Intensive Care Medicine

Intensive Care Medicine: Annual Update 2010......Page 1
Front-matter......Page 2
Title Page......Page 4
Copyright Page......Page 5
Table of Contents......Page 6
List of Contributors......Page 10
Common Abbreviations......Page 21
I The Microcirculation......Page 23
Reaetive Oxygen Species......Page 25
NADPH Oxidase......Page 27
Xanthine Oxidase......Page 28
Interactions of ROS with the Microcirculation......Page 29
leukocyte-endothelial (eil Adhesion......Page 30
The Vast Spectrum of Intracellular Targets for ROS......Page 31
Ischemia-reperfusion......Page 32
Sepsis......Page 33
References......Page 35
Normal Microcirculation......Page 38
The Microcirculation in Sepsis......Page 40
The Microcirculation in Distributive Shock......Page 41
Recruiting the Microcirculation Network During Distributive Shock......Page 45
Conclusion......Page 46
References......Page 47
Traditional Therapies and Biomarkers have Centered on the Macrocirculation......Page 49
New Methods of Assessing the Microcirculation......Page 50
Suppression of Intracellular Inflammatory Signaling......Page 51
Other inhibitors of cellular inflammation......Page 52
Neutralizing antibodies......Page 53
Conclusion......Page 54
References......Page 55
II Hemodynamic Monitoring......Page 59
Diagnosing Hypovolemia......Page 61
Arterial waveform-derived variables......Page 62
Passive leg raising......Page 64
Perspective......Page 65
References......Page 66
Why do we need Non-invasive Cardiovascular Measurements?......Page 68
Electrical Impedance Tomography......Page 69
EKG Gating......Page 70
Optimized Separation in the Temporal and Spatial Domains......Page 71
Contrast Agents......Page 72
Deriving Strake Valume from Cardiac Impedance Images......Page 73
Impedance-time (urves......Page 74
Conclusion......Page 75
References......Page 76
Case Study 1: Components of an Arterial Pressure Waveform......Page 78
Case Study 2: Hypovolemia......Page 79
Case Study 3: Pulse Pressure as a Measure of Stroke Volume......Page 80
Case Study 5: Effect of Vasoconstrictor Drugs on Pulse Pressure......Page 81
Case Study 6: Effect of Vasoconstriction on the Dicrotic Notch and Secondary Pressure Waves......Page 82
Case Study 7: Sympathetic Stimulation and Reflected Pressure Waves......Page 83
References......Page 84
What 00 We Have and What (an they Do?......Page 86
Factors Affecting Choices......Page 89
References......Page 91
III Resuscitation Issues......Page 95
Regurgitation and Aspiration after Cardiac Arrest......Page 97
Disadvantages of Tracheal Intubation......Page 98
Supraglottic Airway Devices......Page 99
Passive Oxygen Insufflation......Page 100
Conclusion......Page 101
References......Page 102
Introduction......Page 105
The Frequency of Gasping in Global Ischemic Events......Page 106
The Meaning of Gasping in Global Ischemic Events......Page 107
The Unique Physiology of Sudden Circulatory Collapse......Page 108
Gasping as an Independent Factor for Improving Survival......Page 110
Improved Airflow, Blood Flow, or Both?......Page 111
Using Gasps to Avoid the Detriments of Positive Pressure Breaths......Page 112
Better Detection of Cardiac Arrest Using Gasps......Page 113
The Role of Gasping in Trauma Care and Infant Resuscitation......Page 114
References......Page 115
Resuscitation Perspectives......Page 118
(an Metabolie Markers Guide Resuscitation and Help Predict Outcomes?......Page 120
Military Resuscitation Experience (Tables 1 and 2)......Page 122
Nurse-driven Resuscitation......Page 124
Consensus Statements......Page 126
References......Page 127
Introduction......Page 129
Does Hemodynamic Improvement Improve Prognosis in Infarction-triggered Cardiogenic Shock?......Page 130
Effects of IABP on Hemodynamics, Systemic Inflammation and MOF in Infarction-triggered Cardiogenic Shock......Page 132
What Does a Meta-Analysis Tell Us?......Page 133
Extracorporeal Membrane Oxygenation (ECMO)......Page 135
We Should Change the Guidelines tor IABP Use in Intaretion-triggered Cardiogenic Shoek!......Page 136
Intra-aortic Balloon Counterpulsation in Septic Shock?......Page 137
References......Page 139
IV Inflammatory Responses\rin the Lung......Page 141
Biology of VEGF......Page 143
Cellular Actions of VEGF......Page 144
VEGF as a Pathophysiological Driver of Acute Lung Injury?......Page 145
Tissue Studies......Page 146
Conclusion......Page 147
References......Page 149
Introduction......Page 151
C014 and the LPS Receptor Complex......Page 153
CD14 and other Pattern Recognition Receptors......Page 154
Role of CD14 in LPS- and LTA-induced Lung Inflammation......Page 155
Role of CD14 in Lung Infection......Page 157
References......Page 160
V Mechanical Ventilation......Page 163
Introduction......Page 165
Closed Circuit Techniques......Page 166
Open Circuit Wash-in/washout Procedures......Page 169
Respiratory Inductive Plethysmography......Page 171
Conclusion......Page 172
References......Page 173
Introduction......Page 176
Definition and Factors Affecting Recruitment Maneuvers......Page 177
Patient Positioning......Page 178
Impact of Recruitment Maneuver on Ventilator-induced Lung Injury......Page 179
The Role of Variable Ventilation as a Recruitment Maneuver......Page 181
Conclusion......Page 182
References......Page 183
Origin of Pleural Effusions in the Critically III Patient......Page 186
Modeling the Pleural Effusion-Iung Interaction......Page 187
Pleural Effusion and Respiratory Mechanics......Page 188
Effects of Pleural Effusion on Gas Exchange......Page 190
Praetical Irnplications tor the Meehanically Ventilated Patient with Pleural Effusion......Page 191
Pleural Effusions and Ventilator-induced Lung Injury?......Page 193
References......Page 194
Mechanisms Contributing to the Development of Weaning-induced Pulmonary Edema......Page 197
Right Heart Catheterization......Page 198
Transthoracic Echocardiography......Page 199
Cardiac Biomarkers......Page 200
Detection of Weaning-induced Hemoconcentration......Page 201
Therapeutic Options......Page 202
References......Page 203
VI Respiratory Fallure......Page 205
Pathogenesis......Page 207
Effects of Acute Pleural Effusion on Lung Volume, Respiratory System Mechanics, and Gas Exchange......Page 208
Effects of Thoracentesis on Lung Volume, Respiratory System Mechanics, and Gas Exchange......Page 209
Pleural Effusion in Patients with ALI/ARDS......Page 211
Conclusion......Page 212
References......Page 213
The Consequences of Pulmonary Edema during ARDS......Page 215
ARDS: lesional or Hemodynamic Edema?......Page 216
Fluid Restriction and Diuretics: Clinical Studies and Practical Consequences......Page 218
Modulation of Oncotic or Osmotie Pressure: The Effects of Administering Albumin or Hypertonie Saline......Page 220
References......Page 222
Why was Pandemie (H1Nl) 2009 Flu 50 Prevalent in the Southern Cone?......Page 225
How Big was the Outbreak?......Page 226
Common (omplications of Influenza......Page 227
Management......Page 229
Non-pharmacologic Therapy......Page 230
Prone position ventilation......Page 231
Pharmacologic Therapy......Page 232
Baeterial Infection......Page 233
Cryptogenic Organizing Pneumonia......Page 234
Conclusion......Page 235
References......Page 236
VII Infections......Page 239
Ginical Studies......Page 241
References......Page 244
Introduction......Page 245
Staff Educational/Quality Improvement Program......Page 246
Type of Catheter......Page 247
Catheter Insertion Site......Page 248
Skin Antisepsis......Page 249
Antibiotic Prophylaxis......Page 250
Dressing......Page 251
Venous Une Maintenance......Page 252
Conclusion......Page 253
References......Page 254
Prevention and Treatment of VAP......Page 257
Severe Sepsis and Septic Shock......Page 261
References......Page 263
Guidelines......Page 266
Adherence to Guidelines......Page 267
Barriers......Page 268
Theories of Change......Page 269
Implementation Interventions and Strategies......Page 270
The 2000s......Page 271
Interventional studies......Page 272
Systematic review......Page 273
Cost Considerations......Page 275
References......Page 276
STEP l -Include the Antibiotic Stewardship Program within the Hospital Infection Control Program......Page 279
STEP 2-Be Aware of the Different Antibiotic Stewardship Program Strategies......Page 281
srEP 3-Define the Core Strategy/Key Antibiotics/Areas to Include within the Antibiotic Stewardship Program According to the Institution\'s Resources......Page 285
Conclusion......Page 287
References......Page 288
VIII Metabolic Support......Page 293
Historical Perspective......Page 295
Vitamin D and the Musculoskeletal System......Page 296
Vitamin Dand the Immune System......Page 298
Vitamin Dand Sepsis......Page 299
Challenges tor the Intensivist......Page 300
References......Page 301
IX Anticoagulant Therapies......Page 305
Introduction......Page 307
Therapeutic Effects of Antithrombin......Page 308
Coagulation-independent anti-inflammatory effects......Page 309
Interactions with Heparin......Page 311
Experimental Studies......Page 312
(Iinkal Studies......Page 314
References......Page 316
Inflammation-induced Effects on Physiological Anticoagulant Factors......Page 319
The Antithrombin System......Page 320
The Thrombomodulin-protein C System......Page 321
Effects of Natural Anticoagulant Systems on Inflammation......Page 322
Antithrombin Concentrate......Page 324
Recombinant Human Activated Protein C......Page 325
Recombinant Tissue Factor Pathway Inhibitor......Page 328
References......Page 329
X Anemia and Blood\rTransfusions......Page 333
Venous Oxygen Saturation as a Physiologie Transfusion Trigger......Page 335
The Concept of Physiologie Transfusion Trigger......Page 339
References......Page 341
Introduction......Page 343
EPO and Tissue Protection......Page 344
Tissue Proteetion and Clinical Trials......Page 345
Erythropoiesis versus Tissue Protection......Page 346
Conclusion......Page 347
References......Page 348
XI Renal Disease and Therapy......Page 351
Introduction......Page 353
Technique......Page 354
Physiological Significance of the Renal Resistive Index......Page 355
Obstructive Renal Diseases......Page 356
Conclusion......Page 357
References......Page 358
The Discovery of the Atrial Natriuretic Peptide System......Page 361
Tubular Effects of ANP......Page 362
Effects of ANP on Renal Blood Flow and GFR in Postoperative Acute Renal Failure......Page 363
Effects of ANP on Renal Outcome in Acute Renal Failure......Page 364
Meta-Analysis of ANP in the Management of Acute Renal Dysfunction......Page 367
References......Page 368
Co-existing liver and Kidney Disease......Page 371
Serum Creatinine Concentration for the Assessment of Kidney Funetion in Chronic liver Disease......Page 373
Acute Kidney Injury Network Criteria tor staging Acute Kidney Injury......Page 374
Patients with Chronic Liver Disease are more Susceptible to Acute Kidney Injury......Page 375
Hepatorenal Syndrome......Page 376
Acute Kidney Injury and Chronic liver Disease......Page 377
Kidney Disease Outcome Quality Initiative Criteria tor Staging Chronic Kidney Disease......Page 378
Future Directions......Page 381
Orthotopic liver Transplantation......Page 382
Conclusion......Page 383
References......Page 384
Introduction......Page 387
Synergistic action of HVHF and Enhanced Adsorption: Clinical Feasibility and Effects beyond Hemodynamics......Page 388
New Pathophysiological Insight regarding Septic Acute Kidney Injury......Page 390
Update on Very Recent Trials in Critically iII Patients with AKI......Page 391
References......Page 392
A Problem of Uremia......Page 395
From Acute Renal Failure to AKI, and trom Renal Replacement Therapy to Renal Support: A Paradigm Shift......Page 396
Early initiation in the course of AKI......Page 398
Conclusion......Page 399
References......Page 400
XII Neurological Aspects......Page 403
Introduction......Page 405
Multimodal Monitoring in Hypoxic-Ischemic Encephalopathy......Page 406
Multimodal Monitoring in Traumatic Brain Injury......Page 407
Multi-modal Monitoring in Cerebrovascular Disease......Page 409
Conclusion......Page 411
References......Page 412
Overview of the Incidence and Pathophysiology of Acute Traumatic Spinal Cord Injury-induced Cardiovascular Dysfunction......Page 414
Blood Pressure Augmentation in Patients with Acute Traumatic Spinal Cord Injury......Page 415
Spinal Cord Perfusion Pressure, Intrathecal Pressure, and Treatment......Page 417
Conclusion......Page 418
References......Page 419
Introduction......Page 421
Quantitative Computed Tomography......Page 422
Quantative CT Study of Non-contused Hemispheric Areas......Page 424
Quantitative CT Study of Contused Hemispheric Areas......Page 427
Interpretation of Estimated Specific Gravity Variation......Page 428
Conclusion......Page 430
References......Page 431
Inflammation and the Brain......Page 433
Effe(ts of Sepsis on the Blood-brain Barrier and the Vascular Endothelium......Page 434
Regulation of CerebraI Perfusion......Page 435
Cerebral perfusion and sepsis-associated delirium......Page 436
Conclusion......Page 437
References......Page 438
Introduction......Page 441
Cardiac Abnormalities......Page 442
Lung Abnormalities......Page 443
Anemia......Page 444
Electrolyte Abnormalities......Page 445
References......Page 447
XIII Perioperative Management......Page 451
Introduction......Page 453
Effects of Thoracic Epidural Anesthesia on Myocardial Function......Page 454
Effects of Thoracic Epidural Anesthesia on Gastrointestinal Function......Page 455
Effects of Thoracic Epidural Anesthesia on Long-term Outcome......Page 456
Adverse Effects and Potential Risks of Epidural Anesthesia......Page 457
References......Page 458
Pathophysiology......Page 461
Review of Clincal Studies......Page 463
Preventive Strategies......Page 471
Conclusion: Proposed/useful Clinical Perioperative Guidelines......Page 473
References......Page 474
Pathology......Page 477
Preoperative Pain......Page 478
Others......Page 479
References......Page 481
XIV Abdominal Compartment\rSyndrome......Page 485
Orbital compartment Syndrome......Page 487
Intracranial Compartment Syndrome......Page 490
Thoracic Compartment Syndrome......Page 491
Cardiac Compartment Syndrome......Page 493
Limb or Extremity Compartment Syndrome......Page 495
Renal Compartment Syndrome......Page 497
Abdominal Compartment Syndrome......Page 498
Abdominal perfusion pressure measurement......Page 501
Clinical Management......Page 502
References......Page 503
Who Started laparostomy?......Page 507
Temporary Abdominal Cover......Page 508
Definitive Abdominal Wall Closure......Page 509
Does laparostomy Improve Outcome?......Page 510
References......Page 512
XV Drug Distribution and\rClearance......Page 515
Defining Augmented Renal Clearance......Page 517
Assessing Renal Function in Critical IIIness......Page 518
Prevalence and Natural History of Augmented Renal Clearance in the Critically III......Page 519
Traumatic Brain Injury......Page 520
Hematological Malignancy......Page 521
Concentration-dependent Killing......Page 522
Time-dependent Killing......Page 523
AUCo_24/MIC antibiotics......Page 524
Therapeutic Drug Monitoring......Page 525
References......Page 526
Overview of Pharmacokinetic and Pharmacokineticlpharmacodynamic Parameters......Page 529
Volume of Distribution versus Clearance: How do they Affect Serum Drug Concentration and Half-Iife?......Page 530
Causes and Consequences of Increased Volume of Distribution......Page 531
Chronic Increases in Volume of Distribution......Page 532
Other seenarios......Page 533
Hypoalbuminemia......Page 534
Clinkal Significance and Recommended Dose Strategies......Page 535
References......Page 536
XVI Risk Stratification......Page 539
Introduction......Page 541
Organ Dysfunction/Failure Scores......Page 542
From Multiple Organ Dysfunction/Failure Scores to the PIRO Concept......Page 543
Should We Have One PIRO Or Many PIROs?......Page 546
Should we use PIRO or MOF Scores?......Page 547
References......Page 548
XVII Critical Care Outreach......Page 551
Sub-optimal Care......Page 553
\'Track and Trigger\' Mechanisms......Page 554
Role of Critical Care Outreach Services......Page 555
Educational Tools......Page 556
Use of Technology as a Tool to \'Track and Trigger\'......Page 557
Human Factors......Page 558
References......Page 559
Introduction......Page 561
Existing Non-invasive (ardiovaseular Monitoring is Ineffeetive at Identifying Instability In Step-down Units......Page 562
Integrated Monitoring Systems to Monitor the Monitors......Page 564
References......Page 565
XVIII End-of-life Issues......Page 567
Role of the Intensivist......Page 569
Protocols tor Management of the Potential Organ Donor......Page 570
Cardiovascular......Page 571
Pulmonary......Page 574
Endocrine......Page 575
Donation after Cardiac Death......Page 576
Conclusion......Page 578
References......Page 579
Diserepaney between Preferred and Actual Place of Death......Page 582
Variation in End-of-life Intensive Care Use......Page 583
An American Perspective......Page 584
A European Perspective......Page 586
Unintended Consequences of End-of-life Decision-making......Page 587
References......Page 588
XIX Patient Care......Page 591
Anesthesia/sedation and Sieep are not Identical, but may Share Cornmon Mechanisms......Page 593
Exploring Sieep in ICU Patients......Page 594
Charaeteristies of Sieep Alteration in ICU Patients......Page 595
ICU Environment......Page 596
Drugs......Page 597
Impact of Sieep Disturbance on Patient Outcome......Page 598
Attenuation of Noise and Light......Page 599
Use of Pharmacological Interventions......Page 600
References......Page 601
The Importance of Communication and Culture......Page 603
\"Say what you Mean, and Mean what you Say\"......Page 604
Mitigating Speech: \"No ifs, and, or Buts\"......Page 605
Graded Assertiveness: Getting the Message Across......Page 606
Questioning Authority and Handing Over Responsibility: Underappreciated Skills......Page 607
Managing Interruptions and Distractions......Page 608
Conclusion......Page 609
References......Page 610
\'The Missing Curriculum\' [3]......Page 612
Engineering and Acute Care Medicine......Page 613
Understanding the Basics of Human Error......Page 614
Educating for Safety......Page 615
Maximizing the Best of Human and Machine......Page 616
Conclusion......Page 617
References......Page 618
Subject Index......Page 619