Versus Continuous
			Ultrafiltration
			Nesiritide
			Renal-Dose Dopamine
			Sacubitril-Valsartan in AHF
		References
	13: Management of Acute Coronary Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
			Initial Assessment and Early Risk Stratification
			Initial Medical Therapy
			Anti-ischemic Therapy
				Oxygen
				Nitrates
				Morphine
			Beta-Adrenergic Blockers
			Lipid Lowering Therapy
			Anti-thrombotic Therapy
			Antiplatelet Therapy
				Aspirin
				P2Y12 receptor inhibitors
				Glycoprotein IIb/IIIa Inhibitors
			Anticoagulation
			Early Reperfusion and Revascularization
				STEMI
				NSTE-ACS
		Evidence Contour
			Routine Early PCI After Successful Thrombolysis in STEMI
			Culprit Only Vs. Complete Revascularization in STEMI
			Manual Thrombectomy During Primary PCI in STEMI
			Optimal Duration of Dual Antiplatelet Therapy (DAPT)
			Optimal Antiplatelet Regimen in Patients Requiring Long-term Anticoagulation
		References
	14: Management of Cardiac Tamponade
		Case Presentation
		Principles of Management
			Hemodynamic Derangements
			Clinical Findings
			Non-invasive Diagnostic Testing
			Invasive Diagnostic Testing
			Closed Pericardiocentesis
			Surgical Drainage
		Evidence Contour
			Effusive-Constrictive Pericarditis
		References
	15: Hypertensive Crises
		Case Presentation
		Principles of Management
			Diagnosis
			Treatment of Hypertensive Crises
		Pharmacotherapy (Table 15.1)
			Evaluation for Secondary Causes of Hypertension
		Evidence Contour
		References
	16: Atrial Fibrillation and Other Supraventricular Tachycardias
		Case Presentation
		Principles of Management
			Diagnosis
				Triggers for Atrial Fibrillation
			Physiologic Effects
			Treatment Strategies
			Rate Control
			Rhythm Control
			Stroke Prevention
			Other Supraventricular Tachycardias (SVT)
		Evidence Contour
			High Bleeding Risk in Post-operative Cardiac Surgery Patients
			Concurrent Inotropic Support
			Rhythm Control in HFrEF
		References
	17: Ventricular Arrhythmias
		Management of Ventricular Arrhythmias
			Case Presentation
		Principles of Management
			Diagnosis
				Classification of VT
				Monitoring and Testing
			General Measures
			Beta Blockers
			Amiodarone
			Lidocaine
			Digoxin Immune Fab
		Evidence Contour
			Anti-arrhythmic Drug Therapy
			Mechanical Circulatory Support: IABP
			Mechanical Circulatory Support: ECMO
			Radiofrequency Catheter Ablation
			Transcoronary Ethanol Ablation
			Cardiac Sympathetic Denervation
		References
	18: Management of Acute Aortic Syndromes
		Case Presentation
		Principles of Management
			Classification
			Epidemiology and Risk Factors
			Clinical Presentation and Diagnosis
			Treatment
			Type A
			Type B
			Long-Term Follow Up
		Evidence Contour
			Diagnosis and Biomarkers
			Treatment of Isolated Arch Dissection, Ascending IMH or PAH
			Patient Selection for Surgery in Type A Dissection
			Intervention for Uncomplicated Type B Dissection
			Multidisciplinary Care Models
		References
	19: Management of Endocarditis
		Case Presentation
		Principles of Management
			Epidemiology
			Diagnosis
			Antimicrobial Therapy
			Indications for Surgery
			Follow-Up Evaluation
		Evidence Contour
			Timing of Non-emergent Surgery in IE
			Neuroimaging in IE
			Timing of Surgery in IE with Septic Cerebral Embolic Strokes or Hemorrhage
			Valve Repair Versus Valve Replacement
			Cardiac Device Related IE
		References
Part III: Respiratory Disease
	20: Community Acquired Pneumonia
		Case Presentation
		Principles of Management
			Site-of-Care Decisions
			Microbial Etiologies
			Diagnostic Testing
			Antibiotic Treatment
			Parapneumonic Effusions
		Evidence Contour
			Risk of Multidrug Resistant (MDR) Pathogens
			Drugs to Suppress Toxin Production
			Procalcitonin
			Corticosteroids
			Extracorporeal Membrane Oxygenation (ECMO)
		References
	21: Management of Acute Respiratory Distress Syndrome
		Case Presentation
		Principles of Management
			Risk Factors for ARDS and Diagnosis
			Berlin Definition of ARDS
			Lung Protective Ventilation
			High PEEP Strategy
			Prone Ventilation
			Fluid Management
			Supportive Care
		Evidence Contour
			Requirement for Positive Pressure Ventilation
			Subgroups and Subphenotypes
			Noninvasive Ventilation
			Transpulmonary Pressure
			Pressure Limited Mechanical Ventilation
			Neuromuscular Blockade
			High Frequency Oscillatory Ventilation (HFOV)
			Extra Corporeal Membrane Oxygenation (ECMO)
			Corticosteroids
			Inhaled Vasodilators
		References
	22: Acute Exacerbation of COPD
		Case Presentation
		Principles of Management
			Diagnosis and Impact of COPD Exacerbations
			NIPPV
			Bronchodilators
			Glucocorticoids
			Antibiotics
			Smoking Cessation
		Evidence Contour
			Extracorporeal Carbon Dioxide Removal
			AECOPD and Thromboembolic Disease
		References
	23: Management of Status Asthmaticus
		Case Presentation
			Ideal Gas Law
		Principles of Management
			Inhaled Bronchodilators
			Corticosteroids
			Monitoring of Arterial Blood Gases
			Ventilator Strategies
			Permissive Hypercapnia/Hypoventilation
			Monitoring for Hyperinflation
			Recognizing Barotrauma
		Evidence Contour
			Adjuvant Pharmacologic Treatments
			Magnesium
			Intravenous Bronchodilators
			Lactic Acidosis from Beta Agonist
			Heliox
			Noninvasive Positive Pressure Ventilation (NIV)
			Anesthetics
			Bronchoscopy
			Extracorporeal Life Support (ECLS)
			Antibiotics
			Anti-IgE Therapy
		References
	24: Immunocompromised Pneumonia
		Case Presentation
		Principles of Management
			Presentation
			Etiology
			Diagnosis
			Empiric treatment
			Supportive care
		Evidence Contour
			Utility of invasive testing
			Serum indices of infection
			Noninvasive ventilation
		References
	25: Venous Thromboembolism in the Intensive Care Unit
		Case Presentation
		Priniciples of Management
			Epidemiology of VTE in the ICU
			Risk Factors
			Clinical Presentation
			Pulmonary Embolism Severity
			Diagnosis
			Treatment
		Evidence Contour
			Reperfusion Therapy in Patients with Hemodynamically Stable Pulmonary Embolism
			Veno-arterial ECMO for High Risk PE
			IVC Filter Placement
			DOACs: Direct Factor Xa and Thrombin Inhibitors for Acute Intermediate and High Risk PE
			Pulmonary Embolism Response Team (PERT) in the Management of Acute PE
		References
	26: Massive Hemoptysis
		Case Presentation
		Principles of Management
			Epidemiology
			Sources of Hemorrhage
			Diseases Associated with Massive Hemoptysis
			An Approach to Managing Life Threatening Hemoptysis (Algorithm, Fig. 26.4)
			Assessment
		Evidence Contour
			The Role of Bronchoscopy: Rigid Versus Flexible
			Bleeding Localization in the Stable Patient
			Recurrent Bleeding; Repeat Embolization or Surgery?
		References
	27: Sedation and Delirium
		Case Presentation
		Principles of Management
			Monitoring Sedation and Delirium
			Minimizing Sedation
			Risk Factors for Delirium
		Evidence Contour
			Sedative Choice
			Spontaneous Awakening Trials (SATs)
			Sedative-Related Delirium
			Prevention of Delirium
			Antipsychotics
			Delirium and Long-Term Outcomes
		References
	28: Prolonged Mechanical Ventilation
		Case Presentation
		Principles of Management
			Diagnosis
			Assess Expected Survival
			Place Tracheostomy
			Daily tracheostomy collar trials with full ventilator support between trials
			Early Mobility
			Speaking valve trials
			Tracheostomy removal
		Evidence Contour
			Timing of tracheostomy
			Benefit of transfer to LTAC
			Survivorship clinics and symptom burden
		References
	29: Ventilator-Associated Pneumonia
		Case Presentation
		Principles of Management
			Rapid Identification and Empiric Treatment of VAP Is Essential
			Treat Patients with Vap Broadly for Multidrug Resistant Organisms
			Duration of Therapy: 8 or 15 Days
			Rapidly De-escalate Antimicrobial Therapy
			Clinicians Should Remain Vigilant for Other Causes of Fever in the ICU
		Evidence Contour
			Invasive vs. noninvasive sampling strategies
			Effective treatment strategies for MRSA VAP
			Utility of ATS/IDSA recommendations for dual gram-negative coverage
			Evolving surveillance definitions
			Strategies to prevent VAP
		References
	30: Respiratory Failure in a Patient with Idiopathic Pulmonary Fibrosis
		Case Presentation
		Principles of Management
			Incidence, Risk Factors and Prognosis
			Pathologic insult
			Corticosteroids
			Supportive care
			Palliative care
			Ensure the correct diagnosis of IPF as underlying ILD
			Exacerbation during surgical procedures
		Evidence Contour
			Noninvasive ventilation
			High flow nasal cannula (HFNC):
			Ventilator settings
			Anticoagulation
			Cyclophosphamide
			Cyclosporine A
			Other agents
			Restrictive operative fluid balance
			Lung transplantation
			Extracorporeal life support (ECLS)
			Anti-fibrotic medications
		References
	31: Weaning from Mechanical Ventilation
		Case Presentation
		Principles of Management
			Strategies to Minimize the Requirement for Mechanical Ventilation
			Strategies to Reduce the Duration of Mechanical Ventilation
			Evaluation of Patient’s Readiness for Spontaneous Breathing
			Perform a Spontaneous Breathing Trial in Patients Deemed Ready
			Assess Patient’s Ability to Protect the Airway
		Evidence Contour
			Assessing the Need for an Artificial Airway
			Weaning Protocols
			Sample Ventilator Liberation Pathway
			Diaphragmatic Ultrasound as an Index for Discontinuation of Mechanical Ventilation
			Pressure Support Versus T-Tube for Weaning from Mechanical Ventilation
			Tracheostomy for Prolonged Transition
		References
	32: Management of Decompensated Right Ventricular Failure in the Intensive Care Unit
		Case Presentation
		Principles of Management
			Diagnosis
			Monitoring of End-Organ Perfusion
			Optimization of Right-Sided Filling Pressures
			Reversal of Conditions that Heighten Pulmonary Vascular Tone
			Ventilation Strategy
			Assessment for Presence of PFO or Other Shunt
			Supportive Care
		Evidence Contour
			Pulmonary Artery Catheter Use in Decompensated RV Failure
			Choice of Vasopressor
			Selective Use of Inotropic Agents
			Use of Selective Pulmonary Vasodilators
			Ventilatory Considerations in the Face of ARDS
			Extra Corporeal Membrane Oxygenation (ECMO)
		References
	33: Diffuse Alveolar Hemorrhage
		Case Presentation
		Principles of Management
			Differential Diagnosis
			Classification
			Diagnosis
			Treatment
		Evidence Contour
			Supportive Care for Treatment of Hypoxia
			Rituximab
			Recombinant Factor VII
			Tranexamic acid (TXA)
		References
	34: Pleural Disease
		Case Presentation
		Principles of Management
			Epidemiology
			Pleural Fluid Studies
			Imaging Studies
			General Management of Pleural Disease in the Intensive Care Unit
		Evidence Contour
			Pleural Biopsy During Chest Tube Insertion for Parapneumonic Effusion or Epyema
			Type and Size of Pleural Drainage Catheter
			Anticoagulation and Pleural Drainage
			Method of Pleural Drainage
			Timing of Chest Tube Removal
			Size of Pleural Effusion for Safe Access and Drainage
			Multidisciplinary Management of Pleural Disease
			Pleural Effusion Drainage as a Weaning Adjunct
			Complications of Pleural Drainage
		Bibliography
Part IV: Neurologic Disease
	35: Acute Stroke Emergency Management
		Case Presentation
		Principles of Management
			Diagnosis
			tPA Administration
			Endovascular Thrombectomy
			Supportive Care
			Atrial Fibrillation, Heart Failure and Anticoagulation
			Secondary Stroke Prevention in the Acute Stroke Setting
		Evidence Contour
			“Wake-Up” Strokes
			Acute Cerebral Artery Dissection, Antiplatelets Versus Anticoagulation
			Blood Pressure Management in Acute Stroke Patients
			Hemicraniectomy in Patients Older than 60 Years Old with Large Hemispheric Stroke
			Early Rehabilitation in Stroke Patients
			Basilar Artery Thrombosis, Therapy After 4.5 h
			Stenting in Acute Stroke Therapy
			Dual Anti-platelet Therapy, Aspirin Plus Clopidogrel, for Secondary Stroke Prevention
		References
	36: Bacterial Meningitis in the ICU
		Case Presentation
		Principles of Management
			Epidemiology
			Diagnosis
			Antibiotics
			Steroids
			Long Term Neurologic Complications
			Meningococcemia
		Evidence Contour
			ICP Management
			Hypothermia
			Gram-Negative Bacilli Meningitis
			Shunts and Other Intracranial Devices
			Post Exposure Prophylaxis
			Future Directions
		References
	37: Approach to Encephalitis in the ICU
		Introduction
		Case Presentation
		Principles of Management
			Unique Clinical Syndromes
				Limbic Encephalitis
				Rhombencephalitis
				Multifocal Encephalitis
				Diagnosis of Encephalitis
				Differential Diagnosis
			Therapeutic Considerations
				Emergent Management
					Approach to Altered Level of Consciousness
					Reasons for Neuro-ICU Admission
					Appropriate Initial Investigations
					Empiric Therapy
					ICU Management of Complications Associated with Encephalitis
					Cerebral Edema
					Other Common Complications of Encephalitis
		Evidence Contour
			Therapy
			Conclusions
		References
	38: Management of Intracerebral Hemorrhage
		Case Presentation
		Principles of Management
			Clinical Presentation
			Diagnosis
			Acute Management
			Natural History
			Complications
		Evidence Contour
			Hyperosmolar Therapy
			Seizure Prophylaxis
			Hypothermia
			Hypertension Management
		References
	39: Management of Subarachnoid Hemorrhage
		Case Presentation
		Principles of Management
			Incidence and Risk Factors
			Clinical Presentation
			Diagnostics
			Evaluation and Management
			Complications
		Evidence Contour
			Anemia
			Use of MRI in SAH
			Spreading Depolarizations
			SAH and Pregnancy
		References
	40: Status Epilepticus
		Case Presentation
		Principles of Management
			Classification and Risk Factors
			Pathophysiology
			Epidemiology
			Diagnosis and Evaluation
			Emergent Initial Therapy
			Urgent Control Therapy
			Treatment of RSE
			Systemic Complications of SE
		Evidence Contour
			Alternate Therapies
			Special Patient Populations
				Anoxic Brain Injury
				Pregnancy
				Autoimmune SE
		References
	41: Neuroleptic Malignant Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
			Medication History and Temporal Clues
			The Clinical Tetrad of NMS: Clues to Diagnosis and Management Concerns
				Hyperthermia
				Altered Mental Status
				Muscular Rigidity
				Autonomic Dysfunction
		Evidence Contour
			Benzodiazepines
			Dantrolene
			Bromocriptine
			Amantadine
			Electroconvulsive Therapy
		References
	42: Traumatic Brain Injury
		Case Presentation
		Principles of Management
			Primary and Secondary Brain Injury
			Severity of Traumatic Brain Injury
			Blunt Cerebrovascular Injury
			Prehospital and Emergency Department
				Mechanical Ventilation
				Analgesia, Sedation and Neuromuscular Paralysis
			Surgical Treatment
				Epidural Hematoma
				Subdural Hematoma
				Intraparenchymal Hematoma/Traumatic Cerebral Contusion
		Evidence Contour
			Indication of Intracranial Pressure Monitoring and Pressure Threshold
			Post-Traumatic Seizures
			Therapeutic Hypothermia
			Advanced Neuromonitoring
				Brain Tissue Oxygen
				Cerebral Microdialysis
				Jugular Bulb Oximetry
			Prophylactic Antibiotics
			Steroids and Neuroprotective Agents
		References
	43: Management of Anoxic Brain Injury
		Case Presentation
		Principles of Management
			Diagnosis
			Therapeutic Hypothermia
			Maintenance of Normothermia
			Supportive Care
		Evidence Contour
			Therapeutic Hypothermia
			Rewarming and Maintenance of Normothermia
			Supportive Care
			Neurologic Prognostication
		References
	44: Neuromuscular Disease in the ICU
		Case Presentation
		Principles of Management
			Pulmonary Mechanics and the Pathophysiology of Neuromuscular Respiratory Failure
			Clinical Features of Neuromuscular Respiratory Failure
			Interpreting Diagnostic Studies
			Airway and Ventilatory Support and Disposition
			Causes of Neuromuscular Weakness in the ICU
			Guillain-Barre Syndrome
			Myasthenia Gravis
			Intensive Care Unit Acquired Weakness
		Evidence Contour
			Non-invasive Ventilation in Neuromuscular Respiratory Failure
			Intravenous Immunoglobulin Versus Plasma Exchange for Myasthenia Gravis and Guillain-Barre Syndrome
		References
Part V: Renal Disease
	45: Traditional and Novel Tools for Diagnosis of Acute Kidney Injury
		Case Presentation
		Principles of Management
			Serum Creatinine and Urine Output
			Relationship Between Serum Creatinine and Urine Output
			Differentiating Between AKI and CKD
			Clinical Use of Novel Biomarkers
		Evidence Contour
			Determining Baseline Serum Creatinine
			Imaging Techniques for Diagnosis of AKI
			Emerging Role for Novel Biomarkers
		References
	46: Management of Acute Kidney Injury
		Case Presentation
		Principles of Management
			Intravenous Fluids and Vasopressors
			Consider Alternative Etiologies and Specific Treatments for AKI
			Prevention of Further Injury
			Diuretics
			Medical Management of Complications of AKI
			Renal Replacement Therapy
		Evidence Contour
			Choice of Intravenous Fluid Solution
			Nutrition in AKI
			Tight Glycemic Control
			Vasodilators and Growth Factor Interventions
			Early Initiation of Dialysis
		References
	47: Rhabdomyolysis
		Case Presentation
			What Is the Evidence Based Approach to Manage this Patient’s Acute Kidney Injury?
		Principles of Management
			Diagnosis
			Fluid Therapy
			Treating Reversible Causes of Muscle Damage
			Management of Complications
		Evidence Contour
			Bicarbonate therapy
			Diuretics and Mannitol
			Antioxidants and free radical scavengers
			RRT for prevention of acute kidney injury
		References
	48: Hyponatremia
		Case Presentation
		Principles of Management
			Bolus Therapy
			Avoidance of Overcorrection
			Mechanisms Behind the Hyponatremia
			Hypovolemic Hyponatremia
			Hypervolemic Hyponatremia
			Hyponatremia Despite Suppressed ADH
			Syndrome of Inappropriate Antidiuretic Hormone
			Glucocorticoid Deficiency
		Evidence Contour
			Rate of Correction/Risk of Osmotic Demyelination
			Acute Versus Chronic Hyponatremia
			Hyponatremia and Association with Mortality?
		References
	49: Hypernatremia
		Case Presentation
		Principles of Management
			Risk Stratification
			Evaluation
			Correcting Serum Sodium
			Adverse Sequelae
		Evidence Contour
			Diagnostics
			Novel Treatments
			Outcomes
		References
	50: Hyperkalemia
		Case Presentation
		Principles of Management
			Clinical Manifestations
			Mechanisms of Hyperkalemia
				Pseudohyperkalemia
				Redistribution and Cellular Release
				Impaired Renal Excretion
				Medications
			Treatment
		Evidence Contour
		References
Part VI: Endocrine Disease
	51: Management of Severe Hyponatremia and SIADH
		Case Presentation
		Principles of Management
			Risk Stratification
			Evaluation
			Correcting Serum Sodium
			Monitoring Correction Rate
			Osmotic Demyelination Syndrome (ODS)
		Evidence Contour
			Diagnostics
			Novel Treatments
			Osmotic Demyelination Syndrome
				Outcomes
				Prevention
		References
	52: Diabetic Ketoacidosis
		Case Presentation
		Principles of Management
			Pathogenesis
			Diagnosis
			Fluid Replacement
			Insulin
			Electrolyte Repletion
			Treatment of Precipitating Condition
			Complications
		Evidence Contour
			Bicarbonate Infusion
			Site of Care
		Route of Insulin Administration
			Euglycemic DKA
			DKA and Renal Failure
		References
	53: Thyroid Storm
		Case Presentation
		Principles of Management
			Incidence
			Etiology
			Presentation
			Diagnosis
			Treatment
				Beta-Blockers
				Thionamides
				Iodine Containing Solutions
				Glucocorticoids
				Surgery
				Diagnostic Clinical Tools
		Evidence Contour
			Iodinated Radiocontrast Agents
			Extracorporeal Plasmapheresis
			l-Carnitine
			Cholestyramine
		References
	54: Adrenal Insufficiency
		Case Presentation
		Principles of Management
			Presentation of Adrenal Insufficiency
			Adrenal Insufficiency
			Diagnosis
			Interpretation of Test Results in Critically Ill Patients
			Measurement of Serum Cortisol
			ACTH Stimulation Test
			Interpretation of Results
			Determining the Etiology
			Treatment
		Evidence Contour
			ACTH Stimulation Test: Low Dose Versus High Dose
			Role of Etomidate and Opiates in Development of Adrenal Insufficiency
		References
	55: Critical Illness Related Corticosteroid Insufficiency (CIRCI)
		Case Presentation
		Principles of Management
			Diagnosis
			Additional Testing
			Treatment
		Evidence Contour
			Sepsis
			Severe Community Acquired Pneumonia (CAP)
			Cardiac Arrest
			Cardiopulmonary Bypass Surgery
			Role of Etomidate and Opiates in Development of Adrenal Insufficiency
		References
	56: Management of Hyperglycemic Hyperosmolar Syndrome
		Case Presentation
		Principles of Management
			Diagnosis of HHS
			Common Hyperosmolar Hyperglycemic State Triggers
			Fluid Therapy
			Insulin Therapy
			Correcting Electrolytes
				Sodium
				Potassium
				Magnesium
				Phosphate
		Evidence Contour
			Type of IV Fluid
			Venous Thromboembolism Prophylaxis
		References
	57: Management of Myxedema Coma
		Case Presentation
		Principles of Management
			Diagnosis
			Thyroxine Replacement
			Corticosteroid Replacement
			Supportive Care
		Evidence Contour
		References
Part VII: Infectious Disease
	58: Zika Virus and Guillain–Barré Syndrome
		Case Presentation
		Principles of Management
			Guillain–Barré Syndrome
			Diagnosis of GBS
			Treatment and Supportive Care in GBS
		Evidence Contour
			Outcome of Guillain–Barré Syndrome
			Other Neurologic Complications
			Controlling the Spread of Zika Virus
		References
	59: Urosepsis
		Case Presentation
		Principles of Management
			Diagnosis
			Empiric Antimicrobial Administration
			Procedures/Surgery
		Evidence Contour
			Empiric Antibiotic Choice
			Indications for Imaging
			Intervention Method
		References
	60: Management of Sepsis and Septic Shock
		Case Presentation
		Principles of Management
			Definition and Recognition
			New Definitions and Constructs
			Surviving Sepsis Campaign Sepsis Bundle
			Surviving Sepsis Campaign Bundle [1]
			Fluid Management
			Hemodynamic Response
			Tissue Perfusion
			Vasopressors
			Treatment of Infection and Antimicrobial Stewardship
			Ventilator Management
			Glycemic Control and Nutrition
		Evidence Contour
			Early Goal Directed Therapy (EGDT)
			Corticosteroids
			SIRS Criteria in Sepsis
			Blood Pressure Target in Septic Shock
			Fluid Resuscitation in Septic Shock
			Bicarbonate Infusion in Lactic Acidosis
			Heart Rate Control in Septic Shock
			Vitamin C in Septic Shock
			Sequella After Surviving Severe Sepsis/Septic Shock
		References
	61: Invasive Aspergillus
		Case Presentation
		Principles of Management
			Diagnostic Approach
			Risk Factors for Invasive Aspergillosis
				Classic Risk Factors
				Newer Risk Factors
			Therapy
			Antifungal Therapy
			Monotherapy
				Triazoles
				Polyenes
				Echinocandins
					Combination Therapy
					Antifungal Resistance
		Evidence Contour
		References
	62: Management of Strongyloides Hyperinfection Syndrome
		Case Presentation
		Principles of Management
			Epidemiology
			Life Cycle
			Disseminated Infection and Hyperinfection
				Diagnosis
				Anti-Parasitics
			Supportive Care and Follow Up
		Evidence Contour
			Severe Infections
			Hyperinfection Associated with Paralytic Ileus
		References
	63: Treatment of Viral Hemorrhagic Fever in a Well-Resourced Environment
		Case Presentation
		Principles of Management
			Isolation and Infection Control
			Active Screening
			Isolation Unit
			Protective Equipment
			Protocols and Policies
				Specimen Collection and Handling
				Decontamination
				Waste Management
			Provisions of Clinical Care
				Team Structure
				Monitoring
				Bedside Assessments
			Diagnostic Testing
				Blood Analysis
				Imaging
				Invasive Procedures
			Central Venous Catheter(CVC) Placement
			Endotracheal Intubation
			Emergency Response Teams
			Diagnostic Evaluation
			Supportive Therapy
		Evidence Contour
			Prevention
			Targeted Therapy
			Staffing Model
			Provisions of Care
		References
	64: Management of Severe Malaria
		Case Presentation
		Principles of Management
			Definition of Severe Malaria
			Diagnosis
			Clinical Management
				General Principles
			Antimalarial Therapy (See Treatment Table  64.4)
			Monitoring Parasite Density
			Respiratory System
			Neurologic Involvement
			Seizure Management
			Anemia and Coagulopathy
			Blood Products
			Hypoglycemia
			Volume Management
			Nutrition
			Fever
			Bacterial Infection
		Evidence Contour
			Other Diagnostic Modalities
			Quantitative Buffy Coat
			Antigen Rapid Detection Test (RDT)
			Serology
			Molecular Methods
			Exchange Transfusion
		References
	65: Dengue
		Case Presentation
		Principles of Management
			Classification of Dengue (WHO)
			Phases of Illness and Diagnosis
			Supportive Treatment
		Evidence Contour
			Volume Replacement
			Other Aspects of Care
		References
	66: Leptospirosis
		Case Presentation
		Principles of Management
			Epidemiology
			Microbiology
			Clinical Presentation
			Laboratory Testing
			Differential Diagnosis
			Antibiotic Administration
			Outpatients with Mild Disease
			Hospitalized Adults with Severe Disease
		Evidence Contour
			Diagnostic Tools
				Reference Standard
				Serology
				Molecular Tests
				Culture
				Drug Resistance
			Role of Corticosteroids
			Prevention
		References
Part VIII: Gastrointestinal Disease
	67: Management of Acute Upper Gastrointestinal Hemorrhage
		Case Presentation
		Principles of Management
			Fluid Resuscitation and Triage
			Blood Transfusion
			Proton Pump Inhibitors
			Risk Stratification
		Evidence Contour
			Nasogastric Lavage
			Platelet Transfusion
			Intubation for Upper Endoscopy
			Timing of Upper Endoscopy
		References
	68: Variceal Hemorrhage
		Case Presentation
		Principles of Management
			Initial Resuscitation
			Vasoactive Medications
			Hemostasis Interventions
			Transjugular Intrahepatic Portosystemic Shunt
			Antibiotic Prophylaxis
		Evidence Contour
			Red Blood Cell Transfusion
			Correction of Coagulopathy
			Endotracheal Intubation
			Acid Suppression
			Balloon Tamponade
			Esophageal Stent
			Transjugular Intrahepatic Portosystemic Shunt
			Balloon-Occluded Retrograde Transvenous Obliteration
			Surgery
		References
	69: Acute Pancreatitis
		Case Presentation
		Principles of Management
			Disease Burden, Diagnosis, and Assessment of Severity
			Intravenous Fluids
			Antibiotics
			Pain Control
			Etiology
		Evidence Contour
			Early Nutritional Support
		References
	70: Management of Acute Liver Failure
		Case Presentation
		Principles of Management
			Etiology of ALF
			Correction of Coagulopathy
			Hemodynamic Support
			Renal Insufficiency
			Infection
			Neurologic Complications
		Evidence Contour
			Recombinant Factor VIIa to Correct Coagulopathy
			Serial NH3 Levels in ALF Patients
			Targeted Temperature Management
			Bioartificial Hepatic Support Systems
			Criteria for Liver Transplantation
		References
	71: Acute Lower Gastrointestinal Bleeding
		Case Presentation
		Principles of Management
			Definitions
			Initial Evaluation
			Initial Resuscitation and Management
			Appropriate Patient Disposition
			Nasogastric Tube Lavage
			Urgent Colonoscopy
			Mesenteric Angiography
			Surgery
		Evidence Contour
			Predicting Severity and Outcomes of LGIB
				Blood Transfusion Goals
			Massive Transfusions
			Diagnostic Imaging Modalities
			Provocation Testing
		References
	72: Diagnosis and Management of Clostridium difficile Infection (CDI)
		Case Presentation
		Principles of Management
			Symptoms of C. difficile Infection
			Diagnosis
			Risk Factors
			Severity of Disease
			Medical Therapies
			Surgical Intervention
			Epidemiology and Infection Control
		Evidence Contour
			Fecal Microbiota Transplant (FMT)
			Capsulized Frozen Fecal Microbiota
			Probiotics
			Monoclonal Antibodies and Vaccines
			Nontoxogenic C. Difficile (NTCD) Spores
			Investigational Antibiotics
		References
	73: Principles of Nutrition in the Critically Ill Patient
		Case Presentation
		Principles of Management
			If the Gut Works, Use It
			Timing
			Determining Gastrointestinal Tolerance: Do Not Withhold EN for Increased Gastric Residuals or Decreased Bowel Sounds
			Full Feedings Are Preferred; Trophic Feedings Are Acceptable
			Obese Patients Should be Treated like Normal or Underweight Patients
			Immunologic Benefits of Enteric Feeding
		Evidence Contour
			The Importance of Autophagy
			The Protein Predicament
			The CALORIES Trial Did Not Reliably Support PN Due to Study Design
			Actual Caloric Goals Remain an Area of Ongoing Research
			Actual Micronutrient Goals Are Not Clear
			No Recommendations Can be Made for or Against Specific Lipid Choices in Tube Feeds
		References
	74: Spontaneous Bacterial Peritonitis
		Case Presentation
		Principles of Management
			Diagnosis
			Pathogenesis & Microbiologic Etiology
			Treatment
			Antibiotics
			Albumin
			Clinical Diagnosis of Hepatorenal Syndrome
			Discontinue Nonselective Beta Blockers (NSBB)
			Prophylaxis
				Antibiotic Prophylaxis
		Evidence Contour
			Duration of Therapy
			Investigational Diagnostic Tests & Predictors of SBP Infection
			Choice of Antibiotics
			Patient with Non-neutrocytic Bacterascites
		References
	75: The ICU Management of Alcoholic Liver Disease
		Case Presentation
		Principles of Management
			Classification of Alcoholic Liver Disease
			Prognosis in AH
			Standard ICU Management of Alcohol Use Disorders, Including Alcohol Withdrawal Syndrome (AWS) and Delirium Tremens (DTs)
			Nutritional and Micronutrient Supplementation
		Evidence Contour
			Upper GI Bleeding in Patients with Alcoholic Liver Disease
			Medical Management of Acute Alcoholic Hepatitis
			Management of Hepatorenal Syndrome
		References
Part IX: Hematologic Disease
	76: Diagnosis and Management of Thrombotic Thrombocytopenic Purpura
		Case Presentation
		Principles of Management
			Diagnosis of Thrombotic Thrombocytopenic Purpura
			ADAMTS13 Activity Level and Autoantibody Testing
			The ‘PLASMIC Score’ for Rapid Assessment
			Therapeutic Plasma Exchange
			Fresh Frozen Plasma (FFP)
			Immunosuppressive Agents
			Discontinuation and/or Treatment of the Offending Agent/Condition
			Venous Thromboembolism Prophylaxis
		Evidence Contour
			Prevention of Relapses with Other Immunosuppressive Agents
			Anti-Platelet Agents
			Duration and Intensity of TPE
			Amount of FFP
			Caplacizumab
		References
	77: Acute Leukemia Presentation with DIC
		Case Presentation
		Principles of Management
			Confirm the Diagnosis of AML
			Differential Diagnosis of DIC
			Laboratory Profile of DIC
			Treat the Underlying Disease
			Supportive Care/Blood Product Transfusion for DIC
		Evidence Contour
			Heparin
			Anti-Thrombin III
			Recombinant Factor VIIa
		References
	78: Disseminated Intravascular Coagulation
		Case Presentation
		Principles of Management
			Diagnosis
			Treatment of the Underlying Disorder
			Management of Acute Coagulopathy in Hemorrhaging Patients
			Thrombotic Predominant DIC and Purpura Fulminans
			Outcomes
		Evidence Contour
			Heparin Therapy
			Thrombomodulin-α
			Antithrombin III (ATIII)
			Combination ATIII and Thrombomodulin-α
			Conclusion
		References
	79: Hemophagocytic Lymphohistiocytosis and Other Culture Negative Sepsis-Like Syndromes in the ICU
		Case Presentation
		Principles of Management
			HLH Presentation and Diagnosis
				Presentation
				Diagnosis
			HLH Treatment
				Treatment
			HLH Outcomes
				Outcomes
		Evidence Contour
			Outcomes and Prognosis
			Diagnosis and Biomarker Testing
			Treatment
			Other Inflammatory Syndromes in the ICU
			Macrophage Activation Syndrome (MAS)
				Presentation
				Diagnosis
				Treatment
			Cytokine Release Syndrome
				Presentation
				Diagnosis
			Idiopathic Pneumonia Syndrome
				Presentation
				Diagnosis
				Treatment
			Conclusion
		References
	80: ICU Complications of Hematopoietic Stem Cell Transplant, Including Graft vs Host Disease
		Case Presentation
		Principles of Management
			Early Complications of Hematopoietic Stem Cell Transplant
			Neutropenic Fever and Neutropenic Sepsis
			Respiratory Failure
			Neurologic Complications
			Acute Kidney Injury
			Hepatic Veno-Occlusive Disease
			Acute Graft-Versus-Host Disease
			Chronic Graft vs Host Disease
				Pulmonary Chronic GVHD
		Evidence Contour
			Biology of Neutropenic Sepsis and Respiratory Failure
			Resistant and Multi-Drug Resistant Organisms
			Thrombotic Microangiopathy
			Cytokine Release Syndrome and Emerging Toxicities of Transplant
			Organization of Critical Care: Need for Specialty Hematopoietic Stem Cell Transplant ICUs?
		References
	81: Tumor Lysis Syndrome
		Case Presentation
		Principles of Management
			There Are Laboratory and Clinical Classifications of Tumor Lysis Syndrome (TLS)
			Risk Stratification for Development of Clinical TLS Is Complex, but Useful
			Treatment Prephase with Low Intensity Chemotherapy May Prevent TLS in High-Risk Patients
			Hydration Is Essential to Prevention and Treatment of TLS
			Hypouricemic Agents Are Essential to the Prevention and Treatment of TLS
			Close Monitoring Is Essential in TLS
			Prevention of Cardiac Arrhythmias
			Hyperkalemia
			Hypocalcemia
			Acute Renal Failure Requiring Renal Replacement Therapy May Develop despite Best Practice
		Evidence Contour
			Use of IV Diuretics in Addition to IV Hydration Has Conflicting Clinical Outcomes
			There Is Unclear Utility of Phosphate Binders in TLS with AKI
			Choice of Renal Replacement Therapy Has Variable Outcomes
			Tumor Lysis Syndrome in the Era of Novel Cancer Treatments
		References
	82: Management of Hyperviscosity Syndromes
		Case Presentation
		Principles of Management
			Pathophysiology
			Diagnosis
			Management
		Evidence Contour
			How to Measure Viscosity
			Lack of Procedural Standardization
			Efficacy of Leukapheresis in AML
		References
	83: Thrombocytopenia in the Intensive Care Unit
		Case Presentation
		Principles of Management
			Platelet Structure and Function
			Epidemiology
			Implications
			Differential Diagnosis and Evaluation
			Step 1: Confirm True Thrombocytopenia
				Pseudothrombocytopenia
			Step 2: Is the Patient Bleeding?
			Step 3: Consider a Thrombotic Microangiopathy
				TTP
				Disseminated Intravascular Coagulation
			Step 4: Careful Medication Review
				Heparin-Induced Thrombocytopenia
			Step 5: Evaluation for Sepsis
			Step 6: Consider Hemodilution
			Step 7: Evaluate Support Devices
		Evidence Contour
			Indications for Prophylactic Platelet Transfusion
			Platelet Thresholds for Invasive Procedures
		References
	84: Coagulopathy in the Intensive Care Unit
		Case Presentation
		Principles of Management
			Rotational Thromboelastometry
			ROTEM Parameters
			Normal Clot Physiology
			ROTEM Assay Interpretation and Qualitative Produce Replacement
			Transfusion Based on Standard Laboratory Testing
		Evidence Contour
			Transfusion Based on Viscoelastic Hemostatic Assays
			Conclusion
		References
Part X: Surgical
	85: Thoracic Trauma
		Case Presentation
		Principles of Management
			Pneumothorax
			Hemothorax
			Rib Fractures
			Lung Contusion
			Blunt Thoracic Aortic Injury
		Evidence Contour
			Pneumothorax
			Hemothorax
			Rib Fractures
			Lung Contusion
			BTAI
		References
	86: Blunt Abdominal Trauma
		Case Presentation
		Principles of Management
			Unstable Versus Stable Blunt Abdominal Trauma
			Balanced Resuscitation
			Imaging and Diagnosis
			Nonoperative Management (NOM) of Blunt Solid Organ Injury
			Angioembolization for Blunt Solid Organ Injury
			Post-splenectomy Vaccinations
		Evidence Contour
			Who Should Be Managed Nonoperatively?
			How Should Nonoperative Management Be Accomplished?
			Is Follow-Up Imaging Necessary?
			When Should We Initiate Venous Thromboembolism (VTE) Prophylaxis in Solid Organ Injury Patients?
		References
	87: Abdominal Sepsis and Complicated Intraabdominal Infections
		Case Presentation
		Principles of Management
			Diagnosis
			Resuscitation
			Source Control
			Anti-Infective Therapy
		Evidence Contour
			Management of the Open Abdomen
			Intra-Abdominal Fungal Infections
		References
	88: Intestinal Obstruction: Small and Large Bowel
		Case Presentation
		Principles of Management
		Evidence Contour
			Timing of Operating for SBO
			Management Differences Between Small and Large Bowel Obstruction
			Management of Acute Small Bowel Obstruction in a Patient with No Prior Abdominal Surgery or Pathology
			CT Imaging Findings Indicative of a Need for Exploration
		References
	89: Management of Acute Compartment Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
			Abdomen
			Extremity
			Management
			Abdomen
			Extremity
			Wound Management
			Abdomen
			Extremity
		Evidence Contour
			Abdomen
				Abdominal Perfusion Pressure
				Fluid Management
				Percutaneous Drainage
			Extremity
				Infrared Spectroscopy
				Dermotraction
		References
	90: Extracorporeal Membrane Oxygenation (ECMO) and Extracorporeal CO2 Removal (ECCO2R)
		Case Presentation
		Principles of Management
			ECMO Indications
			ECMO Contraindications
			Initial ECMO Management
			Weaning off of ECMO
			Post-ECMO Considerations
			Extracorporeal CO2 Removal (ECCO2R)
		Evidence Contour
			ECMO
			Prolonged ECMO
			ECMO Trial Data
			ECMO Outcome Prediction
		References
	91: Management of Acute Thermal Injury
		Case Presentation
		Principles of Management
			Diagnosis
			Risk of Pneumonia
			Wound Care
			Surgical Intervention
			Fluid Management
			Transfusion Targets
			Supportive Care
		Evidence Contour
			Fluid Resuscitation Monitoring
			Scar Management
			Conclusion
		References
	92: Acute Arterial Ischemia
		Case Presentation
		Principles of Management
			Initial Evaluation
			Diagnostic Imaging
			Intervention and Post-Operative Management
		Evidence Contour
			Controversial Aspects of Management/Imaging
			Endovascular Treatment Approach to Lower Extremity Vascular Trauma
		References
	93: Management of Necrotizing Soft Tissue Infection
		Case Presentation
		Principles of Management
			Rapid Diagnosis
			Empiric Broad Spectrum Antibiotic Therapy and Resuscitation
			Surgical Source Control
		Evidence Contour
			Predicting NSTI Diagnosis and Outcome
			Early Amputation
			Adjunctive Therapies
				IVIG Immunomodulatory Therapy
				Hyperbaric Oxygen
				New Treatment Strategies
		References
	94: Biliary Infections
		Case Presentation
		Priniciples of Management
			Diagnosis
			Severity Assessment
			Medical Management
			Surgical and/or Interventional Management
		Evidence Contour
			Diagnostic Studies
			Duration of Antibiotics
			Type and Timing of Intervention
		References
	95: Hemorrhagic Shock
		Case Presentation
		Principles of Management
			Diagnosis of Hemorrhagic Shock
			Resuscitation
				Vascular Access
				Massive Transfusion
				Crystalloid
				Vasopressors
			Laboratory Results
				Hematology Labs
				Chemistries
				Endpoints of Resuscitation
			Hemostatic Adjuncts
				TXA
			Early Hemorrhage Control
				Surgical Hemostasis
				Angiographic Hemostasis
		Evidence Contour
			REBOA
			Whole Blood
			Other Hemostatic Adjuncts
			Viscoelastic Testing
			Summary
		References
	96: Management of the Open Abdomen Patient
		Case Presentation
		Principles of Management
			Etiologies
			Second Look Laparotomy
			Temporary Management of Hemorrhage
			Abdominal Compartment Syndrome
		Evidence Contour
			Temporary Abdominal Closure
			Timing of Re-Exploration/Abdominal Closure
			Hypothermia
			Volume Status
			Fluid Loss/Nutrition
			Mechanical Ventilation
			Adhesions/Frozen Abdomen
			Antibiotic Use
			Conclusion
		References
Part XI: Critical Care in Obstetrics
	97: Peripartum Cardiomyopathy
		Case Presentation
		Principles of Management
			Pathophysiology
			Presentation and Diagnosis
			Treatment of Peripartum Cardiomyopathy
				Acute Management
					Mechanical Support
					Delivery
				Chronic Management
					Systemic Anticoagulation
					Device Therapy
			Prognosis in Peripartum Cardiomyopathy
				Risk Factors for Poor Recovery
					Low EF at Baseline
					Hypotension and Tachycardia
					Race and Left Ventricular End-Diastolic Dimension
				Long-Term Medical Management after LV Recovery
				Subsequent Pregnancies
		Evidence Contour
		References
	98: Management of Amniotic Fluid Embolism
		Case Presentation
		Principles of Management
			Pathophysiology
			Diagnosis
			Management
			Initial Assessment
			Oxygenation
			Hemodynamic Support
			Delivery of Fetus
		Evidence Contour
			Diagnosis
			Adjunctive Therapies
		References
	99: Respiratory Diseases of Pregnancy
		Case Presentation
		Principles of Management
			Physiologic Respiratory Changes Seen in Pregnancy
			Respiratory Pathology during Pregnancy
				Pulmonary Edema
					Pre-eclampsia associated pulmonary edema
					Tocolytic Induced Pulmonary Edema
					Ovarian Hyperstimulation Syndrome (OHSS)
					Aspiration
					Peripartum Cardiomyopathy (PPCM)
				Airway Disease
				Obstructive Sleep Apnea (OSA) in Pregnancy
			Pulmonary Infections in Pregnancy
				Viral Pneumonia
				Bacterial Pneumonia
				Neuromuscular Diseases and Central Causes
				Pneumothorax
				Pulmonary Embolism in Pregnancy
				Cystic Fibrosis
		Evidence Contour
			Ventilation Strategies in the Pregnant Patient
			Goals of Ventilation
			Extra Corporeal Membrane Oxygenation (ECMO)
			Prone Ventilation
			Delivery
		References
	100: Preeclampsia, Eclampsia, HELLP Syndrome
		Case Presentation
		Principles of Management
		Evidence Contour
		Appendix
		References
			Further Re ading
	101: Obstetric Hemorrhage
		Case Presentation
		Principles of Management
			Causes of Hemorrhage during Pregnancy
				Antepartum/Intrapartum
				Postpartum
			Management
			Medical Management
				Uterotonic Agents
				Tranexamic Acid
				Transfusion Therapy
					Massive Transfusion Protocol
				Recombinant Factor VII
				Tamponade
			Surgical
				Uterine Compression Sutures
				Uterine Embolization
				Vascular Ligation (Uterine/Ovarian)
				Hysterectomy
		Evidence Contour
			Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
			Non-Pneumatic Anti-Shock Garment (NASG)
			Post-Partum Hemorrhage Response Teams
		References
	102: Sepsis in Pregnancy
		Case Presentation
		Principles of Management
			Risk Factors for Sepsis in Pregnancy
			Background
			Definitions
			Identification
			Management
			Initial Assessment
			Hemodynamic Support
			Source Control
			Antimicrobial Therapy
		Evidence Contour
			Adjunctive Therapies
		References
Part XII: Other Conditions
	103: Management of Severe Skin Eruptions
		Case Presentation
			Pathogenesis
		Principles of Management
			Supportive Care
			Wound Care
			Management of Facial Involvement
		Evidence Contour
			Systemic Corticosteroids
			Intravenous Immunoglobulins (IVIG)
			Cyclosporine
			TNF Alpha Inhibitors
			Summary
		References
	104: Management of Alcohol Withdrawal Syndromes
		Case Presentation
		Principles of Management
			Diagnosis
			Initial Phase of Care
		Evidence Contour
			Patient Disposition
			Propofol
			Phenobarbital
			Central Alpha 2 Agonists
			Antipsychotics
			Anticonvulsants
			Other Agents
		References
Part XIII: ICU Care Delivery and Medical Ethics
	105: Interdisciplinary Care and Communication in the Intensive Care Unit
		Case Presentation
		Principles of Management and Evidence Contour
			Stakeholders of the Interdisciplinary Team
			Implementation Barriers
			Interdisciplinary Rounds
			Interdisciplinary Rounds: The Process
			Protocolization
			Family Meetings
			Interdisciplinary Handoffs and Huddles
			Recognition of Errors
			Interdisciplinary Debriefing
			Training in Interdisciplinary Care and Communication: Creating a Culture of Durable Stakeholders
		Conclusion
		References
	106: End of Life Care in the ICU
		Case Presentation
		Principles of Management
			Making Decisions in the ICU
			Prognostication
			What Constitutes Good End of Life Care?
		Evidence Contour
			Code Status and the ICU Patient
			Background
			Problems with DNR
			Who Should Make Decisions about Life Support?
			Going Forward with Life-Sustaining Treatment Decisions
			Futility and Requests for Inappropriate Treatments
				Defining Futility
		References
	107: Palliative Care in the ICU
		Case Presentation
		Principles of Management
			Background
			From Acute to Chronic Critical Illness
		Evidence Contour
			Communication Interventions
			Proactive Palliative Care and Palliative Care Triggers
			Spiritual Support
			Disparities in Palliative Care Access
			Advanced Care Planning
			Communication Tools
		References
	108: Family Involvement in ICU
		Case Presentation
		Principles of Management
			Introduction to Family Involvement in the ICU
				Studying Family Involvement
			Patient-Centered Visitation
			Family Participation in Rounds
			Family Involvement at the Bedside
			ICU Diaries
			Family Impact on Patient Safety
		Evidence Contour
			Patient-Family Advisory Councils
			Peer Support
			Burnout
			Conclusion
		References
	109: The Post-Intensive Care Syndrome
		Case Presentation
		Principles of Management
			Diagnosis
			Prevention and Rehabilitation
			Components of the ABCDEF Bundle
				A Recommended Strategy to Mitigate the Risk of Post-intensive Care Syndrome
		Evidence Contour
			ICU Follow Up Clinic
			Cognitive and Physical Rehabilitation
		References
Index