Evidence-Based Practice of Critical Care

Front matter......Page 1
Copyright......Page 3
List of Contributors......Page 4
Dedication......Page 15
Monitoring Alveolar Strain......Page 16
Gas Exchange......Page 17
Computed Tomography......Page 18
Volume-Pressure Curve......Page 19
Prognostic Value of Pulmonary Function Variables......Page 20
References......Page 21
Hypoxic Respiratory Failure......Page 24
Hypercarbic Ventilatory Failure......Page 25
Impaired Consciousness and Airway Protection......Page 26
References......Page 27
Management of COPD\r......Page 28
Antibiotics......Page 29
Assisted Ventilation......Page 30
Prognosis and Outcomes......Page 31
References......Page 32
Contraindications to Noninvasive Ventilation......Page 34
Extubating Patients With COPD\r......Page 35
Neuromuscular Disease......Page 36
Conclusion......Page 37
References......Page 38
Treatment of Acute Episodes in the Emergency Department......Page 40
Treatment of Acute Asthma in the Intensive Care Unit......Page 41
References......Page 43
Clinical Presentation......Page 45
Diagnostic Tools......Page 46
Acute Right Ventricular Dysfunction Management......Page 47
References......Page 48
Assessment of Readiness to Wean......Page 50
Individual Limitations of the Readiness-to-Wean Predictors......Page 51
Suitability for Extubation......Page 52
Assist Control Ventilation......Page 53
Preventing Extubation Failure in Selected Patients (Prophylactic Therapy)......Page 54
References......Page 55
Manifestations of Oxygen Toxicity......Page 58
Central Nervous System Toxicity......Page 59
Management of Oxygen Toxicity......Page 60
Hyperoxia and Surgical Site Infections: is Oxygen Beneficial?......Page 61
References......Page 62
Growth and Transcription Factors......Page 64
Anti-Inflammatory Effects of HBO2\r......Page 66
Carbon Monoxide Poisoning......Page 67
Thermal Burns......Page 68
References......Page 69
Previous Definitions......Page 72
Current AECC Definition\r......Page 73
Chest Radiology......Page 74
Hypoxemia......Page 75
Possible Modifications to the Ards Criteria......Page 76
References......Page 77
Epidemiology......Page 79
Exudative Phase......Page 80
Pulmonary and Neurocognitive Dysfunction......Page 81
References......Page 82
Limitation of Generation of Alveolar Edema......Page 84
Maximizing Alveolar Fluid Clearance......Page 85
Vasodilators......Page 86
Proinflammatory Mediator Inhibition......Page 87
Antioxidant Therapy......Page 88
References......Page 89
Pathology of Acute Lung Injury......Page 93
Physiologic Changes That Characterize Acute Lung Injury......Page 95
Resolution of Pulmonary Edema Fluid is Critical to Resolution of Acute Lung Injury\r......Page 96
References......Page 97
Epidemiology......Page 99
Radiology......Page 100
Respiratory Mechanics......Page 101
Conclusion......Page 102
References......Page 103
Conventional Ventilation......Page 105
Lung Recruitment......Page 107
Adjuncts to Ventilation in ARDS\r......Page 108
Conclusion......Page 109
References......Page 110
Central Nervous System......Page 111
Neonatal Respiratory Distress Syndrome......Page 112
Persistent Pulmonary Hypertension of the Newborn......Page 113
Permissive Hypercapnia At the Bedside: Practical Issues......Page 114
References......Page 115
Airspace Mechanics......Page 117
Lateral Position......Page 118
Physiology and Physiopathology of Prone Positioning......Page 119
Addendum......Page 120
References......Page 122
Current Understanding and Approaches......Page 124
Airway Pressure Release Ventilation in Practice......Page 125
References......Page 127
Ventilator-Induced Lung Injury and Recruitment......Page 129
Systematic Review of the Literature and Interpretation of Data\r......Page 130
References......Page 134
Overview and Physiologic Effects......Page 136
Clinical Studies in Acute Lung Injury and ARDS\r......Page 137
Potential Limitations and Pitfalls......Page 139
References......Page 140
Nitric Oxide......Page 142
Conclusion......Page 143
References......Page 144
Steroids in Early ARDS\r......Page 146
Timing of Doses......Page 147
Prostaglandin E1......Page 149
References......Page 150
Evidence Supporting the Benefit of ECLS for Patients With ARDS\r......Page 152
Principles and Objectives of ECLS\r......Page 153
Clinical Trial Evidence Supporting the Use of ECLS in Routine Care For ARDS\r......Page 154
Importance of Adequately Explicit Clinical Trial Protocols......Page 156
References......Page 157
What is Inflammation?......Page 159
What is Sepsis?......Page 160
What is Mods?......Page 161
References......Page 163
Pathophysiology of Fever......Page 165
How to Proceed With a Diagnostic Evaluation......Page 167
Microbiologic Approach to Diagnosis......Page 168
Interpretation of the Data And Conclusion......Page 169
References......Page 170
What is the Role of the Endothelium in the Pathophysiology of Organ Dysfunction?......Page 172
Cardiovascular System......Page 173
Renal System......Page 174
Respiratory System......Page 175
Central Nervous System......Page 176
Hematologic Abnormalities......Page 177
References......Page 178
Bacterial Translocation and Gut-Derived Sepsis: Do They Exist?\r......Page 180
Do Bacterial Translocation and Gut-Derived Sepsis Exist, and are They Clinically Relevant?......Page 181
What Can We Do About It?......Page 182
Conclusion......Page 183
References......Page 184
Pathophysiology and Mechanism of Action\r......Page 186
Presentation of Available Data Based on Systematic Review......Page 187
References......Page 188
What is the Role of Empirical Antibiotic Therapy in Sepsis?\r......Page 190
Community-Acquired Pneumonia......Page 191
Ventilator-Associated Pneumonia......Page 198
Timing of Antibiotic Administration as a Performance Standard......Page 201
The Surviving Sepsis Campaign Guidelines......Page 203
References......Page 204
Timing of Fluid Resuscitation......Page 206
Hydroxyethyl Starches......Page 209
Crystalloid Resuscitation......Page 210
Hypertonic Saline......Page 211
References......Page 212
Vasopressor Therapy......Page 214
Norepinephrine......Page 215
Dobutamine......Page 216
Vasopressin......Page 217
References......Page 218
Vasopressin Concentration In Septic Shock......Page 220
Efficacy of Vasopressin In Septic Shock......Page 221
Safety of Vasopressin In Septic Shock......Page 223
References......Page 224
Drainage......Page 226
Definitive Control......Page 227
What Method Should Be Used to Establish Source Control?......Page 228
Gastrointestinal Perforations......Page 229
Infected Pancreatic Necrosis......Page 230
Skin and Soft Tissue Infections......Page 231
Evaluation of the Adequacy of Source Control\r......Page 232
References......Page 233
Immunologic Response to Sepsis: Sirs to Cars......Page 235
Mechanisms of Immune Dysfunction......Page 236
Identifying Immune Dysfunction In The Septic Patient......Page 237
References......Page 238
Multiple-Organ Dysfunction Syndrome......Page 241
Conclusion......Page 242
References......Page 246
Impaired Oxidative Phosphorylation In Sepsis......Page 248
Cytochrome Oxidase Inhibition, Metabolic Downregulation, and Suspended Animation......Page 249
Evidence of Hibernation in Sepsis......Page 250
References......Page 251
Mineralocorticoids......Page 253
Thyroid Axis......Page 254
Hypothalamic-Pituitary-Adrenal Axis......Page 255
Lactotrophic Axis......Page 256
References......Page 257
Predictors of Outcome......Page 259
Recommended Diagnostic Testing......Page 262
Common Pathogens......Page 263
Treatment......Page 264
Nonresponding Pneumonia......Page 265
References......Page 266
Incidence......Page 269
Diagnosis......Page 270
Hygiene and Aseptic Technique......Page 271
Insertion Site......Page 272
Biopatch Device......Page 273
References......Page 274
Trends in Antibiotic Resistance in the Intensive Care Unit\r......Page 277
Strategies for Reducing or Reversing Resistance\r......Page 279
Antimicrobial Stewardship......Page 280
References......Page 281
Outcomes......Page 283
Concerns......Page 291
References......Page 292
Compression First Versus Shock First For Ventricular Fibrillation in Sudden Cardiac Arrest......Page 295
Vasopressors, Antiarrhythmics, and Sequence of Actions During Treatment Of Cardiac Arrest......Page 296
Postresuscitation Care......Page 297
References......Page 298
Pathophysiology and Mechanisms of Action......Page 300
General Intensive Care and High-Risk Surgical Patients......Page 301
Complications of the Pulmonary Artery Catheter......Page 303
Should Pulmonary Artery Catheters Be Eliminated From The Intensive Care Unit?......Page 304
References......Page 305
Diagnosis: Biomarkers......Page 307
Diagnosis: Electrocardiography......Page 308
Management: Pharmacologic Approaches......Page 309
Mechanical Support and Coronary Revascularization......Page 311
References......Page 312
Diagnosis......Page 315
Mechanical Therapy......Page 317
Revascularization Therapy......Page 318
References......Page 319
Neurologic Hypertensive Emergencies......Page 321
Hypertension With an Acute Coronary Syndrome......Page 322
Hypertension in the Perioperative Period......Page 325
Pheochromocytoma......Page 326
Recent Advances......Page 327
References......Page 328
What Strategies are Effective for Prophylaxis of Atrial Fibrillation?......Page 330
Atrial Pacing......Page 331
beta-Blockers......Page 332
What is Appropriate Therapy for New-Onset Postoperative Atrial Fibrillation in Patients With Hemodynamic Instability?.........Page 333
Rate Control......Page 334
Anticoagulation Strategy Before Restoration of Sinus Rhythm: Atrial Fibrillation for More than 48 Hours......Page 335
Should Anticoagulation Be Instituted or Continued After Electrical Cardioversion to Sinus Rhythm?\r......Page 336
References......Page 337
Diagnosis......Page 339
Management of Right Ventricular Failure......Page 340
Right Ventricular Myocardial Infarction......Page 341
Vasodilator Therapy......Page 342
Prognosis......Page 345
References......Page 346
Pulmonary Hypertension, Right Heart Failure, and Death......Page 348
Prostaglandins......Page 349
Levosimendan......Page 350
References......Page 351
Options......Page 353
beta-Blocking Agents......Page 354
alpha2-Agonists\r......Page 356
Areas of Uncertainty......Page 357
Guidelines......Page 358
References......Page 359
Loop Diuretics......Page 361
Dopamine......Page 362
Controversies......Page 363
References......Page 364
Optimizing Volume Status......Page 366
Vasoactive Agents......Page 367
Correction of Electrolyte, Acid-Base, and Mineral Homeostasis......Page 369
Conclusion......Page 370
References......Page 371
The Uremic State......Page 373
Should Renal Replacement Therapy be Initiated in Acute Kidney Injury Before Complications have Developed?......Page 374
Should Higher Doses of Ultrafiltration than are Conventionally Used Be Prescribed In Cases of Septic Acute Kidney Injury?......Page 376
Lung Support......Page 377
References......Page 378
Intensity of Renal Replacement Therapy......Page 380
Renal Recovery......Page 381
More Recent Evidence......Page 382
References......Page 383
Risk Factors......Page 384
Pharmacologic Therapy......Page 385
Sodium Bicarbonate......Page 386
Hemodialysis and Hemofiltration......Page 387
References......Page 388
Weak Acids......Page 391
Metabolic Acidosis Due to Unmeasured Anions......Page 392
Acute Metabolic Alkalosis......Page 393
The Base Deficit Excess (Copenhagen) Approach......Page 394
Stewart-Fencl Approach......Page 395
References......Page 396
Intracranial Compartments and the Monro-Kellie Doctrine......Page 399
Increased Intracranial Pressure......Page 400
Intracranial Compliance......Page 401
Cerebral Perfusion Pressure and Cerebral Autoregulation......Page 402
Brain Edema......Page 403
References......Page 404
Background......Page 406
Evidence......Page 407
Intracranial Pressure Monitoring Technology......Page 408
Evidence......Page 409
Background......Page 410
Recommendations......Page 411
References......Page 412
Surgical and Endovascular Measures......Page 414
Hydrocephalus......Page 415
Prevention and Treatment......Page 416
Conclusion......Page 418
References......Page 419
Airway, Ventilation, and Oxygenation......Page 422
Blood Pressure Management......Page 423
Temperature......Page 424
Recurrent Ischemic Stroke......Page 425
References......Page 426
Significance of Intensive Care Unit Weakness......Page 429
Pathophysiology......Page 431
Diagnosis......Page 432
Controversy in Electrophysiologic Studies......Page 433
Long-Term Outcomes......Page 434
References......Page 435
Cooling Methods......Page 437
Complications Associated With Therapeutic Hypothermia......Page 438
Hypothermia in Cardiac Arrest......Page 439
Hypothermia for Spinal Cord Injury......Page 440
Hypothermia for Hypoxic-Ischemic Encephalopathy......Page 441
Conclusion......Page 442
References......Page 443
Fluids, Electrolytes, and Nutrition......Page 445
Renal......Page 446
Interpretation of Data......Page 447
References......Page 448
Enteral Nutrition Versus Parenteral Nutrition......Page 450
Early Enteral Nutrition Versus Early Parenteral Nutrition......Page 451
References......Page 453
Arginine Metabolism......Page 455
Arginine and Critical Illness......Page 456
References......Page 457
Causes of Trace Element Deficiency......Page 459
Available Systematic Reviews......Page 461
Supplementation: Practical Issues......Page 462
References......Page 463
Branched-Chain Amino Acids......Page 465
Critically Ill Burn Patients......Page 466
Overall Critically Ill Patients......Page 467
Interpretation......Page 468
References......Page 469
Observational Studies on Hypocaloric Nutrition in Critically Ill Patients......Page 471
Randomized Controlled Trials Comparing Early Aggressive and Early Lower-Dose Enteral Nutrition......Page 473
Randomized Controlled Trials Comparing Early and Delayed Enteral Nutrition......Page 474
References......Page 475
Peptic Ulcers......Page 477
Diagnosis and Treatment of Lower Gastrointestinal Bleeding......Page 479
Guidelines......Page 480
References......Page 481
Pathophysiology......Page 483
Management......Page 484
Specific Stress Ulcer Prophylaxis......Page 485
Risk for Nosocomial Pneumonia With Gastric Acid Suppression......Page 486
References......Page 487
Prognosis......Page 489
Therapy for Specific Causes......Page 491
Grade I and Ii Hepatic Encephalopathy......Page 492
Sedation and Analgesia......Page 493
Coagulopathy......Page 494
Gastrointestinal Bleeding......Page 495
Hepatectomy and Auxiliary Transplantation......Page 496
Conclusion......Page 497
References......Page 498
Pathophysiology and Mechanism Of Action......Page 500
Presentation of Available Data Based on Systematic Review......Page 501
Conclusion......Page 502
References......Page 503
Cytokines and the Hpa Axis......Page 504
Cortisol Response to Critical Illness......Page 505
Measurement of Random Serum Cortisol Levels......Page 506
Diagnosis of Relative Adrenal Insufficiency in Critically Ill Patients......Page 507
Therapeutic Approach to Patients With Presumed Adrenal Insufficiency......Page 508
References......Page 513
Mode of Action and Mineralocorticoid Receptors......Page 516
Prevalence of Mineralocorticoid Insufficiency in Critical Illness......Page 517
Should Critical Illness-Associated Mineralocorticoid Insufficiency Be Treated?......Page 518
References......Page 519
Fluid and Electrolyte Replacement......Page 520
Insulin Therapy......Page 521
Hyperosmolar Hyperglycemic State......Page 523
Fluid and Electrolyte Replacement......Page 524
Insulin Therapy......Page 525
Pathophysiology......Page 526
Decrease Hormone Production and Secretion......Page 527
Antagonize Adrenergic Effects of Thyroid Hormone......Page 528
Definitive Treatment......Page 529
Clinical Presentation......Page 530
Precipitating Factors......Page 531
Pathophysiology......Page 532
Therapy......Page 533
References......Page 534
Agents......Page 537
Administration Strategies......Page 538
References......Page 539
Sedation......Page 540
Anti-Inflammatory and Immunologic Effects......Page 541
Neuroprotection......Page 542
Conclusion......Page 543
References......Page 544
Neurotransmitter Imbalance and Cholinergic Deficiency......Page 545
Recognition of Delirium......Page 546
Primary Prevention......Page 547
Pharmacologic Intervention......Page 548
Opioids......Page 550
References......Page 551
Normally Occurring Sleep......Page 553
Conclusion......Page 554
References......Page 555
Thoracic Spinal Cord Injury......Page 556
Chest Tube Management......Page 557
Noninvasive Positive-Pressure Ventilation......Page 558
References......Page 560
Respiratory System and Intra-Abdominal Hypertension and Abdominal Compartment Syndrome......Page 562
Effects of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome On the Renal System......Page 563
Treatment of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome......Page 564
References......Page 565
Interventional Radiology......Page 566
Thromboembolic Prophylaxis......Page 568
Guidelines......Page 569
References......Page 570
Initial Assessment and Emergency Treatment......Page 571
Fluid Resuscitation......Page 572
Inhalation Injury......Page 573
Burn Wound Excision......Page 574
Metabolic Response and Nutritional Support......Page 575
Conclusion......Page 576
References......Page 577
Choice of Fluid......Page 580
Uncontrolled Hemorrhagic Shock......Page 584
End Points of Resuscitation......Page 585
References......Page 586
Clinical Manifestations......Page 588
Causes......Page 589
Management......Page 590
Clinical Manifestations......Page 592
Management......Page 593
References......Page 594
Do the Surviving Sepsis Campaign Guidelines for the Management of Sepsis and Septic Shock Apply in the Case of the Pregnant or Postpartum Patient?......Page 596
Is Recombinant Factor Viia Indicated in Life-Threatening Postpartum Hemorrhage?......Page 598
References......Page 599
Definitions of Accidental and Induced Hypothermia......Page 601
Central Nervous System......Page 602
Detrimental Effects of Mild Hypothermia......Page 603
References......Page 604
Airway Management......Page 607
Respiratory......Page 608
Pharmacotherapy......Page 609
Sedatives and Analgesics......Page 610
Nutritional Care......Page 611
Outcomes in Critically Ill Obese Patients......Page 612
References......Page 614
Risk-to-Benefit Ratio of Intrahospital Transport......Page 616
Selection of Personnel......Page 617
Prehospital Personnel......Page 618
References......Page 619
Salicylates......Page 621
Management Principles......Page 622
Decontamination Strategies......Page 623
Multidose Activated Charcoal......Page 624
References......Page 625
Glycemic Control......Page 626
Hormone Replacement......Page 627
Cardiovascular Support......Page 628
Renal Support......Page 629
References......Page 630
Epidemiology of Thrombocytopenia in the Intensive Care Unit......Page 632
Causes of Thrombocytopenia......Page 633
Heparin-Induced Thrombocytopenia......Page 634
Disseminated Intravascular Coagulation......Page 635
Hellp Syndrome......Page 636
Definition of Thrombocytosis......Page 637
Diagnostic Evaluation of Thrombocytosis In the Intensive Care Unit......Page 638
Secondary (Reactive) Thrombocytosis......Page 639
Normal Platelet Function......Page 640
Definition of Functional Platelet Disorders......Page 641
Inherited Platelet Disorders......Page 643
References......Page 646
Packed Red Blood Cell Transfusion......Page 648
Cryoprecipitate Transfusion......Page 650
Adverse Events Associated With Recombinant Factor Viia......Page 651
References......Page 652
Intensivist-Led, Multidisciplinary Care......Page 654
Protocol-Based Care......Page 655
Regionalization......Page 656
Future Directions......Page 657
References......Page 658
Evidence......Page 660
Role of the Intensive Care Unit Medical Director......Page 664
Guidelines......Page 665
References......Page 666
What is the Evidence Supporting the Effectiveness of Intensivists in Increasing Intensive Care Unit Survival?......Page 668
Is It the Multiprofessional Team Or the Intensivist (Or Both) That Leads to the Difference in Quality?......Page 670
What Caregivers Should Be Members of the Multidisciplinary Team and Make Daily Rounds?......Page 671
References......Page 672
Intensive Care Unit and Hospital Mortality......Page 674
Intensive Care Unit and Hospital Length of Stay......Page 675
Limitations......Page 676
References......Page 677
Is the Telemedical Intensive Care Unit Needed?......Page 678
What are the Potential Disadvantages of the Telemedical Intensive Care Unit?......Page 680
Conclusion......Page 681
References......Page 682
Defining Innovative Practice......Page 683
From Innovative Practice to Research: the Pulmonary Artery Catheter in Critical Care......Page 684
Monitoring......Page 685
Challenges of Quality Improvement Initiatives......Page 686
References......Page 687
A......Page 688
C......Page 690
E......Page 692
H......Page 693
I......Page 695
M......Page 696
N......Page 697
P......Page 698
R......Page 699
S......Page 700
T......Page 701
U......Page 702
Z......Page 703