Cardiopulmonary Critical Care

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ISBN: 9781859962374 | 1859962378
Cover: Hardcover
Copyright: 6/15/2002

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A thorough understanding of the cardiopulmonary system is one of the foundations of critical care. In this new book, specialists in respiratory medicine, cardiology and critical care have united to present information essential for effective patient management. Cardiopulmonary Critical Care is a clinically relevant reference, not only as a study resource, but also for everyday use in the unit. Experts discuss thoracic trauma, fluid resuscitation in the ICU, acid base disorders, oxygen transport and tissue oxygenation, acute myocardial infarction and many other topics. This book, complete with diagrams, flowcharts and checklists, is essential for every ICU and hospital emergency room.

Abbreviations

xii

Contributors

Introduction

xvi

Acknowledgements

xviii

Respiratory physiology/pulmonary gas exchange

(16)

Robert M. Kacmarek

Introduction

(1)

Lung mechanics

(4)

The law of motion

(1)

Auto-PEEP

(1)

V/Q relationships

(2)

Evaluation of hypoxemia

(7)

Cardiac physiology

(18)

Jay S. Steingrub

Cardiac function

(1)

Preload

(2)

Afterload

(1)

Contractility

(1)

Heart rate

(1)

Diastolic function

(2)

Diagnosis and therapy of acute congestive heart failure

(3)

Therapy

(2)

Patient subsets

(6)

Oxygen transport and tissue oxygenation

(14)

William T. McGee

Paul Jodka

Introduction

(1)

Calculating oxygen transport

(2)

Balancing oxygen supply and demand

(1)

Clinical factors influencing oxygen supply

(1)

Determinants of oxygen consumption

(1)

Critical factors influencing cellular oxygen utilization

(1)

Evaluation of tissue oxygenation

(2)

Influence of loss of vasoregulation

(1)

Continuous mixed venous oxygen saturation in clinical medicine

(1)

Goal-directed therapy with DO2 and VO2

(2)

Summary

(1)

Essential equations

(3)

Acid-base disorders

(14)

Ali Al-Khafaji

Marcus J. Hampers

Howard L. Corwin

Introduction

(1)

Basic concepts and definitions

(2)

Approach to acid-base abnormalities

(1)

Metabolic acidosis

(1)

Anion gap metabolic acidosis

(4)

Normal anion gap metabolic acidosis

(2)

Respiratory acidosis

(1)

Metabolic alkalosis

(1)

Respiratory alkalosis

(3)

Bedside hemodynamic monitoring

(18)

Jay S. Steingrub

Introduction

(1)

Central venous monitoring

(2)

Pulmonary artery catheterization

(4)

Validity of measurements

(2)

Intrathoracic pressure changes during spontaneous respiration

(1)

Positive end-expiratory pressure (PEEP)

(1)

Ventricular compliance

(1)

Limitations of pulmonary artery wedge pressure

(1)

Thermodilution cardiac output

(1)

Derived hemodynamic parameters

(3)

Risk versus benefit

(3)

Shock in the intensive care unit

(18)

Jay S. Steingrub

Introduction

(1)

Pathophysiology

(1)

Specific shock syndromes

(1)

Hypovolemic shock

(3)

Distributive shock

(5)

Anaphylactic shock

(3)

Cardiogenic shock

(2)

Obstructive shock

(1)

Shock states

(3)

Fluid resuscitation in the ICU

(12)

Laurie A. Loiacono

Introduction

100

(1)

Definitions

100

(1)

Physiology of resuscitation

101

(3)

Strategy

104

(1)

Red blood cells (RBCs)

105

(1)

Crystalloid products

105

(2)

Cell-free colloids

107

(1)

Summary and conclusions

108

(1)

Recommendations for fluid resuscitation in the ICU

109

(2)

Circulatory support

111

(16)

Thomas L. Higgins

Introduction

112

(1)

The sympathetic nervous system

112

(2)

Receptors and signal transduction

114

(1)

Monitoring

115

(1)

Catecholamines and sympathomimetics

116

(5)

Alterations in adrenergic response

121

(2)

Bypassing the adrenergic receptor

123

(1)

Vasopressin

123

(1)

Weaning pharmacologic support

124

(1)

Summary

124

(3)

Hypertensive urgencies and emergencies

127

(20)

Thomas L. Higgins

Introduction

128

(1)

Definitions

128

(2)

Physiology of blood pressure control: MAP = SVR x CO

130

(2)

Monitoring considerations

132

(1)

Agents to decrease blood pressure

132

(9)

Specific clinical considerations

141

(3)

Medication-related hypertension

144

(1)

Conclusions

144

(3)

Acute myocardial infarction

147

(18)

Marc Schweiger

Overview

148

(1)

Diagnosis, definitions and triage

148

(3)

Initial treatment of acute ischemic syndrome

151

(4)

Thrombolytic therapy

155

(1)

Primary angioplasty

156

(1)

Lipid-lowering therapy

157

(1)

Complications of myocardial infarction

157

(1)

Subsequent treatment strategies

158

(3)

Summary

161

(4)

Cardiac rhythm disturbances

165

(18)

Magdy Migeed

Lawrence S. Rosenthal

Introduction

166

(1)

ECG analysis and interpretation

166

(1)

Supraventricular tachycardias

166

(2)

Treatment of supraventricular arrhythmias

168

(2)

Atrial fibrillation

170

(1)

Therapy of AF

171

(1)

Wide complex tachycardias

172

(2)

Approach to the patient with cardiac arrest

174

(5)

Bradyarrhythmias

179

(1)

Summary

179

(4)

Pulmonary embolism in the critically ill patient

183

(18)

Jay S. Steingrub

Introduction

184

(1)

Risk factors

184

(2)

Pathophysiology of pulmonary embolism

186

(1)

Differential diagnosis in the ICU

186

(1)

Diagnostic tests

187

(4)

Treatment

191

(5)

Right ventricular function

196

(1)

Other clinical interventions

197

(1)

Risk reduction

197

(4)

Modes of mechanical ventilation

201

(10)

Robert M. Kacmarek

Introduction

202

(1)

Volume versus pressure targeting

202

(4)

Traditional modes of ventilation

206

(3)

Pressure control inverse ratio ventilation (PCIRV)

209

(2)

Airway pressure release ventilation (APRV)

211

(1)

Combined modes of ventilation

212

The acute respiratory distress syndrome

221

(24)

C. Allen Bashour

James K. Stoller

Introduction

222

(1)

Historical perspective

222

(1)

Pathogenesis

223

(2)

Clinical presentation

225

(1)

Treatment

225

(6)

Prognosis and outcome

231

(1)

Conclusions

231

(4)

Lung-protective ventilation strategies

235

(18)

Robert M. Kacmarek

Ventilator-induced lung injury (VILI)

236

(6)

Lung-protective ventilatory strategies (LPVSs)

242

(6)

Setting of PEEP

248

(1)

Prone positioning

248

(2)

Summary

250

(3)

Nosocomial pneumonia

253

(18)

Thomas L. Higgins

Introduction

254

(1)

Risk factors for developing nosocomial pneumonia

254

(1)

Pathogens and routes of entry

255

(1)

Diagnosis

255

(3)

Antibiotic therapy

258

(2)

Choice of antibiotic

260

(4)

Prevention of nosocomial pneumonia

264

(1)

Antimicrobial resistance

265

(1)

Summary

266

(5)

Obstructive lung disease: asthma and COPD

271

(16)

Robert M. Kacmarek

Introduction

272

(1)

Auto-PEEP

272

(1)

Non-ventilatory management

272

(6)

Intubation

278

(1)

Mechanical ventilation

278

(3)

Weaning from ventilatory support

281

(6)

Weaning from mechanical ventilation

287

(20)

James K. Stoller

Thomas L. Higgins

Introduction

288

(1)

Who requires gradual withdrawal of mechanical ventilation

288

(1)

Sequelae of prolonged intubation and ventilation

289

(1)

Overview of the logic of weaning

289

(1)

Evaluation of breathing pattern

290

(2)

Work of breathing (WOB)

292

(1)

Tracheal occlusion pressure

293

(1)

Endurance measurements

293

(1)

Techniques of weaning

293

(2)

Studies comparing weaning modes

295

(1)

Non-respiratory impediments to successful weaning

296

(3)

Respiratory impediments to weaning

299

(1)

Pharmacologic aids to weaning

300

(1)

Weaning failure

301

(1)

Long-term prognosis

301

(6)

Noninvasive positive pressure ventilation (NIPPV)

307

(22)

Robert M. Kacmarek

Introduction

308

(1)

NIPPV for acute respiratory failure

308

(1)

Indication for noninvasive positive pressure

308

(9)

When should NIPPV be initiated for acute respiratory failure?

317

(1)

Complications or problems with NIPPV

317

(1)

The application of NIPPV

318

(6)

Summary

324

(5)

Postoperative care of the cardiac surgical patient

329

(16)

Thomas L. Higgins

Introduction

330

(1)

Delivery of the patient to the ICU

330

(1)

Respiratory management

330

(3)

Cardiovastular support

333

(3)

Postoperative complications

336

(4)

Discharge criteria

340

(1)

Prognosis and outcome

341

(1)

Summary

342

(3)

Postoperative care of the thoracic surgical patient

345

(18)

Thomas L. Higgins

Introduction

346

(1)

Identifying the high-risk patient

346

(1)

Operating room events affecting ICU care

347

(2)

Immediate postoperative issues

349

(1)

Endotracheal extubation and airway concerns

350

(1)

Postoperative fluid management

351

(1)

Prolonged ventilator support

352

(3)

Specific postoperative complications

355

(3)

Pulmonary parenchymal complications

358

(1)

Pleural complications

359

(1)

Other considerations

360

(3)

Thoracic trauma

363

(18)

Imtiaz A. Munshi

Introduction

364

(1)

Anatomy

364

(1)

Pathophysiology

364

(1)

Initial evaluation-ABCs

365

(1)

Injuries to the chest wall

366

(1)

Injuries to the bony thorax

367

(2)

Injuries to the lung

369

(5)

Tracheobronchial injury

374

(1)

Blunt aortic injury

375

(2)

Blunt cardiac injury

377

(4)

Techniques of vascular access for invasive hemodynamic monitoring

381

(24)

William T. McGee

Jay S. Steingrub

Thomas L. Higgins

Introduction

382

(1)

Intraarterial blood pressure monitoring

382

(2)

Central venous access

384

(5)

Femoral venous cannulation

389

(1)

Internal jugular vein

390

(4)

Subclavian vein cannulation

394

(4)

Introducer placement

398

(1)

Complications and their prevention

399

(6)

Index

405

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Cardiopulmonary Critical Care

Summary

Table of Contents

Supplemental Materials