Lessons from the ICU Under the Auspices of the European Society of Intensive Care Medicine

Lessons from the ICU Under the Auspices of the European Society of Intensive Care Medicine Maurizio Cecconi, Head Dept Anesthesia and ICU, Humanitas Research Hospital, Rozzano, Milano, Italy Series Editor Daniel De Backer, Dept Intensive Care Erasme University, Université Libre de Bruxelles, Bruxelles, Brussels Hoofdst.ge., Belgium Series Editor Lessons from the ICU is a Book Series published by Springer under the auspices of the European Society of Intensive Care Medicine (ESICM). The aim of the Series is to provide focused and state-of-the-art reviews of central topics in Intensive Care. Ultimately, its mission is to transfer the latest knowledge to the bedside in order to improve patient outcomes. Accordingly, the ESICM has also developed Lessons from the ICU with the vision or providing the best resources for everyone working in Intensive Care. Each volume presents a comprehensive review of topical issues in Intensive Care. The volumes are intended to cover the majority of aspects that intensive care professionals are likely to encounter in the course of their career. Books offer an excellent guide for residents who are new to the ICU, and for allied professionals, senior consultants as well as nurses and allied healthcare professionals. The chapters are organized in a way that allows the reader to quickly familiarize or reacquaint them- selves with the pathophysiological background before moving on to diagnosis and treatment. Each chapter includes a list of Take Home Messages, as well as practical examples that apply theoretical knowledge in real clinical scenarios. Each volume in the Series is edited by international Key Opinion Leaders in Intensive Care, and each chapter is written by experts in the field. In summary, this Series represents a valuable contribution to fill the gap in the current Intensive Care literature by providing top-quality literature reviews that can be easily digested and used at the bedside to improve patient outcomes. More information about this series at http://www.springer.com/series/15582 Michael R. Pinsky Jean-Louis Teboul Jean-Louis Vincent Editors Hemodynamic Monitoring Editors Michael R. Pinsky Jean-Louis Teboul Critical Care Medicine Dept. Bicetre University Hospital University of Pittsburgh Paris South University Pittsburgh, PA Le Kremlin-Bicêtre USA France Jean-Louis Vincent Department of Intensive Care Erasme University Hospital Brussels Belgium ISSN 2522-5928 ISSN 2522-5936 (electronic) Lessons from the ICU ISBN 978-3-319-69268-5 ISBN 978-3-319-69269-2 (eBook) https://doi.org/10.1007/978-3-319-69269-2 Library of Congress Control Number: 2019930093 © European Society of Intensive Care Medicine 2019 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recita- tion, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland V The editors wish to dedicate this volume to all our teachers who through hard work and dedication mentored us through our careers, our colleagues who have been with us always on this journey of shared patient care, and to our patients, for whose optimal care and comfort is our never-ending goal. Foreword Critical illness often presents problems of such complexity that the bedside clinician is forced to integrate information from many data streams into the management decision. As the ‘evidence-based’ investigational paradigm gained traction and eventual dominance in medicine, initial hope was entertained by many intensivists that solid evidence from trials, together with advanced imaging and the laboratory data, would generate effective ‘rules’ to guide practice. In fact, well-designed and conducted clinical trials (RCTs) do characterize general behaviors and may provide defensible starting points for making some choices, especially if positive. To this point however, we have been disappointed by RCT output; fundamentally, such problems are too imprecisely defined, complicated, interactive, and labile to allow RCTs, ‘snapshot’ imaging, and biomarkers – even considered together – to reliably direct the next best step for the individual patient. Effective life support needs a more ‘personalized’ approach that adheres to established principles aimed at supporting the patient’s own efforts to recover homeostasis and viability. Our decisions must remain flexible; within the physical boundaries of the ICU, the principles of therapeutic challenge, frequent reassessment, continual re-eval- uation, and timely mid-course correction remain fundamental elements of the inten- sivist’s art. Moment-by-moment access to key information relevant to the patient’s status is central to well-timed interventions. Successful management still depends upon having a firm grasp of the physiology of critical illness, coupled with the ability to expertly integrate and act upon monitored information from key indicators that reflect cardiopulmonary functioning. A few foundational elements of critical care physiology share precedence over the others, but none is more important than the circulation. This important volume, written by the foremost experts of our field and directed toward bedside management, is a wide-ranging compendium of in-depth chapters that address essential cardiovascular physiology as well as the pragmatics of diagnosing, monitoring, and supporting the circulatory system. The mechanistic basis for clinical decision making is emphasized throughout. Cardio-respiratory management of the critically ill has advanced rather impressively in recent decades, and such progress is clearly evident in the attention given to such up-to-date topics as bedside ultrasound, assessment of the microcirculation and perfusion adequacy, advanced monitoring options, and extracorporeal circulatory assistance and gas exchange. The chapters of this book are not meant to be read sequentially from cover to cover (even though such an exercise might prove highly rewarding), but rather to be accessed in a focused man- ner as specific clinical issues arise in patient care or when knowledge gaps need to be filled. In this current exciting age of rapidly expanding knowledge of genetic and molecular sciences, exhaustive statistical analyses, empirical evidence gathering, RCTs and meta- analysis, it sometimes seems that our attention as practitioners has been diverted from VII Foreword understanding the ‘why?’ to the ‘what and how’?. I congratulate the editors and authors for addressing both in admirable fashion. It is refreshing and most welcome to see a definitive work based upon the often neglected but invaluable middle ground of applied pathophysiology. Mastery of physiology will always be needed to unravel our most dif- ficult clinical challenges and remains the foundation of intelligent critical care. John J. Marini Minneapolis/St. Paul, MN, USA Preface An essential aspect of the care of the critically ill patient is to identify cardiovascular insufficiency, treat it, and know when to stop over resuscitation while also attending to the various other aspects of pathology that each patient brings to the clinical environ- ment. No two patents are alike in their presentation of acute illness, response to therapy, or potential for a good outcome from the treatment of disease and a minimal amount of treatment-associated morbidities. Furthermore, most people, if they live long enough, will experience some acute potentially life-taking process that if not treated correctly and rapidly will result in death or morbidity before their time. These realities make the practice of critical care medicine one of the most demanding of all medical specialties, and also one of its greatest attractions in the recruitment of dedicated and passionate bedside clinicians. Within this context, this volume has been crafted to systematically address all aspects of hemodynamic monitoring-related cardiovascular diagnosis and management. Part I of this volume addresses the essential aspects of the physiology and pathophysiology of cardiovascular insufficiency. The authors of these eleven chapters are some of the leading clinical investigators in the field with many years of bedside clinical experience and an impressive publication record of clinical trials and basic science companion studies. Although these chapters are arranged in a progressive sequence to supplement each

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