Yearbook of Intensive Care and Emergency Medicine 2010

Yearbook of Intensive Care and Emergency Medicine 2010......Page 1
Front-matter......Page 2
Title Page\r......Page 3
Copyright Page\r......Page 4
Table of Contens......Page 5
List of Contributors......Page 9
Common Abbreviations......Page 20
Section I.               The Microcirculation......Page 21
Reactive Oxygen Species......Page 22
NADPH Oxidase......Page 24
Xanthine Oxidase......Page 25
Interactions of ROS with the Microcirculation......Page 26
Leukocyte-endothelial Cell Adhesion......Page 27
The Vast Spectrum of Intracellular Targets for ROS......Page 28
Ischemia-reperfusion......Page 29
Sepsis......Page 30
References......Page 32
Normal Microcirculation......Page 35
The Microcirculation in Sepsis......Page 37
The Microcirculation in Distributive Shock......Page 38
Recruiting the Microcirculation Network During Distributive Shock......Page 42
Conclusion......Page 43
References......Page 44
Traditional Therapies and Biomarkers have Centered on the Macrocirculation......Page 46
New Methods of Assessing the Microcirculation......Page 47
Suppression of Intracellular Inflammatory Signaling......Page 48
Other inhibitors of cellular inflammation......Page 49
Neutralizing antibodies......Page 50
Conclusion......Page 51
References......Page 52
Section II. Hemodynamic Monitoring......Page 55
Diagnosing Hypovolemia......Page 56
Arterial waveform-derived variables......Page 57
Passive leg raising......Page 59
Perspective......Page 60
References......Page 61
Why do we need Non-invasive Cardiovascular Measurements?......Page 63
Electrical Impedance Tomography......Page 64
EKG Gating......Page 65
Optimized Separation in the Temporal and Spatial Domains......Page 66
Contrast Agents......Page 67
Deriving Stroke Volume from Cardiac Impedance Images......Page 68
Impedance-time Curves......Page 69
Conclusion......Page 70
References......Page 71
Case Study 1: Components of an Arterial Pressure Waveform......Page 73
Case Study 2: Hypovolemia......Page 74
Case Study 3: Pulse Pressure as a Measure of Stroke Volume......Page 75
Case Study 5: Effect of Vasoconstrictor Drugs on Pulse Pressure......Page 76
Case Study 6: Effect of Vasoconstriction on the Dicrotic Notch and Secondary Pressure Waves......Page 77
Case Study 7: Sympathetic Stimulation and Reflected Pressure Waves......Page 78
References......Page 79
What Do We Have and What Can they Do?......Page 81
Factors Affecting Choices......Page 84
References......Page 86
Section III. Resuscitation Issues......Page 89
Regurgitation and Aspiration after Cardiac Arrest......Page 90
Disadvantages of Tracheal Intubation......Page 91
Supraglottic Airway Devices......Page 92
Passive Oxygen Insufflation......Page 93
Conclusion......Page 94
References......Page 95
Introduction......Page 98
The Frequency of Gasping in Global Ischemic Events......Page 99
The Meaning of Gasping in Global Ischemic Events......Page 100
The Unique Physiology of Sudden Circulatory Collapse......Page 101
Gasping as an Independent Factor for Improving Survival......Page 103
Improved Airflow, Blood Flow, or Both?......Page 104
Using Gasps to Avoid the Detriments of Positive Pressure Breaths......Page 105
Better Detection of Cardiac Arrest Using Gasps......Page 106
The Role of Gasping in Trauma Care and Infant Resuscitation......Page 107
References......Page 108
Resuscitation Perspectives......Page 111
Can Metabolic Markers Guide Resuscitation and Help Predict Outcomes?......Page 113
Military Resuscitation Experience (Tables 1 and 2)......Page 115
Nurse-driven Resuscitation......Page 117
Consensus Statements......Page 119
References......Page 120
Introduction......Page 122
Does Hemodynamic Improvement Improve Prognosis in Infarction-triggered Cardiogenic Shock?......Page 123
Effects of IABP on Hemodynamics, Systemic Inflammation and MOF in Infarction-triggered Cardiogenic Shock......Page 125
What Does a Meta-Analysis Tell Us?......Page 126
Extracorporeal Membrane Oxygenation (ECMO)......Page 128
We Should Change the Guidelines for IABP Use in Infarction-triggered Cardiogenic Shock!......Page 129
Intra-aortic Balloon Counterpulsation in Septic Shock?......Page 130
References......Page 132
Section IV. Inflammatory Responses in the Lung......Page 134
Biology of VEGF......Page 135
Cellular Actions of VEGF......Page 136
VEGF as a Pathophysiological Driver of Acute Lung Injury?......Page 137
Tissue Studies......Page 138
Conclusion......Page 139
References......Page 141
Introduction......Page 143
CD14 and the LPS Receptor Complex......Page 145
CD14 and other Pattern Recognition Receptors......Page 146
Role of CD14 in LPS- and LTA-induced Lung Inflammation......Page 147
Role of CD14 in Lung Infection......Page 149
References......Page 152
Section V. Mechanical Ventilation......Page 155
Introduction......Page 156
Closed Circuit Techniques......Page 157
Open Circuit Wash-in/washout Procedures......Page 160
Respiratory Inductive Plethysmography......Page 162
Conclusion......Page 163
References......Page 164
Introduction......Page 167
Definition and Factors Affecting Recruitment Maneuvers......Page 168
Patient Positioning......Page 169
Impact of Recruitment Maneuver on Ventilator-induced Lung Injury......Page 170
The Role of Variable Ventilation as a Recruitment Maneuver......Page 172
Conclusion......Page 173
References......Page 174
Origin of Pleural Effusions in the Critically Ill Patient......Page 177
Modeling the Pleural Effusion-lung Interaction......Page 178
Pleural Effusion and Respiratory Mechanics......Page 179
Effects of Pleural Effusion on Gas Exchange......Page 181
Practical Implications for the Mechanically Ventilated Patient with Pleural Effusion......Page 182
Pleural Effusions and Ventilator-induced Lung Injury?......Page 184
References......Page 185
Mechanisms Contributing to the Development of Weaning-induced Pulmonary Edema......Page 188
Right Heart Catheterization......Page 189
Transthoracic Echocardiography......Page 190
Cardiac Biomarkers......Page 191
Detection of Weaning-induced Hemoconcentration......Page 192
Therapeutic Options......Page 193
References......Page 194
Section VI. Respiratory Failure......Page 196
Pathogenesis......Page 197
Effects of Acute Pleural Effusion on Lung Volume, Respiratory System Mechanics, and Gas Exchange......Page 198
Effects of Thoracentesis on Lung Volume, Respiratory System Mechanics, and Gas Exchange......Page 199
Pleural Effusion in Patients with ALI/ARDS......Page 201
Conclusion......Page 202
References......Page 203
Why was Pandemic (H1N1) 2009 Flu So Prevalent in the Southern Cone?......Page 205
How Big was the Outbreak?......Page 206
Common Complications of Influenza......Page 207
Management......Page 209
Ventilatory settings......Page 210
Prone position ventilation......Page 211
Antivirals......Page 212
Bacterial Infection......Page 213
Cryptogenic Organizing Pneumonia......Page 214
Conclusion......Page 215
References......Page 216
The Consequences of Pulmonary Edema during ARDS......Page 218
ARDS: Lesional or Hemodynamic Edema?......Page 219
Fluid Restriction and Diuretics: Clinical Studies and Practical Consequences......Page 221
Modulation of Oncotic or Osmotic Pressure: The Effects of Administering Albumin or Hypertonic Saline......Page 223
References......Page 225
Section VII. Infections......Page 228
Clinical Studies......Page 229
References......Page 232
Introduction......Page 233
Staff Educational/Quality Improvement Program......Page 234
Type of Catheter......Page 235
Catheter Insertion Site......Page 236
Skin Antisepsis......Page 237
Antibiotic Prophylaxis......Page 238
Dressing......Page 239
Venous Line Maintenance......Page 240
Conclusion......Page 241
References......Page 242
Prevention and Treatment of VAP......Page 245
Severe Sepsis and Septic Shock......Page 249
References......Page 251
Guidelines......Page 254
Adherence to Guidelines......Page 255
Barriers......Page 256
Theories of Change......Page 257
Implementation Interventions and Strategies......Page 258
The 2000s......Page 259
Interventional studies......Page 260
Systematic review......Page 261
Cost Considerations......Page 263
References......Page 264
STEP 1-Include the Antibiotic Stewardship Program within the Hospital Infection Control Program......Page 267
STEP 2-Be Aware of the Different Antibiotic Stewardship Program Strategies......Page 269
STEP 3-Define the Core Strategy/Key Antibiotics/Areas to Include within the Antibiotic Stewardship Program According to the Institution’s Resources......Page 273
Conclusion......Page 275
References......Page 276
Section VIII. Metabolic Support......Page 280
Historical Perspective......Page 281
Vitamin D and the Musculoskeletal System......Page 282
Vitamin D and the Immune System......Page 284
Vitamin D and Sepsis......Page 285
Challenges for the Intensivist......Page 286
References......Page 287
Section IX. Anticoagulant Therapies......Page 290
Introduction......Page 291
Therapeutic Effects of Antithrombin......Page 292
Coagulation-independent anti-inflammatory effects......Page 293
Interactions with Heparin......Page 295
Experimental Studies......Page 296
Clinical Studies......Page 298
References......Page 300
Inflammation-induced Effects on Physiological Anticoagulant Factors......Page 303
The Antithrombin System......Page 304
The Thrombomodulin-protein C System......Page 305
Effects of Natural Anticoagulant Systems on Inflammation......Page 306
Antithrombin Concentrate......Page 308
Recombinant Human Activated Protein C......Page 309
Recombinant Tissue Factor Pathway Inhibitor......Page 312
References......Page 313
Section X.       Anemia and Blood Transfusions......Page 316
Venous Oxygen Saturation as a Physiologic Transfusion Trigger......Page 317
The Concept of Physiologic Transfusion Trigger......Page 321
References......Page 323
Introduction......Page 325
EPO and Tissue Protection......Page 326
Tissue Protection and Clinical Trials......Page 327
Erythropoiesis versus Tissue Protection......Page 328
Conclusion......Page 329
References......Page 330
Section XI.         Renal Disease and Therapy......Page 333
Introduction......Page 334
Technique......Page 335
Physiological Significance of the Renal Resistive Index......Page 336
Obstructive Renal Diseases......Page 337
Conclusion......Page 338
References......Page 339
The Discovery of the Atrial Natriuretic Peptide System......Page 342
Tubular Effects of ANP......Page 343
Effects of ANP on Renal Blood Flow and GFR in Postoperative Acute Renal Failure......Page 344
Effects of ANP on Renal Outcome in Acute Renal Failure......Page 345
Meta-Analysis of ANP in the Management of Acute Renal Dysfunction......Page 348
References......Page 349
Co-existing Liver and Kidney Disease......Page 352
Serum Creatinine Concentration for the Assessment of Kidney Function in Chronic Liver Disease......Page 354
Acute Kidney Injury Network Criteria for staging Acute Kidney Injury......Page 355
Patients with Chronic Liver Disease are more Susceptible to Acute Kidney Injury......Page 356
Hepatorenal Syndrome......Page 357
Acute Kidney Injury and Chronic Liver Disease......Page 358
Kidney Disease Outcome Quality Initiative Criteria for Staging Chronic Kidney Disease......Page 359
Future Directions......Page 362
Orthotopic Liver Transplantation......Page 363
Conclusion......Page 364
References......Page 365
Introduction......Page 368
Synergistic action of HVHF and Enhanced Adsorption: Clinical Feasibility and Effects beyond Hemodynamics......Page 369
New Pathophysiological Insight regarding Septic Acute Kidney Injury......Page 371
Update on Very Recent Trials in Critically ill Patients with AKI......Page 372
References......Page 373
A Problem of Uremia......Page 376
From Acute Renal Failure to AKI, and from Renal Replacement Therapy to Renal Support: A Paradigm Shift......Page 377
Early initiation in the course of AKI......Page 379
Conclusion......Page 380
References......Page 381
Section XII. Neurological Aspects......Page 383
Introduction......Page 384
Multimodal Monitoring in Hypoxic-Ischemic Encephalopathy......Page 385
Multimodal Monitoring in Traumatic Brain Injury......Page 386
Multi-modal Monitoring in Cerebrovascular Disease......Page 388
Conclusion......Page 390
References......Page 391
Overview of the Incidence and Pathophysiology of Acute Traumatic Spinal Cord Injury-induced Cardiovascular Dysfunction......Page 393
Blood Pressure Augmentation in Patients with Acute Traumatic Spinal Cord Injury......Page 394
Spinal Cord Perfusion Pressure, Intrathecal Pressure, and Treatment......Page 396
Conclusion......Page 397
References......Page 398
Introduction......Page 400
Quantitative Computed Tomography......Page 401
Quantative CT Study of Non-contused Hemispheric Areas......Page 403
Quantitative CT Study of Contused Hemispheric Areas......Page 406
Interpretation of Estimated Specific Gravity Variation......Page 407
Conclusion......Page 409
References......Page 410
Inflammation and the Brain......Page 412
Effects of Sepsis on the Blood-brain Barrier and the Vascular Endothelium......Page 413
CO2-reactivity......Page 414
Cerebral perfusion and sepsis-associated delirium......Page 415
Conclusion......Page 416
References......Page 417
Introduction......Page 420
Cardiac Abnormalities......Page 421
Lung Abnormalities......Page 422
Anemia......Page 423
Electrolyte Abnormalities......Page 424
References......Page 426
Section XIII. Perioperative Management......Page 429
Introduction......Page 430
Effects of Thoracic Epidural Anesthesia on Myocardial Function......Page 431
Effects of Thoracic Epidural Anesthesia on Gastrointestinal Function......Page 432
Effects of Thoracic Epidural Anesthesia on Long-term Outcome......Page 433
Adverse Effects and Potential Risks of Epidural Anesthesia......Page 434
References......Page 435
Pathophysiology......Page 438
Review of Clinical Studies......Page 440
Preventive Strategies......Page 448
Conclusion: Proposed/useful Clinical Perioperative Guidelines......Page 450
References......Page 451
Pathology......Page 454
Preoperative Pain......Page 455
Others......Page 456
References......Page 458
Section XIV. Abdominal Compartment Syndrome......Page 461
Orbital Compartment Syndrome......Page 462
Intracranial Compartment Syndrome......Page 465
Thoracic Compartment Syndrome......Page 466
Cardiac Compartment Syndrome......Page 468
Limb or Extremity Compartment Syndrome......Page 470
Renal Compartment Syndrome......Page 472
Abdominal Compartment Syndrome......Page 473
Abdominal perfusion pressure measurement......Page 476
Clinical Management......Page 477
References......Page 478
Who Started Laparostomy?......Page 482
Temporary Abdominal Cover......Page 483
Definitive Abdominal Wall Closure......Page 484
Does Laparostomy Improve Outcome?......Page 485
References......Page 487
Section XV.          Drug Distribution and Clearance......Page 489
Defining Augmented Renal Clearance......Page 490
Assessing Renal Function in Critical Illness......Page 491
Prevalence and Natural History of Augmented Renal Clearance in the Critically Ill......Page 492
Traumatic Brain Injury......Page 493
Hematological Malignancy......Page 494
Aminoglycosides......Page 495
ß-lactam antibiotics......Page 496
Glycopeptides......Page 497
Therapeutic Drug Monitoring......Page 498
References......Page 499
Overview of Pharmacokinetic and Pharmacokinetic/pharmacodynamic Parameters......Page 502
Volume of Distribution versus Clearance: How do they Affect Serum Drug Concentration and Half-life?......Page 503
Causes and Consequences of Increased Volume of Distribution......Page 504
Obesity......Page 505
Other scenarios......Page 506
Hypoalbuminemia......Page 507
Clinical Significance and Recommended Dose Strategies......Page 508
References......Page 509
Section XVI.        Risk Stratification......Page 512
Introduction......Page 513
Organ Dysfunction/Failure Scores......Page 514
From Multiple Organ Dysfunction/Failure Scores to the PIRO Concept......Page 515
Should We Have One PIRO Or Many PIROs?......Page 518
Should we use PIRO or MOF Scores?......Page 519
References......Page 520
Section XVII. Critical Care Outreach......Page 523
Sub-optimal Care......Page 524
‘Track and Trigger’ Mechanisms......Page 525
Role of Critical Care Outreach Services......Page 526
Educational Tools......Page 527
Use of Technology as a Tool to ‘Track and Trigger’......Page 528
Human Factors......Page 529
References......Page 530
Introduction......Page 532
Existing Non-invasive Cardiovascular Monitoring is Ineffective at Identifying Instability In Step-down Units......Page 533
Integrated Monitoring Systems to Monitor the Monitors......Page 535
References......Page 536
Section XVIII. End-of-life Issues......Page 537
Role of the Intensivist......Page 538
Protocols for Management of the Potential Organ Donor......Page 539
Cardiovascular......Page 540
Pulmonary......Page 543
Endocrine......Page 544
Donation after Cardiac Death......Page 545
Conclusion......Page 547
References......Page 548
Discrepancy between Preferred and Actual Place of Death......Page 551
Variation in End-of-life Intensive Care Use......Page 552
An American Perspective......Page 553
A European Perspective......Page 555
Unintended Consequences of End-of-life Decision-making......Page 556
References......Page 557
Section XIX.    Patient Care......Page 560
Anesthesia/sedation and Sleep are not Identical, but may Share Common Mechanisms......Page 561
Exploring Sleep in ICU Patients......Page 562
Characteristics of Sleep Alteration in ICU Patients......Page 563
ICU Environment......Page 564
Drugs......Page 565
Impact of Sleep Disturbance on Patient Outcome......Page 566
Attenuation of Noise and Light......Page 567
Use of Pharmacological Interventions......Page 568
References......Page 569
The Importance of Communication and Culture......Page 571
“Say what you Mean, and Mean what you Say”......Page 572
Mitigating Speech: “No ifs, and, or Buts”......Page 573
Graded Assertiveness: Getting the Message Across......Page 574
Questioning Authority and Handing Over Responsibility: Underappreciated Skills......Page 575
Managing Interruptions and Distractions......Page 576
Conclusion......Page 577
References......Page 578
‘The Missing Curriculum’ [3]......Page 580
Engineering and Acute Care Medicine......Page 581
Understanding the Basics of Human Error......Page 582
Educating for Safety......Page 583
Maximizing the Best of Human and Machine......Page 584
Conclusion......Page 585
References......Page 586
Subject Index......Page 587