Suchen und Finden
Title Page
2
Copyright Page
3
Table of Contents
4
List of Contributors
8
Common Abbreviations
19
I The Microcirculation
20
The Microcirculation and Oxidative Stress
21
Introduction
21
Reactive Oxygen Species
21
Sources of ROS in the Microcirculation
23
Mitochondria
23
NADPH Oxidase
23
NO Synthase
24
Xanthine Oxidase
24
Other Sources of Superoxide Anion Production
25
Interactions of ROS with the Microcirculation
25
Leukocyte-endothelial Cell Adhesion
26
Vascular Tone Regulation
27
The Vast Spectrum of Intracellular Targets for ROS
27
Role of Oxidative Stress in Microcirculatory Dysfunction
28
Ischemia-reperfusion
28
Sepsis
29
Conclusion
31
References
31
Diagnosis and Treatment of the Septic Microcirculation
34
Introduction
34
Normal Microcirculation
34
The Microcirculation in Sepsis
36
Bedside Study of the Microcirculation
37
The Microcirculation in Distributive Shock
37
Recruiting the Microcirculation Network During Distributive Shock
41
Conclusion
42
References
43
Targeted Treatment of Microvascular Dysfunction
45
Introduction: Microvascular dysfunction is the Root Cause of Inflammatory Organ Dysfunction
45
Traditional Therapies and Biomarkers have Centered on the Macrocirculation
45
New Methods of Assessing the Microcirculation
46
Therapeutic Approaches
47
Suppression of Intracellular Inflammatory Signaling
47
Other inhibitors of cellular inflammation
48
Suppression of Circulating Mediators of Inflammation
49
Large scale removal by hemofiltration
49
Intravenous immunoglobulin
49
Neutralizing antibodies
49
Coagulation
50
Conclusion
50
References
51
II Hemodynamic Monitoring
54
Diagnosing Hypovolemia in Critically Ill Patients
55
Introduction
55
Defining Hypovolemia
55
Diagnosing Hypovolemia
55
Static Diagnostic Tests
56
Dynamic Diagnostic Tests
56
Fluid challenge
56
Arterial waveform-derived variables
56
Passive leg raising
58
Perspective
59
Conclusion
60
References
60
Measuring Stroke Volume Using Electrical Impedance Tomography
62
Introduction
62
Why do we need Non-invasive Cardiovascular Measurements?
62
Electrical Impedance Tomography
63
EIT-based Methods to Measure Stroke Volume
64
Holding the Breath
64
EKG Gating
64
Optimized Separation in the Temporal and Spatial Domains
65
Contrast Agents
66
Deriving Stroke Volume from Cardiac Impedance Images
67
Impedance-time Curves
68
Parametric EIT
69
Conclusion
69
References
70
Direct Arterial Pressure Monitoring: Pattern Recognition in the Management of Circulatory Failure
72
Introduction
72
Case Study 1: Components of an Arterial Pressure Waveform
72
Case Study 2: Hypovolemia
73
Case Study 3: Pulse Pressure as a Measure of Stroke Volume
74
Case Study 4: Effect of Aortic Capacitance on Pulse Pressure
75
Case Study 5: Effect of Vasoconstrictor Drugs on Pulse Pressure
75
Case Study 6: Effect of Vasoconstriction on the Dicrotic Notch and Secondary Pressure Waves
76
Case Study 7: Sympathetic Stimulation and Reflected Pressure Waves
77
Conclusion
78
References
78
Choosing Patient-tailored Hemodynamic Monitoring
80
Introduction
80
What Do We Have and What Can they Do?
80
Factors Affecting Choices
83
Conclusions and Perspective
85
References
85
III Resuscitation Issues
88
Airway and Ventilation during CPR
89
Introduction
89
Regurgitation and Aspiration after Cardiac Arrest
89
The Pros and Cons of Tracheal Intubation
90
Advantages of Tracheal Intubation
90
Disadvantages of Tracheal Intubation
90
Reducing the Risk of Unrecognized Esophageal Intubation
91
Supraglottic Airway Devices
91
Ventilation during CPR
92
Passive Oxygen Insufflation
92
Mouth-to-mouth Ventilation
93
Conclusion
93
References
94
The Role of Gasping in Resuscitation
97
Introduction
97
The Frequency of Gasping in Global Ischemic Events
98
The Meaning of Gasping in Global Ischemic Events
99
The Unique Physiology of Sudden Circulatory Collapse
100
Gasping as an Independent Factor for Improving Survival
102
Improved Airflow, Blood Flow, or Both?
103
Using Gasps to Avoid the Detriments of Positive Pressure Breaths
104
Better Detection of Cardiac Arrest Using Gasps
105
The Role of Gasping in Trauma Care and Infant Resuscitation
106
Creating Gasps for Those Who Do Not Do So
107
Conclusion
107
References
107
Recent Concepts in Burn Resuscitation
110
Introduction
110
Resuscitation Perspectives
110
Can Metabolic Markers Guide Resuscitation and Help Predict Outcomes?
112
Military Resuscitation Experience (Tables 1 and 2)
114
Nurse-driven Resuscitation
116
Consensus Statements
118
Conclusion
119
References
119
Intra-aortic Balloon Counterpulsation in Cardiogenic Shock
121
Introduction
121
What do the Guidelines tell Us and What about ‘Real Life’?
122
Does Hemodynamic Improvement Improve Prognosis in Infarction-triggered Cardiogenic Shock?
122
Effects of IABP on Hemodynamics, Systemic Inflammation and MOF in Infarction-triggered Cardiogenic Shock
124
What Does a Meta-Analysis Tell Us?
125
Beyond IABP: Do We Have Better Alternatives for the Treatment of Cardiogenic Shock?
127
Impella® Pump
127
Extracorporeal Membrane Oxygenation (ECMO)
127
Tandem Heart®
128
Assisted Extracorporeal Life-support in Adults with In-hospital Cardiac Arrest
128
IABP versus Percutaneous LVAD in Cardiogenic Shock: A Meta-analysis
128
We Should Change the Guidelines for IABP Use in Infarction-triggered Cardiogenic Shock!
128
Intra-aortic Balloon Counterpulsation in Septic Shock?
129
Conclusion
131
References
131
IV Inflammatory Responses in the Lung
133
Vascular Endothelial Growth Factor in Acute Lung Injury
134
Introduction
134
Biology of VEGF
134
VEGF Receptors
135
Cellular Source of VEGF within the Lung
135
Cellular Actions of VEGF
135
VEGF as a Pathophysiological Driver of Acute Lung Injury?
136
VEGF Compartmentalization in Acute Lung Injury
137
Tissue Studies
137
Regulation of VEGF Bioactivity
138
Is there a Unifying Hypothesis for the Role of VEGF in Acute Lung Injury?
138
Conclusion
138
References
140
Role of CD14 in Lung Inflammation and Infection
142
Introduction
142
CD14 and the LPS Receptor Complex
144
CD14 and other Pattern Recognition Receptors
145
Role of CD14 in LPS- and LTA-induced Lung Inflammation
146
Role of CD14 in Lung Infection
148
Conclusion
151
References
151
V Mechanical Ventilation
154
Measurement of Functional Residual Capacity during Mechanical Ventilation
155
Introduction
155
Methods for FRC Measurement During Mechanical Ventilation
156
Closed Circuit Techniques
156
Open Circuit Wash-in/washout Procedures
159
Respiratory Inductive Plethysmography
161
Computed Tomography Scan
162
Conclusion
162
References
163
New and Conventional Strategies for Lung Recruitment in Acute Respiratory Distress Syndrome
166
Introduction
166
Definition and Factors Affecting Recruitment Maneuvers
167
Nature and Extent of Lung Injury
168
Patient Positioning
168
Types of Recruitment Maneuver
169
Impact of Recruitment Maneuver on Ventilator-induced Lung Injury
169
The Role of Variable Ventilation as a Recruitment Maneuver
171
Conclusion
172
References
173
Consequences of Pleural Effusions for Respiratory Mechanics in Ventilated Patients
176
Introduction
176
Origin of Pleural Effusions in the Critically Ill Patient
176
Modeling the Pleural Effusion-lung Interaction
177
Pleural Effusion and Respiratory Mechanics
178
Effects of Pleural Effusion on Gas Exchange
180
Practical Implications for the Mechanically Ventilated Patient with Pleural Effusion
181
Pleural Effusions and Ventilator-induced Lung Injury?
183
Conclusion
184
References
184
Weaning Failure of Cardiac Origin: Recent Advances
187
Introduction
187
Mechanisms Contributing to the Development of Weaning-induced Pulmonary Edema
187
Diagnosis of Weaning-induced Pulmonary Edema
188
Clinical Context
188
Right Heart Catheterization
188
Transthoracic Echocardiography
189
Cardiac Biomarkers
190
Detection of Weaning-induced Hemoconcentration
191
Therapeutic Options
192
Conclusion
193
References
193
VI Respiratory Failure
195
The Effects of Pleural Effusion
196
Introduction
196
Pathogenesis
196
Effects of Acute Pleural Effusion on Lung Volume, Respiratory System Mechanics, and Gas Exchange
197
Effects of Thoracentesis on Lung Volume, Respiratory System Mechanics, and Gas Exchange
198
Pleural Effusion in Patients with ALI/ARDS
200
Conclusion
201
References
202
Fluid Management in Acute Lung Injury and ARDS
204
Introduction
204
The Consequences of Pulmonary Edema during ARDS
204
ARDS: Lesional or Hemodynamic Edema?
205
Resorption and Drainage of Pulmonary Edema
207
Fluid Restriction and Diuretics: Clinical Studies and Practical Consequences
207
Modulation of Oncotic or Osmotic Pressure: The Effects of Administering Albumin or Hypertonic Saline
209
Increasing Resorption of Alveolar Edema – A Complementary Objective
211
Conclusion
211
References
211
Life-threatening Respiratory Failure from H1N1 Influenza: Lessons from the Southern Cone Outbreak
214
Introduction
214
Why was Pandemic (H1N1) 2009 Flu So Prevalent in the Southern Cone?
214
How Big was the Outbreak?
215
Common Complications of Influenza
216
Risk Factors for the Acquisition of Severe H1N1 2009 Primary Influenza Pneumonia
218
Differences Comparing this Pandemic with the usual Seasonal Flu
218
Management
218
Non-pharmacologic Therapy
219
Ventilatory settings
219
Recruitment maneuvers
220
Prone position ventilation
220
Adjunctive therapies to mechanical ventilation
221
Pharmacologic Therapy
221
Antivirals
221
Antibacterial antimicrobials
222
Corticosteroid therapy
222
Complications
222
Bacterial Infection
222
Pulmonary Embolism
223
Extrapulmonary Manifestations
223
Renal Failure
223
Cryptogenic Organizing Pneumonia
223
Prognostic Factors for Fatal Influenza Pneumonia
224
Preventive Measures
224
Conclusion
224
References
225
VII Infections
227
Cytomegalovirus Infections in Non-immunocompromised Critically Ill Patients
228
Introduction
228
Clinical Studies
228
Conclusion
231
References
231
Prevention of Central Venous Catheter-related Infection in the Intensive Care Unit
232
Introduction
232
Catheter Care Protocols
233
Staff Educational/Quality Improvement Program
233
Type of Catheter
234
Catheter Insertion Site
235
Ultrasound-guided Placement
236
Insertion Technique
236
Skin Antisepsis
236
Antibiotic Prophylaxis
237
Tunneling
238
Dressing
238
Venous Line Maintenance
239
Conclusion
240
References
241
Standardization of Care to Improve Outcomes of Patients with Ventilator-associated Pneumonia and Severe Sepsis
244
Introduction
244
Prevention and Treatment of VAP
244
Severe Sepsis and Septic Shock
248
Conclusion
250
References
250
Strategies for Implementation of Evidence-based Guidelines for Prevention of Healthcare-associated Infection
253
Introduction
253
Guidelines
253
Adherence to Guidelines
254
Barriers
255
Facilitators
256
Theories of Change
256
Implementation Research
257
Implementation Interventions and Strategies
257
Short Historical Overview
258
The 1990s
258
The 2000s
258
Current insights
259
Implementation of Infection Prevention Guidelines
259
Interventional studies
259
Systematic review
260
Evaluating the Implementation
262
Cost Considerations
262
Conclusion
263
References
263
Antibiotic Stewardship: Possibilities when Resources Are Limited
266
Introduction
266
STEP 1-Include the Antibiotic Stewardship Program within the Hospital Infection Control Program
266
STEP 2-Be Aware of the Different Antibiotic Stewardship Program Strategies
268
STEP 3-Define the Core Strategy/Key Antibiotics/Areas to Include within the Antibiotic Stewardship Program According to the Institution’s Resources
272
STEP 4-Develop and Define Institution-adapted Antibiotic Stewardship Program Performance Indicators
274
Conclusion
274
References
275
VIII Metabolic Support
279
Vitamin D in Critical Illness
280
Introduction
280
Historical Perspective
280
Circadian Rhythm of Vitamin D
281
Pleiotropic Effects of Vitamin D
281
Vitamin D and the Musculoskeletal System
281
Vitamin D and Cardiovascular Disease
283
Vitamin D and the Immune System
283
Vitamin D and Sepsis
284
Miscellaneous Effects of Vitamin D
285
Vitamin D in Critical Illness
285
Challenges for the Intensivist
285
References
286
IX Anticoagulant Therapies
289
Update on Antithrombin for the Treatment of Burn Trauma and Smoke Inhalation Injury
290
Introduction
290
Antithrombin
291
Therapeutic Effects of Antithrombin
291
Anticoagulant Effects
292
Anti-inflammatory effects dependent on the coagulation system
292
Coagulation-independent anti-inflammatory effects
292
Interactions with Heparin
294
Antithrombin for the Treatment of Burn Trauma and Smoke Inhalation Injury
295
Experimental Studies
295
Clinical Studies
297
Conclusion
299
References
299
Update on Physiological Anticoagulant Factor Concentrates in Patients with Sepsis
302
Introduction
302
Inflammation-induced Effects on Physiological Anticoagulant Factors
302
The Antithrombin System
303
The Thrombomodulin-protein C System
304
Tissue Factor Pathway Inhibitor
305
Effects of Natural Anticoagulant Systems on Inflammation
305
Clinical Application of Natural Anticoagulant Factor Concentrates
307
Antithrombin Concentrate
307
Recombinant Human Activated Protein C
308
Soluble Thrombomodulin
311
Recombinant Tissue Factor Pathway Inhibitor
311
Conclusion
312
References
312
X Anemia and Blood Transfusions
315
Venous Oxygen Saturation as a Physiologic Transfusion Trigger
316
Introduction
316
Venous Oxygen Saturation as a Physiologic Transfusion Trigger
316
The Concept of Physiologic Transfusion Trigger
320
Conclusion
322
References
322
Tissue Protective Activities of Erythropoietin
324
Introduction
324
EPO and Tissue Protection
325
Tissue Protection and Clinical Trials
326
Erythropoiesis versus Tissue Protection
327
Conclusion
328
References
329
XI Renal Disease and Therapy
332
Doppler-Based Renal Resistive Index: A Comprehensive Review
333
Introduction
333
Technique
334
Physiological Significance of the Renal Resistive Index
335
Doppler-Based Renal Resistive Index in Selected Renal Diseases
336
Non-obstructive Renal Diseases
336
Obstructive Renal Diseases
336
A Promising Tool in Critically Ill Patients?
337
Conclusion
337
References
338
Atrial Natriuretic Peptide in Postoperative Acute Renal Failure
341
Introduction
341
The Discovery of the Atrial Natriuretic Peptide System
341
Renal Effects of ANP in Humans
342
Renal Blood Flow
342
Glomerular Filtration Rate
342
Tubular Effects of ANP
342
Effects of ANP on Renal Oxygen Consumption
343
Effects of ANP on Renal Blood Flow and GFR in Postoperative Acute Renal Failure
343
Effects of ANP on Renal Outcome in Acute Renal Failure
344
Effects of ANP in Other Forms of Clinical Acute Renal Failure
347
Cyclosporine-induced Acute Renal failure
347
Liver Transplantation
347
Radiocontrast-induced Nephropathy
347
Meta-Analysis of ANP in the Management of Acute Renal Dysfunction
347
Conclusion
348
References
348
Renal Dysfunction in Chronic Liver Disease
351
Introduction
351
Co-existing Liver and Kidney Disease
351
Serum Creatinine Concentration for the Assessment of Kidney Function in Chronic Liver Disease
353
Acute Kidney Injury Network Criteria for staging Acute Kidney Injury
354
Acute Kidney Injury Pathogenesis
355
Patients with Chronic Liver Disease are more Susceptible to Acute Kidney Injury
355
Hepatorenal Syndrome
356
Acute Kidney Injury and Chronic Liver Disease
357
Biomarkers of AKI
358
Kidney Disease Outcome Quality Initiative Criteria for Staging Chronic Kidney Disease
358
Assessment of Chronic Kidney Disease in Patients with Chronic Liver Disease
361
Future Directions
361
Orthotopic Liver Transplantation
362
Conclusion
363
References
364
Hemofiltration and Hybrid Therapies in 2010
367
Introduction
367
Mechanisms of Removal and Transport by Synergistic Action of HVHF and Enhanced Adsorption
368
Synergistic action of HVHF and Enhanced Adsorption: Clinical Feasibility and Effects beyond Hemodynamics
368
New Pathophysiological Insight regarding Septic Acute Kidney Injury
370
Update on Very Recent Trials in Critically ill Patients with AKI
371
Conclusion
372
References
372
Timing of Renal Replacement Therapy
375
Introduction
375
AKI: An Historical Overview
375
A Problem of Uremia
375
The Concept of Prophylactic Dialysis
376
From Acute Renal Failure to AKI, and from Renal Replacement Therapy to Renal Support: A Paradigm Shift
376
Definition of Timing of Initiation of RRT in ICU Patients
378
What does the Evidence tell Us?
378
Urea
378
Volume overload
378
Early initiation in the course of AKI
378
Future Directions: Early Goal-directed Therapy to Improve Renal Outcome
379
Conclusion
379
References
380
XII Neurological Aspects
382
Multimodal Monitoring: A Critical Tool in the Neuro-ICU
383
Introduction
383
Multimodal Monitoring in Hypoxic-Ischemic Encephalopathy
384
Multimodal Monitoring in Traumatic Brain Injury
385
Multi-modal Monitoring in Cerebrovascular Disease
387
Conclusion
389
References
390
Hemodynamic Management of Acute Spinal Cord Injury
392
Introduction
392
Overview of the Incidence and Pathophysiology of Acute Traumatic Spinal Cord Injury-induced Cardiovascular Dysfunction
392
Blood Pressure Augmentation in Patients with Acute Traumatic Spinal Cord Injury
393
Spinal Cord Perfusion Pressure, Intrathecal Pressure, and Treatment
395
Potential Risks of Blood Pressure Augmentation in Acute Spinal Cord Injury
396
Conclusion
396
References
397
Quantitative CT Scan and CT-Estimated Brain Specific Gravity in TBI
399
Introduction
399
Quantitative Computed Tomography
400
Quantative CT Study of Non-contused Hemispheric Areas
402
Quantitative CT Study of Contused Hemispheric Areas
405
Interpretation of Estimated Specific Gravity Variation
406
Conclusion
408
References
409
Cerebral Perfusion in Sepsis
411
Introduction
411
Sepsis and the Brain
411
Inflammation and the Brain
411
Effects of Sepsis on the Blood-brain Barrier and the Vascular Endothelium
412
Cerebral Perfusion
413
Cerebral Perfusion Pressure
413
Regulation of Cerebral Perfusion
413
CO2-reactivity
413
Cerebrovascular pressure autoregulation
414
Perfusion and Brain Dysfunction
414
Cerebral ischemia
414
Cerebral perfusion and sepsis-associated delirium
414
Effects of catecholamines on cerebral perfusion in patients with sepsis
415
Conclusion
415
References
416
Systemic Complications after Subarachnoid Hemorrhage
419
Introduction
419
Cardiac Abnormalities
420
Lung Abnormalities
421
Fever
422
Anemia
422
Hyperglycemia
423
Electrolyte Abnormalities
423
Conclusions
425
References
425
XIII Perioperative Management
428
Epidural Anesthesia: New Indications for an Old Technique?
429
Introduction
429
Effects of Epidural Anesthesia on Pain Management
430
Effects of Thoracic Epidural Anesthesia on Myocardial Function
430
Effects of Thoracic Epidural Anesthesia on Pulmonary Function
431
Effects of Thoracic Epidural Anesthesia on Gastrointestinal Function
431
Effects of Thoracic Epidural Anesthesia on the Immune System
432
Effects of Thoracic Epidural Anesthesia on Long-term Outcome
432
Adverse Effects and Potential Risks of Epidural Anesthesia
433
Conclusion
434
References
434
Risk Assessment and Prevention of Perioperative Stroke
437
Introduction
437
Pathophysiology
437
Review of Clinical Studies
439
Preventive Strategies
447
Conclusion: Proposed/useful Clinical Perioperative Guidelines
449
References
450
Overview of Chronic Post-thoracotomy Pain: Etiology and Treatment
453
Introduction
453
Prevalence
453
Pathology
453
Preoperative Factors
454
Demographic Factors
454
Genetics
454
Psychosocial Factors
454
Preoperative Pain
454
Intraoperative Factors
455
Surgery
455
Analgesia
455
Postoperative Factors
455
Others
455
Strategies for Treating Long Term Pain
457
Conclusion
457
References
457
XIV Abdominal Compartment Syndrome
460
The Polycompartment Syndrome: What’s all the Fuss About?
461
Introduction
461
Pathophysiology
461
Orbital Compartment Syndrome
461
Intracranial Compartment Syndrome
464
Thoracic Compartment Syndrome
465
Cardiac Compartment Syndrome
467
Limb or Extremity Compartment Syndrome
469
Hepatic Compartment Syndrome
471
Renal Compartment Syndrome
471
Pelvic Compartment Syndrome
472
Abdominal Compartment Syndrome
472
Monitoring of intra-abdominal pressure
475
Abdominal perfusion pressure measurement
475
Clinical Management
476
Conclusion
477
References
477
Laparostomy: Why and When?
481
Introduction
481
Who Started Laparostomy?
481
Temporary Abdominal Cover
482
Classification of Open Abdomen
483
Definitive Abdominal Wall Closure
483
Does Laparostomy Improve Outcome?
484
Conclusion
486
References
486
XV Drug Distribution and Clearance
488
Augmented Renal Clearance: Unraveling the Mystery of Elevated Antibiotic Clearance
489
Introduction
489
Defining Augmented Renal Clearance
489
Assessing Renal Function in Critical Illness
490
Changes in Critical Illness Contributing to Augmented Renal Clearance
491
Prevalence and Natural History of Augmented Renal Clearance in the Critically Ill
491
Traumatic Brain Injury
492
Surgery and Trauma
493
Burns
493
Hematological Malignancy
493
Hypoalbuminemia
494
What are the Clinical and Dosing Implications of Augmented Renal Clearance?
494
Concentration-dependent Killing
494
Aminoglycosides
494
Time-dependent Killing
495
ß-lactam antibiotics
495
Oxazolidinone antibiotics
496
AUC0–24/MIC antibiotics
496
Glycopeptides
496
Quinolone antibiotics
497
Therapeutic Drug Monitoring
497
Conclusion
498
References
498
Drug Distribution: Is it a more Important Determinant of Drug Dosing than Clearance?
501
Introduction
501
Overview of Pharmacokinetic and Pharmacokinetic/pharmacodynamic Parameters
501
Volume of Distribution versus Clearance: How do they Affect Serum Drug Concentration and Half-life?
502
Causes and Consequences of Increased Volume of Distribution
503
Chronic Increases in Volume of Distribution
504
Obesity
504
Chronic organ dysfunctions
505
Other scenarios
505
Acute Increases in Volume of Distribution
506
Severe sepsis
506
Burns
506
Hypoalbuminemia
506
Other scenarios
507
Measurement of Volume of Distribution in Critically Ill Patients
507
Clinical Significance and Recommended Dose Strategies
507
Conclusion
508
References
508
XVI Risk Stratification
511
Risk Stratification in Severe Sepsis: Organ Failure Scores, PIRO or Both?
512
Introduction
512
Organ Dysfunction/Failure Scores
513
From Multiple Organ Dysfunction/Failure Scores to the PIRO Concept
514
Should We Have One PIRO Or Many PIROs?
517
Should we use PIRO or MOF Scores?
518
References
519
XVII Critical Care Outreach
522
On the Response to Acutely Deteriorating Patients
523
Introduction: The Deteriorating Patient
523
Sub-optimal Care
523
‘Track and Trigger’ Mechanisms
524
Role of Critical Care Outreach Services
525
Educational Tools
526
Use of Technology as a Tool to ‘Track and Trigger’
527
Human Factors
528
Conclusion
529
References
529
Identifying Cardiorespiratory Insufficiency Outside the ICU
531
Introduction
531
Existing Non-invasive Cardiovascular Monitoring is Ineffective at Identifying Instability In Step-down Units
532
Integrated Monitoring Systems to Monitor the Monitors
534
Implications
535
References
535
XVIII End-of-life Issues
536
An Update on ICU Management of the Potential Organ Donor
537
Introduction
537
Role of the Intensivist
537
Physiologic Changes Associated with Brainstem Death
538
Protocols for Management of the Potential Organ Donor
538
Management of Individual Organ Systems
539
Cardiovascular
539
Pulmonary
542
Endocrine
543
Renal and Gastrointestinal
544
Coagulopathy and Hypothermia
544
Donation after Cardiac Death
544
Conclusion
546
References
547
End-of-life Care in the ICU: Commonalities and Differences between North America and Europe
550
Introduction
550
Discrepancy between Preferred and Actual Place of Death
550
Use of Critical Care Services during Terminal Hospitalization
551
Health Care Costs during Terminal Hospitalization
551
Variation in End-of-life Intensive Care Use
551
End-of-life Decision-making Process
552
An American Perspective
552
A European Perspective
554
Unintended Consequences of End-of-life Decision-making
555
Conclusion
556
References
556
XIX Patient Care
559
Do Sleep Disorders have an Impact on Outcome in ICU Patients?
560
Introduction
560
Anesthesia/sedation and Sleep are not Identical, but may Share Common Mechanisms
560
Exploring Sleep in ICU Patients
561
Characteristics of Sleep Alteration in ICU Patients
562
ICU Environment
563
Mechanical Ventilation
564
Drugs
564
Impact of Sleep Disturbance on Patient Outcome
565
Therapeutic Interventions to Preserve/improve Sleep (Table 2)
566
Attenuation of Noise and Light
566
Limiting Interventions
567
Changing to Assist-control or Proportional Assist Ventilatory Modes
567
Use of Pharmacological Interventions
567
Conclusion
568
References
568
Communication in Crisis: The Importance of ‘Verbal Dexterity’
570
Introduction
570
The Importance of Communication and Culture
570
Airway, Breathing, Communication: The New ABCs of Crisis Management
571
“Say what you Mean, and Mean what you Say”
571
Mitigating Speech: “No ifs, and, or Buts”
572
Silence is not always Golden
573
Graded Assertiveness: Getting the Message Across
573
Questioning Authority and Handing Over Responsibility: Underappreciated Skills
574
Practicing Verbal Dexterity
575
Managing Interruptions and Distractions
575
Communication really Ought to have Three Cs
576
Conclusion
576
References
577
Patient Safety and Acute Care Medicine: Lessons for the Future, Insights from the Past
579
Introduction
579
‘The Missing Curriculum’ [3]
579
Engineering and Acute Care Medicine
580
Engineering and Error Prevention
581
Understanding the Basics of Human Error
581
Educating for Safety
582
Maximizing the Best of Human and Machine
583
Other Lessons from the Chessboard
584
Conclusion
584
References
585
Subject Index
586
Alle Preise verstehen sich inklusive der gesetzlichen MwSt.