Surgical Critical Care, Second Edition

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ISBN: 9780824759117 | 0824759117
Cover: Hardcover
Copyright: 8/12/2005

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Presenting current perspectives on the physiology and metabolism of the critically ill, this reference demonstrates practical approaches for the preoperative, intraoperative, and postoperative care of the critically ill patient with an abundance of clearly laid-out figures, case studies, graphs, and charts.

Preface

iii

Contributors

xxxi

Part I: Altered Metabolism of Critical Illness and Shock

Stress Response and Multiple Organ Failure

(18)

Victor Lazaron

Jerome H. Abrams

Introduction

(2)

Multiple Organ Failure Syndrome

(8)

Clinical Features

(3)

Pathophysiology

(5)

Conceptual Hypotheses

(2)

Clinical Progress

(1)

Future Considerations

(1)

Summary

(1)

References

(4)

Oxygen Transport

(12)

Jerome H. Abrams

Frank B. Cerra

Oxygen Supply and Demand

(1)

Blood Flow

(2)

Adequacy of Oxygen Transport

(3)

Delivery-Dependent Oxygen Consumption

(2)

Delivery-Dependent Lactate Production

(1)

Treatment

(2)

Summary

(1)

Appendix

(3)

Suggested Reading

382

(3)

Hypertensive Emergencies

385

(10)

Rakesh Gupta

John W. Hoyt

Types of Hypertensive Crises

385

(1)

Initial Evaluation

386

(2)

Management of Hypertensive Crisis

388

(1)

Antihypertensive Agents

388

(4)

Cardiac/Vascular Complications and Their Management

392

(1)

CNS Complications and Their Management

393

(1)

Summary

393

(1)

Bibliography

394

(1)

Cardiopulmonary Interactions

395

(16)

Michael R. Pinsky

Cardiopulmonary Interactions

395

(4)

Intrapulmonary Gas Exchange and Work of Breathing

395

(1)

Changes in Lung Volume

395

(2)

Changes in Intrathoracic Pressure

397

(2)

Ventricular Interdependence

399

(1)

Clinical Applications of Cardiopulmonary Interactions

399

(3)

Using Cardiopulmonary Interactions to Diagnose Cardiovascular Insufficiency

402

(1)

Summary

403

(1)

Appendix---Case Examples

404

(2)

Case 1

404

(1)

Case 2

405

(1)

References

406

(5)

Vascular Emergencies in the Surgical Intensive Care Unit

411

(10)

Alexandre d'Audiffret

Steven Santilli

Connie Lindberg

Introduction

411

(1)

Acute Arterial Insufficiency

411

(3)

Lower Extremity Ischemia

411

(2)

Upper Extremity Ischemia

413

(1)

Acute Mesenteric Ischemia

414

(1)

Clinical Presentation and Differential Diagnosis

414

(1)

Medical and Surgical Management

414

(1)

Phlegmasia Cerulea Dolens and Venous Gangrene

414

(1)

Complications Associated with Invasive Monitoring

415

(1)

Radial Artery Catheterization

415

(1)

Brachial Artery Complications

415

(1)

Axillary Artery Catheterization

415

(1)

Access Complications

416

(1)

Vascular Complications Associated with Vascular Procedures

416

(1)

Aortic Procedures

416

(1)

Carotid Endarterectomy

416

(1)

Hypotension/Hypertension

417

(1)

Cervical Hematoma

417

(1)

Hyperperfusion Syndrome

417

(1)

Summary

417

(1)

References

418

(3)

E. Pulmonary Function

Acute Lung Injury

421

(12)

Larry A. Woods

Alan J. Cropp

Bhagwan Dass

Introduction

421

(1)

Incidence

422

(1)

Risk Factors

422

(1)

Mediators of ALI

422

(2)

Pathophysiology

424

(1)

Clinical Course

425

(1)

Management

426

(1)

Hypoxia

427

(1)

Mechanical Ventilation

427

(1)

Alternative Ventilator Strategies

428

(1)

Pharmacologic Therapies

429

(1)

Summary

430

(1)

References

430

(3)

Bronchospasm

433

(10)

Stephen Trzeciak

R. Phillip Dellinger

Pathophysiology

433

(1)

Clinical Findings and Physical Examination

434

(1)

Laboratory Data

435

(1)

Traditional Medical Therapy

435

(2)

Bronchodilator Therapy

435

(2)

Anti-inflammatory Therapy

437

(1)

Other Medical Therapies

437

(3)

Considerations in the Intubated and Mechanically Ventilated Patient

438

(2)

Summary

440

(1)

References

441

(2)

Venous Thromboembolism

443

(26)

Mark D. Cipolle

Incidence

443

(1)

Risk Factors

443

(2)

Diagnosis

445

(5)

Pulmonary Angiography

447

(1)

V/Q Scanning

447

(1)

Helical Computed Tomography

448

(1)

Ultrasonographic Examination of the Lower Extremities for DVT

448

(1)

D-Dimer Assay

449

(1)

Combinations of Diagnostic Tests

449

(1)

Prophylaxis

450

(7)

Low-Dose Heparin

452

(1)

Low-Molecular-Weight Heparin (LMWH)

453

(1)

Oral Anticoagulants

453

(1)

Sequential Compression Devices

454

(1)

Graduated Compression Stockings (GCSs)

454

(1)

Vena Cava Interruption

454

(1)

Recommendations

454

(3)

Treatment

457

(4)

Anticoagulation

457

(3)

Thrombolytic Therapy

460

(1)

Pulmonary Embolectomy

461

(1)

Summary

461

(1)

References

462

(7)

Airway Management

469

(20)

Ian J. Gilmour

Indications for Endotracheal Intubation

469

(1)

Route of Intubation and Selection of Tube

469

(2)

Standard Approaches to Intubation

471

(2)

Difficult Airway

473

(1)

Confirmation of Successful Intubation

474

(3)

Changing of Orotracheal Tube

477

(1)

Extubation

477

(2)

Tracheostomy

479

(5)

Tube Selection

480

(1)

Shape and Construction of Tube

481

(1)

Special Considerations with Recent Tracheostomy

481

(1)

Changing of TT

482

(2)

Pulmonary Hemorrhage/Massive Hemoptysis

484

(2)

All Cases

484

(1)

Bronchoscopy

485

(1)

Balloon Tamponade

485

(1)

Angiography/Embolization

485

(1)

Radionuclear Scanning

485

(1)

Surgery

485

(1)

Summary

486

(1)

References

487

(1)

Suggested Reading

488

(1)

Airway Management

488

(1)

Difficult Intubation

488

(1)

Tracheostomy

488

(1)

Hemoptysis

488

(1)

Mechanical Ventilator Support

489

(12)

Karl L. Yang

Guillermo Guiterrez

Gas Exchange

489

(1)

Respiratory Mechanics

490

(1)

Modes of Ventilation

491

(7)

Control Mode Ventilation (CMV)

493

(1)

Assist-Control Ventilation (ACV)

493

(1)

Intermittent Mandatory Ventilation (IMV)

494

(1)

Other Ventilator Variables

494

(3)

Other Modes of Mechanical Ventilation

497

(1)

Summary

498

(1)

References

498

(3)

Discontinuation of Mechanical Ventilation

501

(10)

Paul Druck

Introduction

501

(1)

Approaches to Discontinuation of Ventilatory Support

502

(3)

The Earliest Approach: Weaning Criteria and T-Piece Trials

502

(1)

``Weaning Modes'' of Ventilation: The Tapered Support Method

502

(1)

Protocol Weaning

503

(1)

What Constitutes an Adequate Trial of Spontaneous Breathing

504

(1)

Current Recommendations

505

(1)

Failure to Wean

505

(3)

Failure to Oxygenate

506

(1)

Failure to Ventilate (CO2 Retention)

506

(2)

Summary

508

(1)

References

508

(3)

F. Renal Function

Disturbances of Acid-Base Homeostasis

511

(16)

Jon F. Berlauk

Jerome H. Abrams

ABG Interpretation

511

(5)

Metabolic Acid--Base Disorders

516

(3)

Metabolic Acidosis

516

(2)

Metabolic Alkalosis

518

(1)

Respiratory Acid-Base Disorders

519

(5)

Respiratory Acidosis

521

(1)

Respiratory Alkalosis

522

(2)

Summary

524

(1)

References

525

(2)

Acute Renal Failure

527

(12)

Mark E. Rosenberg

Introduction

527

(1)

Differential Diagnosis

527

(6)

Prerenal ARF

527

(4)

Intrinsic ARF

531

(1)

Postrenal ARF

532

(1)

Prevention

533

(1)

Mannitol and Loop Diuretics

533

(1)

Dopamine

534

(1)

Management

534

(2)

Fluid Balance

534

(1)

Hyperkalemia

535

(1)

Hyponatremia

535

(1)

Hypocalcemia and Hyperphosphatemia

535

(1)

Acidosis

535

(1)

Nutrition

536

(1)

Dialysis

536

(1)

Bleeding

536

(1)

Drug Dosing

536

(1)

Course and Prognosis of ARF

536

(1)

Summary

537

(1)

Suggested Reading

538

(1)

Support of Renal Function

539

(8)

Connie L. Manske

Hemodialysis

539

(4)

Continuous Venovenous Hemofiltration

543

(1)

Continuous Venovenous Hemofiltration with Dialysis

543

(1)

Choosing a Method of Renal Replacement Therapy

543

(1)

Summary

544

(1)

References

544

(3)

G. Gastrointestinal and Hepatic Function

Gut Function: Practical Considerations for the Intensivist

547

(10)

David C. Evans

The Gut Mucosal Barrier

547

(3)

Physical Barrier Function

547

(1)

Immunologic Barrier

548

(1)

Bacteriologic Barrier

549

(1)

The Gut and MSOF

550

(1)

Supporting Gut Barrier Function

551

(3)

Oxygen Transport

551

(1)

Enhancing Gut Motility

552

(1)

Nutritional Support

552

(1)

Stress Ulcer Prophylaxis

552

(1)

Antibiotic Prophylaxis

553

(1)

Gut Failure: What Do We Mean?

554

(1)

Summary

554

(1)

References

555

(2)

Acute Gastrointestinal Hemorrhage

557

(12)

Jerome H. Abrams

UGI Hemorrhage

557

(2)

Common Causes

559

(4)

Mallory-Weiss Lesion

559

(1)

Esophageal Varices

559

(2)

Gastritis

561

(1)

Peptic Ulcer Disease

562

(1)

LGI Hemorrhage

563

(2)

Patient Evaluation

563

(2)

Summary

565

(1)

References

566

(3)

Acute Pancreatitis in the Surgical Intensive Care Unit

569

(14)

Jeffrey G. Chipman

Introduction

569

(1)

Pathophysiology

569

(2)

Etiology

569

(1)

Pathology

570

(1)

Diagnosis

571

(4)

History and Physical Information

571

(2)

Laboratory Data

573

(1)

Radiologic Data

574

(1)

Fine Needle Aspiration

574

(1)

Treatment

575

(4)

Source Control

575

(1)

Debridement and Drainage

575

(1)

Antibiotics

576

(1)

Restoration of Oxygen Transport

577

(1)

Metabolic Support

578

(1)

Outcomes

579

(1)

Future Considerations

579

(1)

Summary

579

(1)

References

580

(3)

Biliary Complications During Critical Illness

583

(8)

Paul Druck

Acute Cholecystitis

583

(3)

Epidemiology of Acute Cholecystitis in the Critically Ill

583

(1)

Pathogenesis of Acute Cholecystitis in the Critically Ill

583

(1)

Diagnosis of Acute Cholecystitis in the Critically Ill

584

(2)

Treatment of Acute Cholecystitis in the Critically Ill

586

(1)

Obstructive and Nonobstructive Jaundice and Cholangitis

586

(3)

Initial Evaluation of the Jaundiced Patient

586

(1)

Obstructive Jaundice and Cholangitis

587

(1)

Nonobstructive Jaundice

587

(2)

Summary

589

(1)

References

589

(2)

Acute Abdomen

591

(14)

Michael D. Pasquale

Roderick A. Barke

History and Physical Examination

591

(3)

Resuscitation and Monitoring

594

(1)

Diagnostic Evaluation

595

(2)

Laboratory Tests

595

(1)

Radiologic Tests

596

(1)

Miscellaneous Tests

597

(1)

Diagnosis and Treatment

597

(2)

Diagnostic Difficulties in the Critically Ill Patient

599

(2)

Acalculous Cholecystitis

599

(1)

Acute Mesenteric Ischemia

599

(2)

Pancreatitis

601

(1)

Immunosuppression

601

(1)

Summary

601

(1)

Reference

602

(1)

Suggested Reading

602

(3)

A Pathophysiologic Approach to Fulminant Hepatic Failure in the Intensive Care Unit

605

(24)

Kambiz Kosari

Timothy D. Sielaff

Introduction

605

(1)

Definitions

605

(2)

Acute-on-Chronic Liver Failure (ACLF)

605

(1)

Fulminant Hepatic Failure (FHF)

606

(1)

Hepatic Encephalopathy

606

(1)

Causes

607

(2)

Acute-on-Chronic Liver Failure

607

(1)

Fulminant Hepatic Failure

607

(2)

Pathophysiologic Features

609

(4)

Tissue Hypoxia

609

(2)

Hepatic Encephalopathy

611

(2)

Management

613

(11)

Before Transfer to a Liver Center

613

(1)

Treatment of ACLF Patients

614

(1)

Issues Regarding Patient Transfer

614

(1)

Liver Center Care

615

(5)

Liver Transplantation

620

(1)

Liver Assist Devices

621

(1)

Hybrid Bioartificial Livers

622

(2)

Conclusions

624

(1)

Summary

624

(1)

References

625

(4)

H. Endocrine System

Endocrine Emergencies

629

(18)

Paul Druck

Adrenal Insufficiency

629

(5)

Etiology of AI

629

(1)

Clinical Features and Diagnosis of AI

630

(1)

Treatment of Adrenal Crisis

631

(1)

Prevention of Perioperative AI

632

(2)

Thyroid Dysfunction

634

(5)

Thyroid Storm

634

(3)

Myxedema Coma

637

(1)

Sick-Euthyroid Syndrome

638

(1)

Disorders of Glucose Homeostasis

639

(2)

Maintenance of Normoglycemia in Critically Ill Patients

639

(1)

Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (Hyperosmolar Coma)

639

(2)

Summary

641

(1)

Adrenal Insufficiency

641

(1)

Thyroid Disorders

642

(1)

Disorders of Glucose Homeostasis

642

(1)

References

642

(5)

Divalent Ions

647

(14)

Jeffrey A. Bailey

John E. Mazuski

Calcium

647

(4)

Hypocalcemia

648

(2)

Hypercalcemia

650

(1)

Magnesium

651

(3)

Hypomagnesemia

652

(1)

Hypermagnesemia

653

(1)

Phosphorus

654

(3)

Hypophosphatemia

654

(1)

Hyperphosphatemia

655

(2)

Summary

657

(1)

References

658

(3)

Chemical Homeostasis

661

(14)

Roderick A. Barke

Body Compartments and Distribution of Water and Electrolytes

661

(1)

Effect of Stress of Surgery or Trauma on Fluid Homeostasis

662

(2)

Evolution of Understanding of Hormonal Response

663

(1)

Goal of Fluid and Electrolyte Therapy

664

(1)

Hyperosmolality, Hypertonicity, and Hypernatremia

664

(8)

Hypo-Osmolality and Hyponatremia

668

(2)

Potassium

670

(2)

Summary

672

(1)

References

672

(1)

Suggested Reading

673

(2)

I. Infectious Diseases

Antibiotic Resistance in the Intensive Care Unit

675

(18)

Jan E. Patterson

Daniel L. Dent

Introduction

675

(1)

Epidemiology of Antimicrobial Resistance in the ICU

675

(6)

Antibiotic Utilization in the ICU

676

(4)

The Role of Infection Control

680

(1)

Specific Pathogens

681

(5)

Methicillin-Resistant S. aureus (MRSA)

681

(1)

Vancomycin-Resistant Enterococci (VRE)

682

(1)

Pseudomonas aeruginosa

683

(1)

Enterobacter spp

684

(1)

Extended-Spectrum Beta-Lactamase (ESBL)-Producing Klebsiella pneumoniae

685

(1)

Acinetobacter baumannii

686

(1)

Summary

686

(1)

References

687

(6)

Intra-abdominal Infection

693

(10)

Ori D. Rotstein

Jerome H. Abrams

Anatomy and Physiology of Abdominal Cavity

693

(1)

Defense Against Peritoneal Infection

694

(1)

Local Response

694

(1)

Systemic Response

695

(1)

Diagnosis and Management of Intra-abdominal Infection

695

(6)

Secondary Peritonitis

695

(3)

Intra-abdominal Abscess

698

(1)

Tertiary Peritonitis

699

(2)

Summary

701

(1)

References

701

(1)

Suggested Reading

702

(1)

HIV/AIDS and the Surgeon

703

(22)

Omobosola Akinsete

Edward N. Janoff

Introduction

703

(1)

Epidemiology

704

(1)

Transmission of HIV

705

(2)

Transmission of HIV from Surgeon to Patient

707

(1)

Prevention of Occupational HIV Infection

708

(2)

Recognizing HIV Infection

710

(2)

Antiretroviral Therapy

712

(5)

Complications and Outcome of Surgery Among HIV-Infected Patients

717

(1)

HIV/AIDS: Ethical and Legal Issues

718

(1)

Summary

719

(1)

References

720

(5)

Infection in the Immunocompromised Patient

725

(20)

Gregory A. Filice

Basic Concepts

725

(3)

Innate Defects

728

(5)

Neutropenia

728

(2)

Complement Deficiency

730

(1)

Asplenia or Splenic Dysfunction

730

(1)

Malnutrition

731

(1)

Malignancy

731

(1)

Diabetes Mellitus

731

(1)

Neurological Dysfunction

731

(1)

Tobacco Use

732

(1)

Stress

732

(1)

Hypochlorhydria

732

(1)

Altered Microbial Flora

732

(1)

Defects in Immunity

733

(2)

Antibody Deficiency

733

(1)

CMI Defects

733

(1)

Infection-Induced Immune Dysfunction

733

(1)

Transplantation

734

(1)

Fever and Infectious Diseases in Critical Care

735

(2)

Management

737

(1)

Prevention

738

(1)

Summary

739

(2)

References

741

(4)

Part IV: Systemic Dysfunction

J. Critical Care Pharmacology

Optimization of Drug Doses

745

(38)

Pamela K. Phelps

Bruce C. Lohr

Absorption

745

(1)

Distribution

746

(1)

Metabolism

746

(1)

Excretion

747

(1)

Use of Serum Concentrations

748

(31)

Inotropic/Vasoactive Agents

754

(13)

Antihypertensive Agents

767

(9)

Sedative Agents

776

(3)

Summary

779

(1)

References

780

(3)

Adverse Drug Reactions and Drug Interactions in the Intensive Care Unit

783

(16)

Douglas DeCarolis

Cardiovascular Agents

783

(12)

Antiarrhythmic Drugs

783

(3)

Other Antiarrhythmic Agents

786

(1)

Vasoactive Drugs

787

(1)

Inotropic Agents

788

(1)

Vasopressor Agents

788

(1)

Sedative Agents

788

(2)

Analgesic Agents

790

(1)

Non-opioid Agents

791

(4)

References

795

(4)

Anaphylaxis

799

(12)

Paul Druck

Definitions

799

(1)

Epidemiology

799

(1)

Inciting Agents

800

(1)

Pathophysiology

801

(1)

Mediators of Anaphylaxis

801

(1)

Effects of the Principal Mediators

802

(1)

Clinical Manifestations

802

(2)

Respiratory Effects

802

(1)

Cardiovascular Effects

803

(1)

Mucocutaneous Manifestations

803

(1)

Miscellaneous Manifestations

804

(1)

Treatment

804

(3)

Initial Steps and Basic Support

804

(1)

Treatment of Respiratory Compromise

805

(1)

Hemodynamic Compromise

806

(1)

Adjunctive Measures and the Recovery Phase

806

(1)

Prevention

807

(1)

Iodine-Containing RCM

807

(1)

Beta-Lactam Antibiotics

807

(1)

Summary

808

(1)

References

809

(2)

K. Coagulation and Transfusion

Disorders of Coagulation

811

(22)

Aneel A. Ashrani

Nigel S. Key

Introduction

811

(1)

Physiology of Hemostasis

811

(3)

Role of Platelets

811

(1)

Role of the Coagulation Proteins: Secondary Hemostasis

812

(1)

Role of Vascular Endothelium

813

(1)

Pathophysiology of Hemorrhagic and Thrombotic Diatheses

814

(1)

Bleeding Disorders

814

(6)

Preoperative and Postoperative Management of a Patient with a Hemostatic Defect

817

(3)

Special Hemostatic Challenges

820

(2)

Cardiopulmonary Bypass Surgery

820

(1)

Liver Disease

820

(2)

Renal Disease

822

(1)

Thrombotic Disorders

822

(4)

Disseminated Intravascular Coagulation

826

(2)

Heparin-Associated Thrombocytopenia

828

(1)

Summary

829

(2)

References

831

(2)

Transfusion Therapy

833

(62)

James R. Stubbs

Red Blood Cell Transfusion

833

(13)

Principles of Oxygen Delivery and Oxygen Consumption

834

(12)

Plasma Transfusion

846

(2)

Indications

847

(1)

Contraindications

848

(1)

Platelets

848

(8)

Platelet Selection

848

(1)

Prophylactic Platelet Transfusion

849

(2)

Therapeutic Platelet Transfusion

851

(1)

Platelet Refractoriness

851

(4)

Platelet Alloimmunization---Prevention

855

(1)

Contraindications

856

(1)

Cryoprecipitate Transfusion

856

(1)

Indications

856

(1)

Leukoreduced Blood Components

857

(6)

Febrile Nonhemolytic Transfusion Reactions

857

(2)

Cytomegalovirus

859

(2)

Immunomodulation

861

(2)

Recombinant Factor VIIa

863

(6)

Massive Transfusion

867

(2)

Transfusion-Associated Graft-vs.-Host Disease

869

(3)

Implicated Blood Components

871

(1)

Prevention

871

(1)

Gamma Irradiation Guidelines

871

(1)

Noninfectious Risks of Transfusion

872

(2)

Acute

872

(2)

Delayed

874

(1)

Infectious Risks of Blood Transfusion

874

(3)

West Nile Virus

875

(1)

Bacteria

876

(1)

Summary

877

(2)

References

879

(16)

Agents Used for Anticoagulation

895

(10)

James R. Stubbs

Warfarin

895

(2)

Unfractionated Heparin and LMWH

897

(3)

Summary

900

(1)

References

900

(5)

Part V: Common SICU Procedures

Bronchoscopy

905

(10)

Marshall I. Hertz

Paul Gustafson

Overview

905

(1)

Indications

906

(2)

Suspected Pneumonia

906

(1)

Atelectasis

907

(1)

Hemoptysis

907

(1)

Foreign Body

908

(1)

Suspected Tracheobronchial Disruption

908

(1)

Smoke Inhalation

908

(1)

Difficult Intubation

908

(1)

Contraindications

908

(1)

Bronchoscopy and Bronchoalveolar Lavage with Intubation

909

(3)

Supplemental Oxygen

909

(1)

Bronchoscope

909

(1)

Ventilator Management

910

(1)

Monitors

910

(1)

Medications

910

(1)

Bronchoalveolar Lavage Technique

910

(2)

Complications

912

(2)

Summary

914

(1)

References

914

(1)

Vascular Access

915

(14)

Thomas Wozniak

Larry Micon

Central Venous Access

915

(5)

Indications for Catheterization

915

(1)

Subclavian Vein Catheterization

916

(2)

Internal Jugular Approach

918

(1)

Femoral Vein Cannulation

919

(1)

Pulmonary Arterial Access

920

(3)

Systemic Arterial Catheterization

923

(2)

Technique

924

(1)

Complications

924

(1)

Doppler-Guided Catheterization

925

(1)

Summary

925

(1)

References

925

(4)

Care of Central Lines

929

(8)

Steven D. Eyer

Catheter-Related Sepsis

929

(1)

Incidence

929

(1)

Causes

929

(1)

Aseptic Technique

930

(1)

Catheter Removal or Exchange

931

(3)

Central Venous Catheters

931

(1)

Pulmonary Artery Catheters

932

(1)

Samples for Culture

932

(1)

Replacement of Lines

932

(1)

Clinical Reasons for Replacement

933

(1)

Guidewire Exchange

934

(1)

Catheter-Related Thrombosis

934

(1)

Summary

934

(1)

Suggested Reading

935

(2)

Percutaneous Tracheostomy

937

(10)

Jeffrey G. Chipman

Introduction

937

(1)

Background

937

(1)

Indications and Contraindications

938

(1)

Technique

938

(5)

Location

938

(1)

Personnel

939

(1)

Equipment

939

(1)

Method

939

(4)

Pitfalls

943

(1)

Conclusions

943

(1)

Summary

943

(1)

References

944

(3)

Lumbar Puncture, Thoracentesis, Thoracostomy, and Paracentesis

947

(16)

Sharon Henry

Lumbar Puncture

947

(3)

Anatomy

947

(1)

Positioning

947

(1)

Procedure

947

(1)

CSF Analysis

948

(1)

Complications

949

(1)

Thoracentesis

950

(1)

Procedure

950

(1)

Complications

951

(1)

Fluid Analysis

951

(1)

Thoracostomy

951

(4)

Procedure

951

(2)

Complications

953

(1)

Drainage Systems

954

(1)

Chest Tube Removal

955

(1)

Sclerosis

955

(1)

Maintaining Chest Tube Patency

955

(1)

Paracentesis

955

(2)

Procedure

955

(1)

Diagnostic Tests

956

(1)

Complications

956

(1)

Open and Closed Peritoneal Tap and Lavage

957

(1)

Closed Procedure

957

(1)

Open Procedure

958

(1)

Semi-open Procedure

958

(1)

Results

958

(1)

Summary

958

(1)

References

959

(4)

Part VI: Measurement and Interpretation of Data

Blood Pressure Monitoring

963

(10)

Jerome H. Abrams

Damped Oscillating Systems: Resonance

963

(2)

Measuring Damping Coefficient

965

(5)

Theory

965

(1)

Clinical Application

966

(4)

Summary

970

(1)

References

970

(3)

Cardiac Output

973

(8)

Jerome H. Abrams

The Fick Principle

974

(3)

Other Methods of Measurement

977

(1)

Summary

978

(1)

References

978

(3)

Respiratory Monitoring

981

(16)

Ian J. Gilmour

Monitoring Lung Volumes

984

(3)

Monitoring Gas Exchange

987

(2)

Pulse Oximetry

989

(1)

Monitoring Carbon Dioxide Removal

990

(3)

Summary

993

(1)

References

994

(1)

Suggested Reading

994

(3)

Part VII: Approaches to Complex Problems

Responding to Uncertainty in the Intensive Care Unit: Some Unanswered Questions in Critical Care and How They Got That Way

997

(22)

Jerome H. Abrams

Resolving Degeneracy-Distinguishing Response Variables from Control Variables

998

(7)

Use of Dynamical Systems

1005

(3)

Joint Probabilities

1008

(3)

Use of Statistical Ensembles

1011

(6)

Summary

1017

(1)

References

1017

(2)

Index

1019

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Surgical Critical Care, Second Edition

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