Cardiopulmonary Critical Care

by Higgins, Thomas L.

• ISBN13: 9781859962374
• ISBN10: 1859962378
• Edition: 1st
• Format: Hardcover
• Copyright: 2002-06-15
• Publisher: Informa Healthc

Summary

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.

Table of Contents

Abbreviations	xii
Contributors	xv
Introduction	xvi
Acknowledgements	xviii
Respiratory physiology/pulmonary gas exchange	1	(16)
Robert M. Kacmarek
Introduction	2	(1)
Lung mechanics	2	(4)
The law of motion	6	(1)
Auto-PEEP	7	(1)
V/Q relationships	8	(2)
Evaluation of hypoxemia	10	(7)
Cardiac physiology	17	(18)
Jay S. Steingrub
Cardiac function	18	(1)
Preload	18	(2)
Afterload	20	(1)
Contractility	21	(1)
Heart rate	22	(1)
Diastolic function	22	(2)
Diagnosis and therapy of acute congestive heart failure	24	(3)
Therapy	27	(2)
Patient subsets	29	(6)
Oxygen transport and tissue oxygenation	35	(14)
William T. McGee
Paul Jodka
Introduction	36	(1)
Calculating oxygen transport	36	(2)
Balancing oxygen supply and demand	38	(1)
Clinical factors influencing oxygen supply	39	(1)
Determinants of oxygen consumption	40	(1)
Critical factors influencing cellular oxygen utilization	40	(1)
Evaluation of tissue oxygenation	41	(2)
Influence of loss of vasoregulation	43	(1)
Continuous mixed venous oxygen saturation in clinical medicine	43	(1)
Goal-directed therapy with DO2 and VO2	44	(2)
Summary	46	(1)
Essential equations	46	(3)
Acid-base disorders	49	(14)
Ali Al-Khafaji
Marcus J. Hampers
Howard L. Corwin
Introduction	50	(1)
Basic concepts and definitions	50	(2)
Approach to acid-base abnormalities	52	(1)
Metabolic acidosis	52	(1)
Anion gap metabolic acidosis	52	(4)
Normal anion gap metabolic acidosis	56	(2)
Respiratory acidosis	58	(1)
Metabolic alkalosis	59	(1)
Respiratory alkalosis	60	(3)
Bedside hemodynamic monitoring	63	(18)
Jay S. Steingrub
Introduction	64	(1)
Central venous monitoring	64	(2)
Pulmonary artery catheterization	66	(4)
Validity of measurements	70	(2)
Intrathoracic pressure changes during spontaneous respiration	72	(1)
Positive end-expiratory pressure (PEEP)	73	(1)
Ventricular compliance	73	(1)
Limitations of pulmonary artery wedge pressure	74	(1)
Thermodilution cardiac output	75	(1)
Derived hemodynamic parameters	75	(3)
Risk versus benefit	78	(3)
Shock in the intensive care unit	81	(18)
Jay S. Steingrub
Introduction	82	(1)
Pathophysiology	82	(1)
Specific shock syndromes	82	(1)
Hypovolemic shock	83	(3)
Distributive shock	86	(5)
Anaphylactic shock	91	(3)
Cardiogenic shock	94	(2)
Obstructive shock	96	(1)
Shock states	96	(3)
Fluid resuscitation in the ICU	99	(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