Evidence-Based Practice of Critical Care-3판

6. Is oxygen toxic?
Introduction
Mechanisms of toxicity—reactive oxygen species
The evidence for toxicity—from bench to bedside
Oxygen toxicity in practice—from the cradle to the grave
Hyperoxia and carbon dioxide
Hyperoxia in cardiac arrest, traumatic brain injury, and stroke
Therapeutic hyperoxia
Management and prevention of oxygen toxicity
Hyperbaric oxygen therapy and oxygen toxicity
References

7. What is the role of noninvasive respiratory support and high-flow nasal cannula in the intensive care client?

Introduction
Delivery of mechanical noninvasive respiratory support
Selecting patients for noninvasive respiratory support
Contraindications to noninvasive respiratory support
Applications of noninvasive respiratory support in the intensive care unit
Best evidence/first-line therapy
Moderate evidence for use
Conflicting evidence/deleterious effect
References

8. What is the role of PEEP and recruitment maneuvers in ARDS?
Introduction
Ventilator-induced lung injury
The open lung ventilation approach
Clinical trials of PEEP strategies
Clinical trials of recruitment maneuvers
Individualized PEEP titration at the bedside
Imaging
Oxygenation response to PEEP
Esophageal pressure
Compliance curves
Electrical impedance tomography
Conclusion and future directions
References

9. What is the best way to wean and liberate patients from mechanical ventilation?
Introduction
Clinical suspicion that weaning may be possible
Assessment of readiness to wean
Suitability for extubation
Ventilator management of the difficult-to-wean patient
References

10. How does mechanical ventilation damage lungs? What can be done to prevent it?
Introduction and definitions
How do ventilators damage the lungs in patients?
How to minimize lung damage
Conclusions
References


SECTION 3. Non-ARDS and Noninfectious Respiratory Disorders

11. How should exacerbations of COPD be managed in the intensive care unit?
Prevalence of COPD
Respiratory failure
Clinical precipitants of respiratory failure
Prognostic indicators in patients with acute exacerbations of COPD
Management of COPD
Prognosis and outcomes
End-of-life decisions in severe COPD
References

12. Is diaphragmatic dysfunction a major problem following mechanical ventilation?
Introduction
Definition and epidemiology
Pathogenesis
Clinical outcomes
Potential therapies
References


SECTION 4. ARDS

13. ARDS: Are the current definitions useful?
Introduction
Creating the berlin definition—an evidence-based consensus
The berlin definition
Comparing the berlin and AECC definitions
Comparing the berlin definition to lung pathology
Limitations of the berlin definition for recognition and management of ARDS
Conclusion
References

14. What are the pathologic and pathophysiologic changes that accompany ARDS?
Introduction
Pathogenesis
Iatrogenic lung injury
Physiologic consequences
Pathologic findings
References

15. What factors predispose patients to acute respiratory distress syndrome?
Predisposing conditions
Risk modifiers
Risk prediction models
Hospital-acquired exposures
References

16. What is the best mechanical ventilation strategy in ARDS?
Introduction
Ventilator-induced lung injury
Lung-protective ventilation
PEEP optimization and recruitment maneuvers
Driving pressure
Modes of ventilation
Neuromuscular blocking agents
Prone positioning
References

17. Is carbon dioxide harmful or helpful in ARDS?
Introduction
Physiologic effects of hypercapnia
Intracellular mechanisms of action of CO2
Role in clinical ards
Controversies and areas of uncertainty
Permissive hypercapnia at the bedside—practical issues
References

18. Does patient positioning make a difference in ARDS?
Introduction
Prone positioning in ARDS
Other positioning strategies
References

19. Do inhaled vasodilators in ARDS make a difference?
Introduction
Physiologic rationale
Nitric oxide
Prostaglandins
Comparisons of inhaled nitric oxide and prostaglandin
Reconciling the rationale with clinical research findings
Summary
References

20. Does ECMO work?
Introduction
Basics of ECMO
History, evolution, and current status of ECMO
ECMO physiology/gas exchange
Contraindications
VV ECMO cannulation strategies
ECMO: The evidence for its use in ARDS
Factors complicating the study of ECMO
References

21. What lessons have we learned from epidemiologic studies of ARDS?
Lesson 1: Critical care epidemiology is challenging
Lesson 2: ARDS is rare in the population but common in the adult ICU
Lesson 3: There are different ARDS phenotypes
Lesson 4: ARDS is underrecognized and treatment strategies underutilized
Lesson 5: ARDS may be preventable
Lesson 6: The trends in ARDS incidence and mortality are unknown
Conclusion
References

22. What are the long-term outcomes after ARDS?
Introduction
Survival after hospital discharge
Respiratory outcomes after ARDS
Health-related quality of life after ARDS
Post intensive care syndrome after ARDS
Conclusion
References


SECTION 5. General Critical Care Management

23. How do I approach fever in the intensive care unit and should fever be treated?
Critically ill patients with neurological disease
Critically ill patients with sepsis
Critically ill patients without sepsis or neurological disease
References

24. What fluids should be given to the critically ill patient? What fluids should be avoided?
Crystalloids
Colloids
In general ICU patients, what fluids should I give and what should I avoid?
In patients with sepsis, what fluids should I give and what should I avoid?
In trauma patients, what fluids should I give and what should I avoid?
In patients with hemorrhagic shock, what fluids should I give and what should I avoid?
In patients with burn injury, what fluids should I give and what should I avoid?
Conclusions
References

25. Should blood glucose be tightly controlled in the intensive care unit?
Pathophysiology and mechanism of action
Presentation of available data based on systematic review
Interpretation of data
Conclusion
References

26. Is there a role for therapeutic hypothermia in critical care?
Temperature monitoring
Cooling methods
Complications associated with therapeutic hypothermia
Mechanism of action of hypothermia
Hypothermia in cardiac arrest
Therapeutic hypothermia in ischemic stroke
Hypothermia for spinal cord injury
Hypothermia for traumatic brain injury
Hypothermia for acute myocardial infarction
Hypothermia for hypoxic-ischemic encephalopathy
Hypothermia in other clinical scenarios
Conclusion
References

27. How do I manage the morbidly obese critically ill patient?
Introduction
Airway management
Respiratory
Deep venous thrombosis prophylaxis
Pharmacotherapy
Nutritional care
Diagnostic imaging
Intravenous access
Outcomes of critically ill obese patients
Conclusion
References

28. How do I safely transport the critically ill patient?
Introduction
Intrahospital transport of the critically ill
Interhospital transfer
Prehospital transport
References

29. What are the causes of and how do I treat critical illness neuropathy/myopathy?
Neuromuscular weakness
What are the causes of CIP and CIM?
How CIP and CIM can be detected
How to treat CIP and CIM
Conclusions
References


SECTION 6. Sepsis

30. What is sepsis? What is septic shock? What are mods and persistent critical illness?
Introduction
Historical perspective
Pathobiology
References

31. How do I identify the patient with “sepsis”?
Sepsis-1 and sepsis-2
Sepsis-3: An intellectual advance
Sepsis-3 at the bedside
qSOFA: A new screening tool for sepsis
What has happened since sepsis-3?
Conclusion
References

32. Is there immune suppression in the critically ill patient - pro?
Sepsis induces clinical immunosuppression
Mechanisms of immunosuppression in sepsis
Diagnosing immunosuppression in the septic patient
Potential therapies aimed at sepsis-induced immunosuppression
Conclusion
References

33. Is there immune suppression in the critically ill patient—con?
Introduction
Reprogramming of circulating blood leukocytes
Nature of the activating signal
Unaltered functions of circulating leukocytes
Tissue immune cells as the main source of inflammatory cytokines
Enhanced activation within tissues
References

34. Does the timing of antibiotic administration matter in sepsis?
Introduction
How do we measure the timing of antibiotics in sepsis?
What is the evidence that antibiotic timing matters in sepsis?
What are the limitations of existing evidence on early antibiotics’ benefits?
What are the potential adverse effects of early antibiotics?
Conclusions and future directions
References

35. What is the role of vasopressors and inotropes in septic shock?
Hemodynamic derangement in sepsis
Vasopressor therapy
Uncommonly-used vasopressors/inotropes
References

36. Does monitoring the microcirculation make a difference in sepsis? Outcome?
Introduction
Hemodynamic coherence
Oxygen transport and the microcirculation
Monitoring the microcirculation
Nailfold capillaroscopy
Hand-held video-microscopes
Clinical application of hand-held video-microscopes
References

37. Are we getting any better at diagnosing sepsis?
Our evolving definition of sepsis
New sepsis definitions and tools in clinical practice
Identification of sepsis in clinical practice
The role of diagnostic biomarkers
Molecular diagnostics
Biomarker panels
Conclusion
References

38. Do the surviving sepsis campaign guidelines work?
What are bundles?
The need for bundles in severe sepsis and septic shock
Is there evidence that application of the SSC bundles improves outcomes?
Is there evidence that the SSC bundles are cost-effective?
Conclusions
References

39. Has outcome in sepsis improved? What works? What does not?
Have outcomes from sepsis improved?
What has not worked?
What has worked?
Conclusion
References


SECTION 7. Persistent Critical Illness
40. What happens to the autonomic nervous system in critical illness?
Introduction
What is autonomic dysfunction?
At what point does autonomic dysfunction influence the development of critical illness?
Autonomic dysfunction at the very onset of critical illness
Is autonomic dysfunction in critical illness induced by modern critical care strategies?
Cardiovascular dysfunction in critical illness as a direct result of autonomic dysfunction
Immune dysfunction in critical illness as a result of autonomic dysfunction
Conclusions
References

41. Is persistent critical illness a syndrome of ongoing inflammation/immunosuppression/catabolism?
Introduction
Evidence that persistent critical illness is a syndrome of ongoing inflammation, immunosuppression, and catabolism
The self-perpetuating cycle of PICS
Inflammation/immunosuppression
Emergency myelopoiesis
Organ injury
Catabolism in CCI
Treatment and therapy
References


SECTION 8. Infection

42. How do I optimize antibiotic use in critical illness?
Antibiotic pharmacokinetic and pharmacodynamic considerations to minimize resistance and optimize effectiveness
Antibiotic susceptibility testing and resistance
Specific antibiotic classes
Conclusion
References

43. How do I identify pathologic organisms in the 21st century?
Introduction
Pathogen-targeted diagnostics
Host-targeted diagnostics
Future perspectives
References

44. How do I diagnose and manage catheter-related bloodstream infections?
Introduction
Definitions
Incidence and epidemiology
Microbiology
Diagnosis
Treatment
Prevention
Arterial lines and peripherally inserted central catheter lines
Conclusions
References

45. How do I manage central nervous system infections (meningitis/encephalitis)?
Introduction
Bacterial meningitis
Viral central nervous system infection
Central nervous system abscess
Central nervous system infections in the immunocompromised host and global traveler
References

46. How can biomarkers be used to differentiate between infection and non-infectious causes of inflammation?
C-reactive protein
Procalcitonin
Conclusion
References

47. What is ventilator-associated pneumonia? How do I diagnose it? How do I treat it?
Introduction
Pathogenesis
Diagnosis
Differential diagnosis
Treatment of VAP
Prevention
Ventilator-associated event definitions
References


SECTION 9. Hemodynamic Management

48. What is the role of invasive hemodynamic monitoring in critical care?
Introduction
Invasive or noninvasive arterial pressure monitoring?
Central venous pressure and central venous oxygen saturation
The pulmonary artery catheter
Transpulmonary thermodilution and pulse wave analysis
Hemodynamic optimization with the pulmonary artery catheter or transpulmonary thermodilution
References

49. Does the use of echocardiography aid in the management of the critically ill?
Introduction
Focused echocardiography and advanced echocardiography are useful in the evaluation of undifferentiated shock
Focused echocardiography and advanced echocardiography in the evaluation of ventricular function
Advanced echocardiography in the assessment of hemodynamics
Focused echocardiography and advanced echocardiography in valvular disease
Conclusion
References

50. How do I manage hemodynamic decompensation in a critically ill patient?
Assessing volume responsiveness
Initial treatment—addressing hypovolemia/hypovolemic shock
Identification and emergent management of vasodilatory shock
Identification and emergent management of obstructive shock
Identification and emergent management of cardiogenic shock
Conclusion
References

51. What are the best tools to optimize the circulation?
Introduction
Background
Static measures of volume responsiveness
Dynamic measures of fluid responsiveness
References

52. How should cardiogenic shock be managed (including assist devices)?
Epidemiology and etiology
Diagnosis
Management: An evidence-based approach
References


SECTION 10. Cardiovascular Critical Care

53. How do I manage acute heart failure?
Vasodilators
References

54. How do I diagnose and manage myocardial ischemia in the ICU?
Introduction
Pathophysiology
Definition
Epidemiology
Diagnosis
Clinical presentation
Management
References

55. How do I prevent or treat atrial fibrillation in postoperative critically ill patients?
What are the patient risk factors and perioperative conditions that increase the risk of POAF?
What is the pathogenesis of POAF?
What strategies are effective for the prevention of POAF?
Antiarrhythmic agents
Electrolyte repletion and maintenance
Atrial pacing
Reduction of perioperative stressors and modulation of the inflammatory response to surgery
What is appropriate therapy for POAF in a hemodynamically stable patient: Rate control or rhythm control?
Anticoagulation strategy before restoration of sinus rhythm: Atrial fibrillation for less than 48 hours
Anticoagulation strategy before restoration of sinus rhythm: Atrial fibrillation for more than 48 hours
What is appropriate management of POAF in a hemodynamically unstable patient?
Should anticoagulation be instituted or continued after electrical cardioversion to sinus rhythm?
References


SECTION 11. Kidney Injury and Critical Illness

56. How do I rapidly and correctly identify acute kidney injury?
Introduction
The identification of highly susceptible patients
Biochemical diagnosis
Clinical diagnosis
Conclusion
References

57. What is the role of renal replacement therapy in the intensive care unit?
Introduction
References

58. What is the value of nondialytic therapy in acute kidney injury?
Introduction and epidemiology
Intravenous fluid to prevent AKI
Diuretics
Conclusion
Acknowledgments
References


SECTION 12. Metabolic Abnormalities in Critical Illness

59. How should acid-base disorders be diagnosed?
Introduction
Scientific background
Metabolic acid-base abnormalities
Types of metabolic acidosis
The descriptive CO2-bicarbonate (boston) approach
Conclusions
References

60. Is hyperchloremia harmful?
Introduction
Brief chloride physiology
Potential mechanisms of hyperchloremia’s adverse effects
Retrospective observational studies of hyperchloremia
Crystalloid clinical trials
Crystalloid trials meta-analyses
Conclusions from crystalloid clinical trials
Covariation with non-anion gap metabolic acidosis
Differences between available balanced crystalloid solutions
Summary
References

61. Dysnatremias—what causes them and how should they be treated?
Introduction
Hyponatremia
Hypernatremia
References

62. Why is lactate important in critical care?
Introduction
Metabolism of lactate
Lactate and acidosis
Lactate and tissue hypoperfusion
Other causes of increased lactate
Clearance of lactate
How and where to measure lactate levels
Lactate measurements in emergency care
Lactate measurement in the intensive care unit
Goal-directed therapy using lactate levels
How to use lactate in clinical practice
References

63. How does critical illness alter metabolism?
Pathophysiology and mechanism of action
Available data
Interpretation of data
Summary
References


SECTION 13. Neurological Critical Care

64. How should traumatic brain injury be managed?
Introduction
References

65. How should aneurysmal subarachnoid hemorrhage be managed?
Introduction
Emergency setting
Subarachnoid hemorrhage-related complications
Conclusion
References

66. How should acute ischemic stroke be managed in the intensive care unit?
Epidemiology and triage
Classification
Initial evaluation and treatment
Admission to the intensive care unit
Intracranial pressure monitoring of stroke patients
Neurologic complications
Other complications in the stroke patient
Critical care of the stroke patient
References

67. How should status epilepticus be managed?
Epidemiology
Classification
Etiologies of status epilepticus
Management of status epilepticus
References


SECTION 14. Nutrition, Gastrointestinal, and Hepatic Critical Care

68. When and how should I feed the critically ill patient?
Introduction
Metabolism: Critical illness versus starvation
Assessment of nutritional status
Enteral nutrition or parenteral nutrition
Early or late parenteral nutrition (in patients unsuitable for /intolerant of enteral nutrition)
Parenteral nutrition versus limited or no nutrition
Enteral feeding—stomach or postpyloric
Enteral feeding—gastric residual volume
Enteral feeding—bolus or continuous
Deliberate underfeeding (hypocaleric) and trophic feeding
Nutrition in acute pancreatitis
References

69. What does critical illness do to the liver?
Mechanisms and manifestation of liver dysfunction
Impact of liver dysfunction on critical care pharmacology
Hepatic adaptation to critical illness: The acute-phase response
References

70. How do I manage a patient with acute liver failure?
Epidemiology
Clinical presentation
Initial assessment and management
Prognosis
Specific causes and related therapies
Hepatic encephalopathy
Coagulopathy
Infection
Acute kidney injury
Hemodynamic support
Mechanical ventilation
Gastrointestinal bleeding
Metabolic concerns
Nutrition
Transplantation
Areas of controversy
Summary
References


SECTION 15. Endocrine Critical Care

71. Is there a place for anabolic hormones in critical care?
Androgens
Insulin
Growth hormone
Thyroid hormones
References

72. How do I diagnose and manage acute endocrine emergencies in the ICU?
Diabetic ketoacidosis
Hyperosmolar hyperglycemic state
Thyrotoxic crisis
Myxedema coma
Vasopressin deficiency in shock
References

73. What is the current role for corticosteroids in critical care?
Introduction
Septic shock
Acute respiratory distress syndrome
Community acquired pneumonia
Acute exacerbation of chronic obstructive pulmonary disease
Acute severe asthma
Traumatic spinal cord injury
Concerns regarding corticosteroid use
References


SECTION 16. Trauma, Surgery, Obstetrics, and Environmental Injuries

74. How should trauma patients be managed in the intensive care unit?
Infrastructure
Resuscitation
Intensive care unit protocols
Tertiary examination
The extended intensive care unit team
Summary
References

75. What is abdominal compartment syndrome and how should it be managed?
Pathophysiology and mechanism of action
Diagnosis
Systemic impact of ACS
Management approaches
References

76. How should patients with burns be managed in the intensive care unit?
Initial assessment and emergency treatment
Fluid resuscitation
Inhalation injury
Infection/sepsis
Burn wound excision
Metabolic response and nutritional support
Modulation of the hormonal and endocrine response
Glucose control
References

77. What is the best approach to resuscitation in trauma?
Introduction/background
Pathophysiology of hemorrhagic shock
Presentation of available data based on systematic review
Transfusion
Uncontrolled hemorrhagic shock
Endpoints of resuscitation
Summary
References

78. How do I diagnose and treat major gastrointestinal bleeding?
Introduction
Etiologies
Evidence
Controversies
References

79. How should the critically ill pregnant patient be managed?
Introduction
Sepsis in pregnancy
Identifying and diagnosing sepsis in pregnant or postpartum patient
Management of sepsis
Acute respiratory distress syndrome in pregnancy
What is the optimum strategy for mechanical ventilation in a pregnant patient?
What is the role of extracorporeal membrane oxygenation in refractory acute respiratory distress syndrome in obstetric
patients?
Conclusion
References

80. How do I diagnose and manage patients admitted to the intensive care unit after common poisonings?
Diagnosis
Dangerous poisonings: Two important agents
Management principles
Decontamination and enhanced elimination
References


SECTION 17. Hematology Critical Care

81. When is transfusion therapy indicated in critical illness and when is it not?
Introduction
Basis for transfusion of blood products—benefits and risks
Massive exsanguination and transfusion
Recombinant factor VIIa
Tranexamic acid
Conclusion
References

82. Is there a role for granulocyte-macrophage colony-stimulating factor and/or erythropoietin in critical illness?

Chronic critical illness
Role of granulocyte-macrophage colony-stimulating factor
Clinical studies
Heterogeneity of trials
Pathophysiology of anemia in intensive care unit patients
Erythropoietin
Erythropoiesis-stimulating agents
Iron supplementation
References

83. What anticoagulants should be used in the critically ill patient? How do I choose?
Warfarin
Unfractionated heparin
Low-molecular-weight heparin
Intravenous direct thrombin inhibitors
Parenteral indirect factor Xa inhibitors
Direct oral anticoagulants
Oral direct factor Xa inhibitors
How do I choose in the ICU: Which anticoagulant for which patient?
References


SECTION 18. Critical Care Resource Use and Management

84. Is there a better way to deliver optimal critical care services?
Introduction
The interprofessional team
Intensivist staffing models
Advanced practice providers
Protocolization and decision support
Quality measurement and improvement
Regionalization
ICU telemedicine
Future directions
References

85. How do critical care pharmacists contribute to team-based care?
Introduction
Definition of clinical pharmacy
Clinical teams defined
Training and certification
Practice framework
Role of critical care pharmacists
Impact of critical care pharmacists
Research role
References

86. What is the role of advanced practice nurses and physician assistants in the ICU?
Nurse practitioner and physician assistant roles
Use of nurse practitioners and physician assistants in the ICU
Conclusions
References


SECTION 19. Patient Suffering and Other Ethical Issues

87. Do the guidelines for brain death determination need to be revised?
Introduction
History of guidelines for determination of brain death and professional society endorsement
Contents of guidelines for determination of brain death
Rationale behind guidelines for determination of brain death
Problems with guidelines for determination of brain death
Attacks on the integrity of guidelines for determination of brain death
References

88. How do I diagnose, treat, and reduce delirium in the intensive care unit?
Definition
Risk factors
Pathogenesis
Recognition of delirium
Primary prevention
Pharmacologic intervention
References

Index