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Surgical Intensive Care Medicine Surgical Intensive Care Medicine SURGICAL INTENSIVE CARE MEDICINE SURGICAL INTENSIVE CARE MEDICINE EDITORS JOHN MERRITT O'DONNELL, M.D. Director, Surgical Intensive Care Unit Chairman, Department ofSurgical Critical Care Lahey Clinic Medical Center Burlington, MA USA FLAVIO EDUARDO NAcUL, M.D. Senior Fellow Department ofSurgical Critical Care Lahey Clinic Medical Center Burlington, MA USA SPRINGER SCIENCE+BUSINESS MEDIA, LLC Library of Congress Cataloging-in-Publication Data Surgical intensive care medicine I editors, John Merritt O'Donnell, Flävio Eduardo Näcul. p. ;cm. Includes bibliographical references and index. ISBN 978-1-4757-6647-9 ISBN 978-1-4757-6645-5 (eBook) DOI 10.1007/978-1-4757-6645-5 1. Surgical intensive care. 2. Critical care medicine. I. O'Donnell, John Merritt. II. Nacul, Flävio Eduardo. [DNLM: 1. Postoperative Care--methods. 2. Intensive Care--methods. WO 183 S9614 2001] RD49 .S875 2001 617'.919--dc21 2001029713 Copyright © 2001 by Springer Science+Business MediaNew Y ork. Second Printing 2002. Originally published by Kluwer Academic Publishers in 2001 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, mechanical, photo-copying, recording, or otherwise, without the prior written permission of the publisher, Springer Science+Business Media, LLC. Printedon acid-free paper. Although every effort has been made to ensure that drug doses and other information are presented accurately in this publication, the ultimate responsibility rests with the prescribing physician. Neither the publishers nor the authors can be held responsible for errors or for any consequences arising from the use of information contained herein. Products mentioned in this publication should be used in accordance with the prescribing information prepared by the manufacturers. No claims or endorsements are made for any drug or compound at present under clinical investigation. This book is dedicated to my beloved parents, Kay and Frank "Shorty" 0 'Donnell. Their time has passed, but their spirit is everlasting. And to my wife, Rocky, and daughter, Jacquelyn, who put it all in its proper place. JMO'D To my parents with love FEN TABLE OF CONTENTS SECTION 1: RESUSCITATION 1 OXYGEN THERAPY 3 Andrew G. Villanueva 2 AIRWAY MANAGEMENT 23 Marc J Popovich 3 VASCULAR CANNULATION 37 J Esteban Varela, Albert J Varon 4 FLUID RESUSCITATION 51 Joseph R. Fontana, Thomas G. Rainey 5 SHOCK 71 Sneeta Takhar, Myer H Rosenthal 6 VASOACTIVE AMINES AND INOTROPIC AGENTS 97 Keith P. Lewis, R. Mauricio Gonzalez 7 EVALUATION OF HEMODYNAMICS AND OXYGEN DELIVERY 109 David A. Kaufman 8 ACID-BASE BALANCE AND BLOOD GAS INTERPRETATION 131 M Fareed Azam, William T. Peruzzi 9 ANALGESIAAND SEDATION 147 JeanKwo 10 NEUROMUSCULAR BLOCKING AGENTS 163 Rafael A. Ortega, Ruben Azocar VIII Table ofContents 11 CARDIOPULMONARY RESUSCITATION 181 Ernest F. J. Block, Jay L. Falk SECTION 2: NEUROLOGYINEUROSURGERY 12 HEAD INmRIES 195 Jack E. Wilberger 13 SPINAL CORD INmRIES 205 Fred H Geisler 14 ISCHEMIC STROKE 219 Jamary Oliveira-Filho, Walter J. Koroshetz 15 HEMORRHAGIC STROKE 243 Jamary Oliveira-Filho, Walter J. Koroshetz 16 INTRACRANIAL HYPERTENSION 259 Romergryko G. Geocadin, Michael A. Williams, Daniel F. Hanley SECTION 3: CARDIOLOGY 17 POSTOPERATIVE MYOCARDIAL INFARCTION 277 Glynne D. Stanley, Sundara Rengasamy 18 POSTOPERATIVE ARRHYTHMIAS 293 Mikhail Torosoff, Ferdinand J. Venditti, Jr. 19 POSTOPERATIVE HYPERTENSION 311 Robert N Sladen Surgical Intensive Care Medicine IX SECTION 4: PULMONARY MEDICINE 20 ACUTE RESPIRATORY FAILURE 333 Lawrence J. Caruso, T James Gallagher 21 MECHANICAL VENTILATION 345 Neil T Bennett, T James Gallagher 22 VENOUS THROMBOEMBOLISM 363 Andrew G. Villanueva 23 FAT EMBOLISM SYNDROME 385 John M 0 'Donnell 24 VENOUS AIR EMBOLISM 397 Carl J. Borromeo SECTION 5: INFECTIOUS DISEASES 25 SEPSIS 411 Geoffrey M Clarke 26 CATHETER-RELATED INFECTION 435 Shubjeet Kaur, Stephen O. Heard 27 VENTILATOR-ASSOCIATED PNEUMONIA 451 Anthony W. Gray, Jr. 28 INTRA-ABDOMINAL SEPSIS 461 Peter W. Marcello 29 EVALUATION OF THE FEBRILE PATIENT 471 Ellen Riccobene, Richard Gleckman x Table of Contents 30 PRINCIPLES OF ANTIBIOTIC THERAPY 483 Ellen Riccobene, Richard Gleckman SECTION 6: HEMATOLOGY 31 COAGULOPATHIC STATES 495 Charise T. Petrovitch, John C. Drummond 32 BLOOD PRODUCTS 515 William D. Hoffman SECTION 7: METABOLISM AND NUTRITION 33 POSTOPERATIVE MANAGEMENT OF DIABETES 533 Byron Unger, Douglas B. Coursin 34 ADRENAL INSUFFICIENCY 547 Gary P. Zaloga, Paul Marik 35 ENTERAL NUTRITION 559 Susan E. Schaefer 36 PARENTERAL NUTRITION 575 James J Pomposelli SECTION 8: NEPHROLOGY AND ELECTROLYTES 37 ACUTE RENAL FAILURE 591 Rinaldo Bellomo, Claudio Ronco 38 DIALYTIC THERAPY 601 Rinaldo Bellomo, Claudio Ronco Surgical Intensive Care Medicine Xl 39 DISORDERS OF SODIUM AND POTASSIUM 611 Flavio E. Nacui 40 DISORDERS OF MAGNESIUM, CALCIUM, AND PHOSPHORUS 621 Flavio E. Nacu/ SECTION 9: GASTROENTEROLOGY 41 ACUTE GASTROINTESTINAL HEMORRHAGE 633 Ronald F Martin 42 ACUTE PANCREATITIS 645 Ronald F. Martin SECTION 10: SURGERY, TRAUMA, AND TRANSPLANTATION 43 BURNS 661 Larry M Jones 44 TRAUMA 675 Michael S. Rosenblatt 45 THE ABDOMINAL COMPARTMENT SYNDROME 689 James M Doly, Jun Oda, Rao R. Ivatury, Harvey J. Sugerman 46 RHABDOMYOLYSIS 699 Frank Tull, Joseph Borrelli, Jr. 47 POSTOPERATIVE CARE OF THE CARDIAC SURGICAL PATIENT 705 Ross F. DiMarco, Jr. XII Table of Contents 48 POSTOPERATIVE CARE OF THE HEART TRANSPLANT PATIENT 741 Nicholas R. Banner, Michael J. Boscoe, Asghar Khaghani 49 POSTOPERATIVE CARE OF THE LUNG TRANSPLANT PATIENT 761 Janet R. Maurer 50 POSTOPERATIVE CARE OF THE LIVER TRANSPLANT PATIENT 775 Elizabeth A. Pomfret, James J. Pomposelli 51 CARE OF THE ORGAN DONOR 795 Joseph M Darby SECTION 11: ADDITIONAL TOPICS 52 HYPERSENSITIVITY REACTIONS 807 Maged S. Mikhail, Delbert R. Black 53 DISORDERS OF THERMOREGULATION 825 Michael H Entrup, Sana Ata 54 SCORING SYSTEMS AND OUTCOME PREDICTION 853 Keith L. Stein 55 TRANSPORT 867 Marc J. Shapiro APPENDIX WORLD WIDE WEB (WWW) CRITICAL CARE INTERNET SITES 881 INDEX 883 CONTRIBUTORS SANAATA, M.D. ERNEST F. J. BWCK, M.D., F.A.C.S., Assistant Clinical Professor F.C.C.M of Anesthesiology Clinical Assistant Professor of Surgery Tufts University School of Medicine University of Florida College of Medicine Director, Liver Transplant Anesthesia Assistant Director of Trauma Services Lahey Clinic Medical Center Director, Trauma Quality Services Burlington, MA USA Orlando Regional Medical Center Orlando, FL USA M. FAREED AZAM, M.D. Assistant Professor JOSEPH BORRELLI, Jr., M.D. Department of Anesthesiology Assistant Professor University of Colorado Health Department of Orthopedic Surgery Science Center Washington University School of Medicine Denver, CO USA Saint Louis, MO USA RUBEN AZOCAR, M.D. CARL J. BORROMEO, M.D. Chief Resident Assistant Clinical Professor of Anesthesiology Department of Anesthesiology Tufts University School of Medicine Boston University Medical Center Staff Anesthesiologist Boston, MA USA Department of Anesthesiology Lahey Clinic Medical Center NICHOLAS R. BANNER, F.R.C.P. Burlington, MA USA Consultant Cardiologist and Transplant Physician MICHAEL J. BOSCOE, F.R.C.A. Royal Brompton and Harefield NHS Trust Consultant Anaesthesist Harefield, Middlesrx, UK Royal Brompton and Harefield NHS Trust Harefield, Middlesex, UK RINALDO BELLOMO, M.D. Associate Professor of Medicine LAWRENCE J. CARUSO, M.D. University of Melbourne Assistant Professor of Anesthesiology Director of Intensive Care Research Staff Anesthesiologist Austin & Repatriation Medical Centre College of Medicine Melbourne, Australia University of Florida Gainesville, FL USA NEIL T. BENNETT, M.D. Staff Anesthesiologist GEOFFREY M. CLARKE, M.D., M.B.B.S. Medical Director of Respiratory Services Head, Intensive Care Unit Assistant Professor of Anesthesiology Director, Division of Critical Care College of Medicine Royal Perth Hospital University of Florida Perth, Western Australia Gainesville, FL USA DOUGLAS B. COURSIN, M.D. DELBERT R. BLACK, M.S., M.D. Professor of Anesthesiology and Internal Medicine Resident in Anesthesia Associate Director of the Trauma and Life Department of Anesthesia Support Center and Critical Care University of Wisconsin Hospitals and School Massachusetts General Hospital of Medicine Boston, MA USA Madison, WI USA XIV Contributors JOSEPH M. DARBY, M.D. T. JAMES GALLAGHER, M.D. Associate Professor of Anesthesiologyl Professor of Anesthesiology and Surgery Critical Care Chief, Critical Care Medicine University of Pittsburgh School of Medicine College of Medicine Medical Director, Trauma/Surgical Intensive University of Florida Care Unit Gainesville, FL USA UPMC - Presbyterian University Hospital Pittsburgh, PA USA FRED H. GEISLER, M.D. Assistant Professor of Surgery ROSS F. DiMARCO, Jr., M.D. Rush University Chief, Cardiovascular Surgery Director of Complex Spine Surgery Mercy Hospital of Pittsburgh Chicago Institute of Neurosurgery and Pittsburgh, PA USA Neuroresearch Chicago, lL USA JAMES M. DOTY, M.D. Generalffrauma Surgery Division ROMERGRYKO G. GEOCADlN, M.D. Department of Surgery Instructor of Neurology Medical College of Virginia Neurosciences Critical Care Division Virginia Commonwealth University Johns Hopkins University School of Medicine Richmond, VA USA Baltimore, MD USA JOHN C. DRUMMOND, M.D. RICHARD GLECKMAN, M.D., F.A.C.P. Professor and Chair Clinical Professor of Medicine Department of Anesthesiology Mt. Sinai School of Medicine UCSD Medical Center Chairman, Department of Medicine San Diego,
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