Nonpulmonary critical care:
Saved in:
| Format: | Book |
|---|---|
| Language: | English |
| Published: |
Philadelphia [u.a.]
Saunders
2003
|
| Series: | Clinics in chest medicine
24,4 |
| Subjects: | |
| Online Access: | Inhaltsverzeichnis |
| Physical Description: | XII S., S. 521 - 815 Ill., graph. Darst. |
Staff View
MARC
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| 245 | 1 | 0 | |a Nonpulmonary critical care |c Mark D. Siegel guest ed. |
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Record in the Search Index
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| adam_text | CONTENTS
Preface xi
Mark D. Siegel
New Approaches to the Treatment of Sepsis 521
James M. O Brien, Jr and Edward Abraham
The clinical spectrum of sepsis, severe sepsis, and septic shock is responsible for a grow¬
ing number of deaths and excessive health care expenditures. Until recently, despite
multiple clinical trials, no intervention provided a beneficial outcome in septic patients.
Within the last 2 years, studies that involved drotrecogin alfa (activated), corticosteroid
therapy, and early goal directed therapy showed efficacy in those with severe sepsis and
septic shock. These results have provided optimism for reducing sepsis related mortality.
Hemodynamic Monitoring in the Intensive Care Unit 549
Michael R. Pinsky
Hemodynamic monitoring is a diagnostic tool. Because it often requires invasive proce¬
dures, hemodynamic monitoring is associated with an increased incidence of untoward
events. Like any diagnostic tool, its ability to improve outcome is primarily related to the
survival benefit that is enjoyed by specific therapies that can only be given without com¬
plications based on their use. Presently, few specific treatment plans fit into this category.
The diagnostic accuracy of preload responsiveness is markedly improved by the use of
arterial pulse pressure or stroke volume variation, neither of which require pulmonary
arterial catheterization. The field of hemodynamic monitoring is rapidly evolving and
will probably continue to evolve at this rapid pace over the next 5 to 10 years as new
technologies, information management systems, and our understanding of the patho
physiology of critical illness progresses.
Critical Issues in Nephrology 561
Aldo J. Peixoto
Acute renal failure, and acid base and electrolyte disorders are common problems in
the care of critically ill patients. This article addresses recent advances in these areas,
with a focus on issues that affect patient management. Novel and controversial issues
are also discussed to keep the reader abreast of new prospective developments in criti¬
cal care nephrology.
VDI T IMP 7A . MI (MRFR A . TlFrPMRFP Onm
Critical Issues in Endocrinology 583
Philip A. Goldberg and Silvio E. Inzucchi
Endocrine emergencies are commonly encountered in the ICU. This article focuses on
several important endocrine emergencies, including diabetic hyperglycemic states,
adrenal insufficiency myxedema coma, thyroid storm, and pituitary apoplexy. Other
endocrine issues that are related to intensive care, such as intensive insulin therapy,
relative adrenal insufficiency, and thyroid function test abnormalities are also covered
in detail.
Critical Issues in Hematology: Anemia, Thrombocytopenia, Coagulopathy, and
Blood Product Transfusions in Critically 111 Patients 607
Reed E. Drews
Anemia, thrombocytopenia, and coagulopathy commonly occur among critically ill
patients. Pursuing structured evaluations of these hematologic problems is essential to
successful diagnosis and management. Certain clinical circumstances warrant adminis¬
tration of red blood cells, platelets, or plasma products, but potential benefits of blood
product transfusions must be balanced against risks. This article reviews evaluation of
anemia, thrombocytopenia, and coagulopathy and examines clinical circumstances that
guide blood product use.
Critical Issues in Digestive Diseases 623
Deborah D. Proctor
Gastrointestinal (GI) diseases are often encountered in the ICU setting, either as the
major cause that prompted admission to the ICU or as a comorbid complication of
another primary disease process. The most common digestive disease that is seen in the
ICU is acute GI bleeding; upper GI bleeding occurring five times more commonly than
lower GI bleeding. This article discusses acute nonvariceal and variceal upper GI bleed¬
ing and lower GI bleeding. Prophylaxis against GI hemorrhage in the ICU setting is also
discussed. Acute pancreatitis is another common cause that mandates ICU admission
and is reviewed in this article. Lastly, acalculous cholecystitis is an example of a disease
that is usually a comorbid complication in critically ill patients and is often a difficult
diagnosis to make. Diagnosis and treatment of acalculous cholecystitis is discussed.
Nutritional Support in Critical Care 633
Simon V. Baudouin and Timothy W. Evans
Most critically ill patients receive some form of nutritional support during their stay in
the ICU. Attempts to maintain adequate body weight and composition in the severely ill
are complicated by a marked hypercatabolic response, which inevitably leads to protein
loss. An evidence based approach to ICU nutrition provides some guidance on optimal
routes of feeding, feed composition, and the use of prokinetics. Recent clinical trials of
immunonutrients, growth hormone, and insulin also inform the debate on best nutri¬
tional practice in the ICU. Despite several studies, many of the key issues in ICU feeding
remain controversial and a pragmatic approach to nutrition is often required in practice.
A Rational Approach to the Evaluation and Treatment of the Infected Patient in
the Intensive Care Unit 645
Jaime F. Avedllas, Peter Mazzone, and Alejandro C. Arroliga
Critically ill patients are at increased risk of acquiring nosocomial infections. A thorough
clinical evaluation, the use of appropriate diagnostic techniques, and the selection of
vi CONTENTS
effective empiric antimicrobial therapy are important elements in the assessment and
management of these patients. This article provides a stepwise approach for the evalu¬
ation and management of common ICU acquired infections, and reviews the different
diagnostic methods and therapeutic options currently available.
Pharmacologic Issues in the Critically 111 671
Vidya Krishnan and Patrick Murray
Pharmacotherapy of critically ill patients poses numerous challenges to the treating
physician. Individualization of therapy is recommended for all patients, using pharma
cokmetic and pharmacodynamic principles to design an optimal regimen. In critically ill
patients, the interplay between drug and patient, drug and disease, and drug drug
interactions causes alterations in drug disposition and effect, which must be accounted
for in regimen design. The approach to pharmacotherapy in the ICU should also include
alterations in response to dynamic physiologic changes, and a systematic approach to
the prevention, reporting, and correction of adverse drug events, including errors.
Toxicology in the Critically 111 Patient 689
Babak Mokhlesi and Thomas Corbridge
Critical care physicians confront intoxications that result from drug overdose, illicit drug
use, and accidental exposures. Current world affairs also require consideration of chem¬
ical and biologic agents of terrorism. In this article, we provide a systematic approach to
the intoxicated patient, review physical examination findings and laboratory data that
may aid in toxidrome (a symptom complex of specific poisoning) identification,
describe selected common intoxications, and briefly review selected chemical and bio¬
logic agents of terrorism.
Management of Agitation in the Intensive Care Unit 713
Mark D. Siegel
Agitation is a frequent, challenging problem in ICUs and affects at least 71% of patients,
both young and old. Contributing factors include underlying illness, pain, anxiety, and
delirium. Dangerous consequences range from poorly tolerated invasive therapy to self
destructive behavior that leads to widespread, sometimes heavy handed, sedation.
Patients in the ICU are often too sedated. A recent study found that fewer than 5% were
agitated when assessed; this suggested that some sedation is excessive or unnecessary.
Used inappropriately, sedatives can impair cognition and depress consciousness and
lead to secondary complications, such as failure to wean from mechanical ventilation,
prolonged ICU stays, and increased cost of care. Conscientious clinicians must strike a
balance between treating agitation and avoiding oversedation. This article outlines a
systematic, practical approach to evaluating agitation and suggests recommendations
for safe, effective treatment.
Cognitive Impairment in the Intensive Care Unit 727
Margaret A. Pisani, Lynn McNicoll, and Sharon K. Inouye
Delirium is a frequent complication in older patients in the ICU and often persists
beyond their ICU stay. Delirium in older persons in the ICU is a dynamic and com¬
plex process. There is a high prevalence of pre existing cognitive impairment in
patients who are admitted to the medical ICU. This pre existing cognitive impair¬
ment is an important predisposing risk factor for the development of delirium during
and after the ICU stay.
CONTENTS vii
Guidelines in the Intensive Care Unit 739
T. Sinuff and D.J. Cook
The recent movement toward standardization of critical care practice is associated with
a growth in the use of guidelines and protocols. Although complex, the process of guide¬
line development, implementation, evaluation, and maintenance can be systematic.
Guideline implementation can improve the processes and outcomes of care; however,
guideline adherence represents a major challenge to their success. The quality of the
growing number of practice guidelines in critical care is important to assess and several
useful instruments are available for this purpose.
Prognostication and Intensive Care Unit Outcome: The Evolving Role of
Scoring Systems 751
Margaret S. Herridge
Scoring systems for critically ill patients should be viewed as works in progress. Their
evolution is driven by new insights into the pathophysiology of critical illness and the
adoption of a new philosophy of critical illness as a continuum from inciting disease to
ICU management to post ICU rehabilitation. Newer applications for existing scoring
systems have enabled us to better characterize the burden of organ failure throughout
the ICU stay, to more fully understand what is truly ICU acquired morbidity, and how
the severity of critical illness has important implications for long term outcome.
Improving Care for Patients Dying in the Intensive Care Unit 763
Gordon D. Rubenfeld and J. Randall Curtis
It is impossible for ICU clinicians to avoid caring for dying patients and their families.
For many, this is an extremely rewarding aspect of their clinical practice. There is
ample evidence that there is room to improve the care of patients who are near death
in the ICU. Despite the considerable holes in our knowledge about optimal care of
dying critically ill patients, there is considerable agreement on the general principles
of caring for these patients and about how to measure the outcomes of palliative care
in the ICU. Practical approaches to improving the quality of end of life care exist and
should be implemented.
The Evaluation and Management of Shock 775
Cheryl L. Holmes and Keith R. Walley
Shock is an emergency that requires continuous bedside evaluation, resuscitation, and
re evaluation. This article provides a clinical approach to the evaluation and manage¬
ment of shock that consists of a primary survey that focuses the clinician on formu¬
lating a working hypothesis and initial resuscitation, and a secondary survey that is
critical to the re evaluation of the hypothesis and institution of specific management
strategies. Hemodynamic management of the initial phase of shock is discussed with
a focus on the tempo of resuscitation. Specifics of therapy for the common causes of
shock are reviewed with emphasis on new therapies for septic shock.
Cumulative Index 2003 791
viii CONTENTS
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| spelling | Nonpulmonary critical care Mark D. Siegel guest ed. Philadelphia [u.a.] Saunders 2003 XII S., S. 521 - 815 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Clinics in chest medicine 24,4 Intensive care gtt Critical Care Critical care medicine Siegel, Mark D. Sonstige oth Clinics in chest medicine 24,4 (DE-604)BV000001084 24,4 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=010682689&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Nonpulmonary critical care Clinics in chest medicine Intensive care gtt Critical Care Critical care medicine |
| title | Nonpulmonary critical care |
| title_auth | Nonpulmonary critical care |
| title_exact_search | Nonpulmonary critical care |
| title_full | Nonpulmonary critical care Mark D. Siegel guest ed. |
| title_fullStr | Nonpulmonary critical care Mark D. Siegel guest ed. |
| title_full_unstemmed | Nonpulmonary critical care Mark D. Siegel guest ed. |
| title_short | Nonpulmonary critical care |
| title_sort | nonpulmonary critical care |
| topic | Intensive care gtt Critical Care Critical care medicine |
| topic_facet | Intensive care Critical Care Critical care medicine |
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