CRITICAL CARE MEDICINE Just the Facts Jesse B. Hall, MD Professor of Medicine and Anesthesia & Critical Care Section Chief, Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois Gregory A. Schmidt, MD Professor of Medicine, Carver College of Medicine, Division of Pulmonary Diseases, Critical Care, and Occupational Medicine University of Iowa, Iowa City, Iowa Associate Editor D. Kyle Hogarth, MD Assistant Professor, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, Illinois New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2007 by The McGraw-Hill Companies, Inc. All rights reserved. Manufactured in the United States of America. 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Also to Larry Wood, MD, PhD, for providing an amazing environment of learning and for setting a standard for Critical Care physicians. D. Kyle Hogarth, MD This page intentionally left blank For more information about this title, click here CONTENTS Contributors xi Preface xvii Section 1 GENERAL MANAGEMENT OF PATIENTS 1 Assessment of the Critically Ill Patient Vidya Krishnan 1 2 Airway Management Nuala J. Meyer 3 3 Resuscitation Steven Q. Davis 6 4 Fluid Therapy E. Mirnalini Mohanraj 8 5 Pain Management D. Kyle Hogarth 12 6 Sedation Management in the ICU D. Kyle Hogarth 14 7 Neuromuscular Blockade Nuala J. Meyer 17 8 Monitoring the Cardiovascular System Joseph Levitt 19 9 Monitoring the Respiratory System Joseph Levitt 21 10 Assessment of Severity of Illness Michael Moore 23 11 Pulmonary Artery Catheter Nina M. Patel 27 12 Nutrition in the Critically Ill Joseph Levitt 30 Section 2 CARDIOVASCULAR DISORDERS 13 An Approach to Shock William Schweickert 33 14 Ventricular Dysfunction in Critical Illness Jay Finigan 35 15 Rhythm Disturbances in the ICU Susan S. Kim 37 16 Noninvasive Assessment of Cardiac Output Sascha Goonewardena 40 v vi CONTENTS 17 Interpretation of Hemodynamic Waveforms Tim Floreth 42 18 Myocardial Ischemia James K. Min 46 19 Echocardiography in the Critically Ill Patient Steven Y. Chang 48 20 Acute Right Heart Syndromes Steven Q. Davis 50 21 Pulmonary Embolism: Thrombus, Fat, Air, and Amniotic Fluid Nuala J. Meyer 51 22 Pericardial Disease D. Kyle Hogarth 55 23 Cardiovascular Diseases Nuala J. Meyer 57 24 Aortic Dissection Nathan Sandbo 62 25 Mechanical Circulatory Assist Devices Ethan L. Gundeck 64 26 Hypertensive Encephalopathy and Hypertensive Emergencies George W. Bell 66 Section 3 RESPIRATORY DISORDERS 27 Pathophysiology of Acute Respiratory Failure Nina M. Patel 73 28 Noninvasive Positive Pressure Ventilation Nathan Sandbo 76 29 Common Modes of Mechanical Ventilation William Schweickert 77 30 Managing the Ventilated Patient William Schweickert 80 31 Responding to Crises in the Ventilated Patient William Schweickert 83 32 Using Respiratory Waveforms to Adjust Ventilator Settings Steve Mathai 85 33 Liberation from Mechanical Ventilation Mark C. Pohlman 89 34 Ventilator-Induced Lung Injury Shashi Kiran Bellam 91 35 Acute Respiratory Distress Syndrome Nuala J. Meyer 92 36 Extracorporeal Membrane Oxygenation Anna N. Kamp 96 37 Acute-on-Chronic Respiratory Failure Timothy K. Baker, Steven Q. Davis 102 38 Status Asthmaticus Maria Dowell 105 39 Hemoptysis and Pulmonary Hemorrhage Maria Dowell 107 CONTENTS vii 40 Restrictive Diseases of the Respiratory System Maria Dowell 109 41 Sleep-Disordered Breathing D. Kyle Hogarth 111 42 Inhalation Injuries Rekha Vij, Shashi Kiran Bellam 113 Section 4 INFECTIOUS DISORDERS 43 Sepsis, Severe Sepsis, and Septic Shock Michael Moore 117 44 Early Goal-Directed Therapy for Sepsis Jonathan D. Paul 123 45 Drotrecogin Alfa (Activated) Michael Moore 125 46 An Approach to Sepsis of Unknown Etiology Nina M. Patel 128 47 Empiric Antibiotic Selection for Severe Infections Kevin Gregg 131 48 Neutropenic Patients Nathan Sandbo 134 49 AIDS in the ICU William Schweickert 137 50 Endocarditis D. Kyle Hogarth 140 51 Infectious Complications of Intravenous Devices Ajeet Vinayak 142 52 Severe Community-Acquired Pneumonia Shashi Kiran Bellam 144 53 Ventilator-Associated Pneumonia D. Kyle Hogarth 146 54 Fungal Infections in the Intensive Care Unit Ben Freed, Steve Davis 149 55 Central Nervous System Infections John A. Schneider 153 56 Viral Encephalitis D. Kyle Hogarth 156 57 Life-Threatening Infections of the Head and Neck Nuala J. Meyer 158 58 Soft-Tissue Infections Joseph Levitt 161 59 Urinary System Infections Michael Moore 163 60 Gastrointestinal Infections Nina M. Patel 169 61 Severe Malaria Nathan Sandbo 173 62 Tetanus William Schweickert 175 63 Viral Hemorrhagic Fevers D. Kyle Hogarth 177 64 Anthrax and Smallpox Ajeet Vinayak 178 65 SARS Shefali Shah 182 66 Influenza Gordon E. Carr 185 67 Plague: The Black Death Samip Vasaiwala 188 68 Botulism David Brush 191 viii CONTENTS Section 5 NEUROLOGIC DISORDERS 69 Cerebrovascular Accident Nina M. Patel 197 70 CNS Hemorrhage Steven Q. Davis, Alex Ulitsky 200 71 Anoxic Encephalopathy Maria Dowell 206 72 Therapeutic Hypothermia John E.A. Blair, Raina M. Merchant 208 73 Status Epilepticus D. Kyle Hogarth 212 74 Acute Spinal Cord Compression Nuala J. Meyer 213 75 Delirium in the Intensive Care Unit Joseph Levitt 215 76 Neuromuscular Weakness in the ICU Michael Moore 217 77 Head Trauma Nina M. Patel 226 78 Coma and Persistent Vegetative State Nathan Sandbo 228 79 Brain Death Nathan Sandbo 230 Section 6 HEMATOLOGY AND ONCOLOGY 80 Anemia, Tranfusion, Massive Tranfusion Maria Dowell 233 81 Sickle Cell Disease D. Kyle Hogarth 235 82 Bleeding Disorders in the ICU Michael Moore 237 83 Thrombolytic Therapy Amit Pursnani 245 84 Thrombotic Thrombocytopenic Purpura-Hemolytic Uremic Syndrome Shashi Kiran Bellam, Joyce Tang 248 85 Disseminated Intravascular Coagulation Steven Q. Davis, Sandy Nasrallah 249 86 Thrombocytopenia in Critically Ill Patients Daniel A. Pollyea 252 87 Plasmapheresis in The ICU Nuala J. Meyer 255 88 Acute Leukemia Shashi Kiran Bellam 258 89 Superior Vena Cava Syndrome Nuala J. Meyer 261 90 Bone Marrow Transplantation Joseph Levitt 263 91 Toxicities of Chemotherapy Michael Moore 266 92 Radiation Pneumonitis Peter H. O’Donnell 278 Section 7 RENAL AND METABOLIC DISORDERS 93 Acute Renal Failure Nina M. Patel 281 94 Renal Replacement Therapy in the ICU Ignatius Y. Tang 283 95 Severe Electrolyte Disorders William Schweickert 286 96 Acid-Base Balance Meredith McCormack 289 97 Diabetic Ketoacidosis in Adults Steve Skjei 292 CONTENTS ix 98 Intensive Insulin Therapy in the Critically Ill Steve Skjei 293 99 Thyroid Disease Stephen Skjei, Shashi Kiran Bellam 295 100 Adrenal Insufficiency Shashi Kiran Bellam 298 101 Rhabdomyolysis Steven Q.