Evidence-Based Critical Care: A Case Study Approach

✍ Scribed by Robert C. Hyzy (editor), Jakob McSparron (editor)

• Publisher: Springer
• Year: 2020
• Tongue: English
• Leaves: 796
• Category: Library

✦ Synopsis

This extensively updated textbook comprehensively reviews the latest developments in evidence-based critical care. Topics are covered in a case study format with an emphasis on the principles of diagnosis and therapy. Each topic is covered using a variety of case studies and features a case vignette, clinical question and an additional discussion section to clarify areas of particular importance. Topics including cytokine release syndrome, sympathomimetic overdose and palliative care in the intensive care unit have been extensively revised, while new sections focusing on neuromuscular disease and subarachnoid hemorrhages have been added.

Evidence-Based Critical Care, 2^nd edition is a critical resource for critical care practitioners, fellows, residents; allied health professionals and medical students who wish to expand their knowledge within critical care. The case study-based approach taken in the textbook makes this an ideal resource for those preparing for board examinations.

✦ Table of Contents

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Preface
Contents
Part I: ER-ICU Shock and Resuscitation
1: Cardiac Arrest Management
Case Presentation
Principles of Management and Standard Approach to Resuscitation
Chest Compressions
Ventilation and Oxygenation
Vasopressors During CPR
Management of Ventricular Fibrillation/Pulseless Ventricular Tachycardia
Defibrillation
Antiarrhythmic Therapy
Management of Pulseless Electrical Activity
Quality Assurance
Evidence Contour
Airway Management During Cardiac Arrest
Hemodynamic-Directed Resuscitation
Bedside Ultrasound During CPR
Mechanical CPR
Extracorporeal Cardiopulmonary Resuscitation
References
2: Post-cardiac Arrest Management
Case Presentation
Overview of Post-cardiac Arrest Syndrome (PCAS)
Post-cardiac Arrest Brain Injury
Post-cardiac Arrest Myocardial Dysfunction
Systemic Ischemia/Reperfusion Response
Persistent Precipitating Pathology
Principles of Management
Hemodynamic Optimization
Mechanical Ventilator Strategy
Management of Acute Coronary Syndrome (ACS)
Hypothermic Targeted Temperature Management (HTTM)
Glycemic Control
Seizure Management
Neuroprognostication
Organ Donation
Evidence Contour
Patient Selection for Emergent Coronary Angiography
Patient Selection for HTTM
HTTM Optimization
Mechanical Support for Refractory Cardiac Arrest or Post-cardiac Arrest Cardiogenic Shock
References
3: Undifferentiated Shock
Case Presentation
Principles of Management
Shock Types
Evidence Contour
Assessment of Volume Responsiveness
Bedside Echocardiography
Summary
References
4: Hypovolemic Shock and Massive Transfusion
Case Presentation
Principles of Management
Establish Adequate IV Access
Consider Physiologic Reserve
Monitor Volume Responsiveness
Administer the Appropriate Fluid(s)
Minimize Crystalloid Administration in Setting of Hemorrhage
Massive Transfusion Protocol
Ionized Calcium Repletion
Track Endpoints of Resuscitation
Hemostatic Resuscitation
Allow for Permissive Hypotension During Hemorrhage
Correct and Reverse Augmenting Factors of Coagulopathy and Shock
Preserve Formed Clot with Antifibrinolytics
Evidence Contour
Point-of-Care Monitoring of the Hemostatic System
Use and Timing of Vasopressors, Traumatic Brain Injury
References
5: Acute Respiratory Failure: Non-invasive Ventilation and High Flow Nasal Cannula
Case Presentation
Principles of Management
Definition
Indications, Contraindications and Settings
Predictors of Failure of Non-invasive Ventilation
Use of High-Flow Nasal Cannula as an Alternative to NIV
Evidence Contour
Use in Patients with Pneumonia
Use in Patients with Asthma Exacerbation
Use in Patients with ARDS
Use of NIV in Patients with Altered Mental Status
Use of NIV for Preoxygenation Prior to Intubation
Use of NIV to Facilitate Weaning from Invasive Ventilation
Palliative Care Indications
References
6: Diagnosis and Management of Tricyclic Antidepressant Ingestion
Case Presentation
Case Conclusion
Principles of Management
Diagnosis
Tricyclic Antidepressant Side Effects
Gastrointestinal Decontamination
Plasma Alkalinization
Management of Hypotension and Vasopressor Support
Extracorporeal Elimination
Seizure Management
Evidence Contour
Intravenous Lipid Emulsion
Hypertonic Saline
Antiarrhythmic Drugs
Physostigmine
References
7: Management of Beta Blocker and Calcium Channel Blocker Toxicity
Case Presentation
Case Conclusion
Principles of Management
Gastrointestinal Decontamination
Hemodynamic Support
Calcium Salts
Glucagon
Atropine
Vasopressors
High-Dose Insulin Euglycemia Therapy
Invasive Circulatory Support
Evidence Contour
Lipid Emulsion Therapy
Sodium Bicarbonate
Methylene Blue
Extracorporeal Removal Strategies
References
8: Management of Sympathomimetic Overdose Including Designer Drugs
Case Presentation
Principles of Management
Gastrointestinal Decontamination
Activated Charcoal
Special Considerations in the “Body Packer”
Management of Agitation
Benzodiazepines
Antipsychotics
Dexmedetomidine
Seizure Management and Choice of Anticonvulsant
Benzodiazepines
Barbiturates
Levetiracetam
Phenytoin/Fosphenytoin
Hypertensive Crisis and Tachycardia
Calcium Channel Blockers
Nitrates
Alpha-Adrenergic Blockers
Chest Pain and Cardiac Ischemia
Cardiac Arrhythmias and Conduction Disturbances
Evidence Contour
Beta-Adrenergic Blockers
Hyperthermia
Benzodiazepines
External Cooling
Dantrolene
Carvedilol
Atypical Antipsychotics
Lipid Emulsion
References
9: Diagnosis and Management of Ethylene Glycol Ingestion
Case Presentation
Principles of Management
Diagnosis
Ventilator and Circulatory Support
Gastric Decontamination/Lavage/Charcoal
Aldehyde Dehydrogenase (ADH) Blockade
Hemodialysis
Evidence Contour
Ethylene Glycol Treatment Threshold
Fomepizole Vs. Ethanol
ADH Inhibition Without Hemodialysis
Serum and Urine Alkalization
Cofactor Supplementation
Other Toxic Alcohols
Methanol
Isopropyl Alcohol
References
10: Accidental Hypothermia
Case Presentation
Principles of Management
Diagnosis
Patient Monitoring
Adjunctive Testing
Rewarming
Hypothermia Without a Pulse
Other Supportive Care
Disposition
Pediatric Patients
Evidence Contour
Withholding CPR
Degree of Rewarming in Cardiac Arrest
Extracorporeal Support When Signs of Life Present
Selection of Extracorporeal Support
Transcutaneous Pacing
Endovascular Rewarming
Esophageal Heat Transfer Device
Core Afterdrop
References
Part II: Cardiac Disease
11: Management of Cardiogenic Shock
Case Presentation
Principles of Management
Diagnosis
Early Revascularization
Vasopressors/Inotropes
Percutaneous Mechanical Circulatory Support
Intra-Aortic Balloon Pump
Impella® 2.5, CP, and 5.0
TandemHeart®
Venoarterial Extracorporeal Membrane Oxygenation (v-a ECMO)
Temporary Surgical Mechanical Circulatory Support
Evidence Contour
Multivessel Revascularization
Vasopressors and Inotropes
Mechanical Circulatory Support
References
12: Management of Acute Heart Failure
Case Presentation
Principles of Management
Diagnosis
Diuretic Therapy
Intravenous Vasodilators
Emergent Mechanical Circulatory Support
Evidence Contour
Pulmonary Artery (PA) Catheters
Inotropic Agents
Diuretic Dosing—Intermittent Versus Continuous
Ultrafiltration
Nesiritide
Renal-Dose Dopamine
Sacubitril-Valsartan in AHF
References
13: Management of Acute Coronary Syndrome
Case Presentation
Principles of Management
Diagnosis
Initial Assessment and Early Risk Stratification
Initial Medical Therapy
Anti-ischemic Therapy
Oxygen
Nitrates
Morphine
Beta-Adrenergic Blockers
Lipid Lowering Therapy
Anti-thrombotic Therapy
Antiplatelet Therapy
Aspirin
P2Y12 receptor inhibitors
Glycoprotein IIb/IIIa Inhibitors
Anticoagulation
Early Reperfusion and Revascularization
STEMI
NSTE-ACS
Evidence Contour
Routine Early PCI After Successful Thrombolysis in STEMI
Culprit Only Vs. Complete Revascularization in STEMI
Manual Thrombectomy During Primary PCI in STEMI
Optimal Duration of Dual Antiplatelet Therapy (DAPT)
Optimal Antiplatelet Regimen in Patients Requiring Long-term Anticoagulation
References
14: Management of Cardiac Tamponade
Case Presentation
Principles of Management
Hemodynamic Derangements
Clinical Findings
Non-invasive Diagnostic Testing
Invasive Diagnostic Testing
Closed Pericardiocentesis
Surgical Drainage
Evidence Contour
Effusive-Constrictive Pericarditis
References
15: Hypertensive Crises
Case Presentation
Principles of Management
Diagnosis
Treatment of Hypertensive Crises
Pharmacotherapy (Table 15.1)
Evaluation for Secondary Causes of Hypertension
Evidence Contour
References
16: Atrial Fibrillation and Other Supraventricular Tachycardias
Case Presentation
Principles of Management
Diagnosis
Triggers for Atrial Fibrillation
Physiologic Effects
Treatment Strategies
Rate Control
Rhythm Control
Stroke Prevention
Other Supraventricular Tachycardias (SVT)
Evidence Contour
High Bleeding Risk in Post-operative Cardiac Surgery Patients
Concurrent Inotropic Support
Rhythm Control in HFrEF
References
17: Ventricular Arrhythmias
Management of Ventricular Arrhythmias
Case Presentation
Principles of Management
Diagnosis
Classification of VT
Monitoring and Testing
General Measures
Beta Blockers
Amiodarone
Lidocaine
Digoxin Immune Fab
Evidence Contour
Anti-arrhythmic Drug Therapy
Mechanical Circulatory Support: IABP
Mechanical Circulatory Support: ECMO
Radiofrequency Catheter Ablation
Transcoronary Ethanol Ablation
Cardiac Sympathetic Denervation
References
18: Management of Acute Aortic Syndromes
Case Presentation
Principles of Management
Classification
Epidemiology and Risk Factors
Clinical Presentation and Diagnosis
Treatment
Type A
Type B
Long-Term Follow Up
Evidence Contour
Diagnosis and Biomarkers
Treatment of Isolated Arch Dissection, Ascending IMH or PAH
Patient Selection for Surgery in Type A Dissection
Intervention for Uncomplicated Type B Dissection
Multidisciplinary Care Models
References
19: Management of Endocarditis
Case Presentation
Principles of Management
Epidemiology
Diagnosis
Antimicrobial Therapy
Indications for Surgery
Follow-Up Evaluation
Evidence Contour
Timing of Non-emergent Surgery in IE
Neuroimaging in IE
Timing of Surgery in IE with Septic Cerebral Embolic Strokes or Hemorrhage
Valve Repair Versus Valve Replacement
Cardiac Device Related IE
References
Part III: Respiratory Disease
20: Community Acquired Pneumonia
Case Presentation
Principles of Management
Site-of-Care Decisions
Microbial Etiologies
Diagnostic Testing
Antibiotic Treatment
Parapneumonic Effusions
Evidence Contour
Risk of Multidrug Resistant (MDR) Pathogens
Drugs to Suppress Toxin Production
Procalcitonin
Corticosteroids
Extracorporeal Membrane Oxygenation (ECMO)
References
21: Management of Acute Respiratory Distress Syndrome
Case Presentation
Principles of Management
Risk Factors for ARDS and Diagnosis
Berlin Definition of ARDS
Lung Protective Ventilation
High PEEP Strategy
Prone Ventilation
Fluid Management
Supportive Care
Evidence Contour
Requirement for Positive Pressure Ventilation
Subgroups and Subphenotypes
Noninvasive Ventilation
Transpulmonary Pressure
Pressure Limited Mechanical Ventilation
Neuromuscular Blockade
High Frequency Oscillatory Ventilation (HFOV)
Extra Corporeal Membrane Oxygenation (ECMO)
Corticosteroids
Inhaled Vasodilators
References
22: Acute Exacerbation of COPD
Case Presentation
Principles of Management
Diagnosis and Impact of COPD Exacerbations
NIPPV
Bronchodilators
Glucocorticoids
Antibiotics
Smoking Cessation
Evidence Contour
Extracorporeal Carbon Dioxide Removal
AECOPD and Thromboembolic Disease
References
23: Management of Status Asthmaticus
Case Presentation
Ideal Gas Law
Principles of Management
Inhaled Bronchodilators
Corticosteroids
Monitoring of Arterial Blood Gases
Ventilator Strategies
Permissive Hypercapnia/Hypoventilation
Monitoring for Hyperinflation
Recognizing Barotrauma
Evidence Contour
Adjuvant Pharmacologic Treatments
Magnesium
Intravenous Bronchodilators
Lactic Acidosis from Beta Agonist
Heliox
Noninvasive Positive Pressure Ventilation (NIV)
Anesthetics
Bronchoscopy
Extracorporeal Life Support (ECLS)
Antibiotics
Anti-IgE Therapy
References
24: Immunocompromised Pneumonia
Case Presentation
Principles of Management
Presentation
Etiology
Diagnosis
Empiric treatment
Supportive care
Evidence Contour
Utility of invasive testing
Serum indices of infection
Noninvasive ventilation
References
25: Venous Thromboembolism in the Intensive Care Unit
Case Presentation
Priniciples of Management
Epidemiology of VTE in the ICU
Risk Factors
Clinical Presentation
Pulmonary Embolism Severity
Diagnosis
Treatment
Evidence Contour
Reperfusion Therapy in Patients with Hemodynamically Stable Pulmonary Embolism
Veno-arterial ECMO for High Risk PE
IVC Filter Placement
DOACs: Direct Factor Xa and Thrombin Inhibitors for Acute Intermediate and High Risk PE
Pulmonary Embolism Response Team (PERT) in the Management of Acute PE
References
26: Massive Hemoptysis
Case Presentation
Principles of Management
Epidemiology
Sources of Hemorrhage
Diseases Associated with Massive Hemoptysis
An Approach to Managing Life Threatening Hemoptysis (Algorithm, Fig. 26.4)
Assessment
Evidence Contour
The Role of Bronchoscopy: Rigid Versus Flexible
Bleeding Localization in the Stable Patient
Recurrent Bleeding; Repeat Embolization or Surgery?
References
27: Sedation and Delirium
Case Presentation
Principles of Management
Monitoring Sedation and Delirium
Minimizing Sedation
Risk Factors for Delirium
Evidence Contour
Sedative Choice
Spontaneous Awakening Trials (SATs)
Sedative-Related Delirium
Prevention of Delirium
Antipsychotics
Delirium and Long-Term Outcomes
References
28: Prolonged Mechanical Ventilation
Case Presentation
Principles of Management
Diagnosis
Assess Expected Survival
Place Tracheostomy
Daily tracheostomy collar trials with full ventilator support between trials
Early Mobility
Speaking valve trials
Tracheostomy removal
Evidence Contour
Timing of tracheostomy
Benefit of transfer to LTAC
Survivorship clinics and symptom burden
References
29: Ventilator-Associated Pneumonia
Case Presentation
Principles of Management
Rapid Identification and Empiric Treatment of VAP Is Essential
Treat Patients with Vap Broadly for Multidrug Resistant Organisms
Duration of Therapy: 8 or 15 Days
Rapidly De-escalate Antimicrobial Therapy
Clinicians Should Remain Vigilant for Other Causes of Fever in the ICU
Evidence Contour
Invasive vs. noninvasive sampling strategies
Effective treatment strategies for MRSA VAP
Utility of ATS/IDSA recommendations for dual gram-negative coverage
Evolving surveillance definitions
Strategies to prevent VAP
References
30: Respiratory Failure in a Patient with Idiopathic Pulmonary Fibrosis
Case Presentation
Principles of Management
Incidence, Risk Factors and Prognosis
Pathologic insult
Corticosteroids
Supportive care
Palliative care
Ensure the correct diagnosis of IPF as underlying ILD
Exacerbation during surgical procedures
Evidence Contour
Noninvasive ventilation
High flow nasal cannula (HFNC):
Ventilator settings
Anticoagulation
Cyclophosphamide
Cyclosporine A
Other agents
Restrictive operative fluid balance
Lung transplantation
Extracorporeal life support (ECLS)
Anti-fibrotic medications
References
31: Weaning from Mechanical Ventilation
Case Presentation
Principles of Management
Strategies to Minimize the Requirement for Mechanical Ventilation
Strategies to Reduce the Duration of Mechanical Ventilation
Evaluation of Patient’s Readiness for Spontaneous Breathing
Perform a Spontaneous Breathing Trial in Patients Deemed Ready
Assess Patient’s Ability to Protect the Airway
Evidence Contour
Assessing the Need for an Artificial Airway
Weaning Protocols
Sample Ventilator Liberation Pathway
Diaphragmatic Ultrasound as an Index for Discontinuation of Mechanical Ventilation
Pressure Support Versus T-Tube for Weaning from Mechanical Ventilation
Tracheostomy for Prolonged Transition
References
32: Management of Decompensated Right Ventricular Failure in the Intensive Care Unit
Case Presentation
Principles of Management
Diagnosis
Monitoring of End-Organ Perfusion
Optimization of Right-Sided Filling Pressures
Reversal of Conditions that Heighten Pulmonary Vascular Tone
Ventilation Strategy
Assessment for Presence of PFO or Other Shunt
Supportive Care
Evidence Contour
Pulmonary Artery Catheter Use in Decompensated RV Failure
Choice of Vasopressor
Selective Use of Inotropic Agents
Use of Selective Pulmonary Vasodilators
Ventilatory Considerations in the Face of ARDS
Extra Corporeal Membrane Oxygenation (ECMO)
References
33: Diffuse Alveolar Hemorrhage
Case Presentation
Principles of Management
Differential Diagnosis
Classification
Diagnosis
Treatment
Evidence Contour
Supportive Care for Treatment of Hypoxia
Rituximab
Recombinant Factor VII
Tranexamic acid (TXA)
References
34: Pleural Disease
Case Presentation
Principles of Management
Epidemiology
Pleural Fluid Studies
Imaging Studies
General Management of Pleural Disease in the Intensive Care Unit
Evidence Contour
Pleural Biopsy During Chest Tube Insertion for Parapneumonic Effusion or Epyema
Type and Size of Pleural Drainage Catheter
Anticoagulation and Pleural Drainage
Method of Pleural Drainage
Timing of Chest Tube Removal
Size of Pleural Effusion for Safe Access and Drainage
Multidisciplinary Management of Pleural Disease
Pleural Effusion Drainage as a Weaning Adjunct
Complications of Pleural Drainage
Bibliography
Part IV: Neurologic Disease
35: Acute Stroke Emergency Management
Case Presentation
Principles of Management
Diagnosis
tPA Administration
Endovascular Thrombectomy
Supportive Care
Atrial Fibrillation, Heart Failure and Anticoagulation
Secondary Stroke Prevention in the Acute Stroke Setting
Evidence Contour
“Wake-Up” Strokes
Acute Cerebral Artery Dissection, Antiplatelets Versus Anticoagulation
Blood Pressure Management in Acute Stroke Patients
Hemicraniectomy in Patients Older than 60 Years Old with Large Hemispheric Stroke
Early Rehabilitation in Stroke Patients
Basilar Artery Thrombosis, Therapy After 4.5 h
Stenting in Acute Stroke Therapy
Dual Anti-platelet Therapy, Aspirin Plus Clopidogrel, for Secondary Stroke Prevention
References
36: Bacterial Meningitis in the ICU
Case Presentation
Principles of Management
Epidemiology
Diagnosis
Antibiotics
Steroids
Long Term Neurologic Complications
Meningococcemia
Evidence Contour
ICP Management
Hypothermia
Gram-Negative Bacilli Meningitis
Shunts and Other Intracranial Devices
Post Exposure Prophylaxis
Future Directions
References
37: Approach to Encephalitis in the ICU
Introduction
Case Presentation
Principles of Management
Unique Clinical Syndromes
Limbic Encephalitis
Rhombencephalitis
Multifocal Encephalitis
Diagnosis of Encephalitis
Differential Diagnosis
Therapeutic Considerations
Emergent Management
Approach to Altered Level of Consciousness
Reasons for Neuro-ICU Admission
Appropriate Initial Investigations
Empiric Therapy
ICU Management of Complications Associated with Encephalitis
Cerebral Edema
Other Common Complications of Encephalitis
Evidence Contour
Therapy
Conclusions
References
38: Management of Intracerebral Hemorrhage
Case Presentation
Principles of Management
Clinical Presentation
Diagnosis
Acute Management
Natural History
Complications
Evidence Contour
Hyperosmolar Therapy
Seizure Prophylaxis
Hypothermia
Hypertension Management
References
39: Management of Subarachnoid Hemorrhage
Case Presentation
Principles of Management
Incidence and Risk Factors
Clinical Presentation
Diagnostics
Evaluation and Management
Complications
Evidence Contour
Anemia
Use of MRI in SAH
Spreading Depolarizations
SAH and Pregnancy
References
40: Status Epilepticus
Case Presentation
Principles of Management
Classification and Risk Factors
Pathophysiology
Epidemiology
Diagnosis and Evaluation
Emergent Initial Therapy
Urgent Control Therapy
Treatment of RSE
Systemic Complications of SE
Evidence Contour
Alternate Therapies
Special Patient Populations
Anoxic Brain Injury
Pregnancy
Autoimmune SE
References
41: Neuroleptic Malignant Syndrome
Case Presentation
Principles of Management
Diagnosis
Medication History and Temporal Clues
The Clinical Tetrad of NMS: Clues to Diagnosis and Management Concerns
Hyperthermia
Altered Mental Status
Muscular Rigidity
Autonomic Dysfunction
Evidence Contour
Benzodiazepines
Dantrolene
Bromocriptine
Amantadine
Electroconvulsive Therapy
References
42: Traumatic Brain Injury
Case Presentation
Principles of Management
Primary and Secondary Brain Injury
Severity of Traumatic Brain Injury
Blunt Cerebrovascular Injury
Prehospital and Emergency Department
Mechanical Ventilation
Analgesia, Sedation and Neuromuscular Paralysis
Surgical Treatment
Epidural Hematoma
Subdural Hematoma
Intraparenchymal Hematoma/Traumatic Cerebral Contusion
Evidence Contour
Indication of Intracranial Pressure Monitoring and Pressure Threshold
Post-Traumatic Seizures
Therapeutic Hypothermia
Advanced Neuromonitoring
Brain Tissue Oxygen
Cerebral Microdialysis
Jugular Bulb Oximetry
Prophylactic Antibiotics
Steroids and Neuroprotective Agents
References
43: Management of Anoxic Brain Injury
Case Presentation
Principles of Management
Diagnosis
Therapeutic Hypothermia
Maintenance of Normothermia
Supportive Care
Evidence Contour
Therapeutic Hypothermia
Rewarming and Maintenance of Normothermia
Supportive Care
Neurologic Prognostication
References
44: Neuromuscular Disease in the ICU
Case Presentation
Principles of Management
Pulmonary Mechanics and the Pathophysiology of Neuromuscular Respiratory Failure
Clinical Features of Neuromuscular Respiratory Failure
Interpreting Diagnostic Studies
Airway and Ventilatory Support and Disposition
Causes of Neuromuscular Weakness in the ICU
Guillain-Barre Syndrome
Myasthenia Gravis
Intensive Care Unit Acquired Weakness
Evidence Contour
Non-invasive Ventilation in Neuromuscular Respiratory Failure
Intravenous Immunoglobulin Versus Plasma Exchange for Myasthenia Gravis and Guillain-Barre Syndrome
References
Part V: Renal Disease
45: Traditional and Novel Tools for Diagnosis of Acute Kidney Injury
Case Presentation
Principles of Management
Serum Creatinine and Urine Output
Relationship Between Serum Creatinine and Urine Output
Differentiating Between AKI and CKD
Clinical Use of Novel Biomarkers
Evidence Contour
Determining Baseline Serum Creatinine
Imaging Techniques for Diagnosis of AKI
Emerging Role for Novel Biomarkers
References
46: Management of Acute Kidney Injury
Case Presentation
Principles of Management
Intravenous Fluids and Vasopressors
Consider Alternative Etiologies and Specific Treatments for AKI
Prevention of Further Injury
Diuretics
Medical Management of Complications of AKI
Renal Replacement Therapy
Evidence Contour
Choice of Intravenous Fluid Solution
Nutrition in AKI
Tight Glycemic Control
Vasodilators and Growth Factor Interventions
Early Initiation of Dialysis
References
47: Rhabdomyolysis
Case Presentation
What Is the Evidence Based Approach to Manage this Patient’s Acute Kidney Injury?
Principles of Management
Diagnosis
Fluid Therapy
Treating Reversible Causes of Muscle Damage
Management of Complications
Evidence Contour
Bicarbonate therapy
Diuretics and Mannitol
Antioxidants and free radical scavengers
RRT for prevention of acute kidney injury
References
48: Hyponatremia
Case Presentation
Principles of Management
Bolus Therapy
Avoidance of Overcorrection
Mechanisms Behind the Hyponatremia
Hypovolemic Hyponatremia
Hypervolemic Hyponatremia
Hyponatremia Despite Suppressed ADH
Syndrome of Inappropriate Antidiuretic Hormone
Glucocorticoid Deficiency
Evidence Contour
Rate of Correction/Risk of Osmotic Demyelination
Acute Versus Chronic Hyponatremia
Hyponatremia and Association with Mortality?
References
49: Hypernatremia
Case Presentation
Principles of Management
Risk Stratification
Evaluation
Correcting Serum Sodium
Adverse Sequelae
Evidence Contour
Diagnostics
Novel Treatments
Outcomes
References
50: Hyperkalemia
Case Presentation
Principles of Management
Clinical Manifestations
Mechanisms of Hyperkalemia
Pseudohyperkalemia
Redistribution and Cellular Release
Impaired Renal Excretion
Medications
Treatment
Evidence Contour
References
Part VI: Endocrine Disease
51: Management of Severe Hyponatremia and SIADH
Case Presentation
Principles of Management
Risk Stratification
Evaluation
Correcting Serum Sodium
Monitoring Correction Rate
Osmotic Demyelination Syndrome (ODS)
Evidence Contour
Diagnostics
Novel Treatments
Osmotic Demyelination Syndrome
Outcomes
Prevention
References
52: Diabetic Ketoacidosis
Case Presentation
Principles of Management
Pathogenesis
Diagnosis
Fluid Replacement
Insulin
Electrolyte Repletion
Treatment of Precipitating Condition
Complications
Evidence Contour
Bicarbonate Infusion
Site of Care
Route of Insulin Administration
Euglycemic DKA
DKA and Renal Failure
References
53: Thyroid Storm
Case Presentation
Principles of Management
Incidence
Etiology
Presentation
Diagnosis
Treatment
Beta-Blockers
Thionamides
Iodine Containing Solutions
Glucocorticoids
Surgery
Diagnostic Clinical Tools
Evidence Contour
Iodinated Radiocontrast Agents
Extracorporeal Plasmapheresis
l-Carnitine
Cholestyramine
References
54: Adrenal Insufficiency
Case Presentation
Principles of Management
Presentation of Adrenal Insufficiency
Adrenal Insufficiency
Diagnosis
Interpretation of Test Results in Critically Ill Patients
Measurement of Serum Cortisol
ACTH Stimulation Test
Interpretation of Results
Determining the Etiology
Treatment
Evidence Contour
ACTH Stimulation Test: Low Dose Versus High Dose
Role of Etomidate and Opiates in Development of Adrenal Insufficiency
References
55: Critical Illness Related Corticosteroid Insufficiency (CIRCI)
Case Presentation
Principles of Management
Diagnosis
Additional Testing
Treatment
Evidence Contour
Sepsis
Severe Community Acquired Pneumonia (CAP)
Cardiac Arrest
Cardiopulmonary Bypass Surgery
Role of Etomidate and Opiates in Development of Adrenal Insufficiency
References
56: Management of Hyperglycemic Hyperosmolar Syndrome
Case Presentation
Principles of Management
Diagnosis of HHS
Common Hyperosmolar Hyperglycemic State Triggers
Fluid Therapy
Insulin Therapy
Correcting Electrolytes
Sodium
Potassium
Magnesium
Phosphate
Evidence Contour
Type of IV Fluid
Venous Thromboembolism Prophylaxis
References
57: Management of Myxedema Coma
Case Presentation
Principles of Management
Diagnosis
Thyroxine Replacement
Corticosteroid Replacement
Supportive Care
Evidence Contour
References
Part VII: Infectious Disease
58: Zika Virus and Guillain–Barré Syndrome
Case Presentation
Principles of Management
Guillain–Barré Syndrome
Diagnosis of GBS
Treatment and Supportive Care in GBS
Evidence Contour
Outcome of Guillain–Barré Syndrome
Other Neurologic Complications
Controlling the Spread of Zika Virus
References
59: Urosepsis
Case Presentation
Principles of Management
Diagnosis
Empiric Antimicrobial Administration
Procedures/Surgery
Evidence Contour
Empiric Antibiotic Choice
Indications for Imaging
Intervention Method
References
60: Management of Sepsis and Septic Shock
Case Presentation
Principles of Management
Definition and Recognition
New Definitions and Constructs
Surviving Sepsis Campaign Sepsis Bundle
Surviving Sepsis Campaign Bundle [1]
Fluid Management
Hemodynamic Response
Tissue Perfusion
Vasopressors
Treatment of Infection and Antimicrobial Stewardship
Ventilator Management
Glycemic Control and Nutrition
Evidence Contour
Early Goal Directed Therapy (EGDT)
Corticosteroids
SIRS Criteria in Sepsis
Blood Pressure Target in Septic Shock
Fluid Resuscitation in Septic Shock
Bicarbonate Infusion in Lactic Acidosis
Heart Rate Control in Septic Shock
Vitamin C in Septic Shock
Sequella After Surviving Severe Sepsis/Septic Shock
References
61: Invasive Aspergillus
Case Presentation
Principles of Management
Diagnostic Approach
Risk Factors for Invasive Aspergillosis
Classic Risk Factors
Newer Risk Factors
Therapy
Antifungal Therapy
Monotherapy
Triazoles
Polyenes
Echinocandins
Combination Therapy
Antifungal Resistance
Evidence Contour
References
62: Management of Strongyloides Hyperinfection Syndrome
Case Presentation
Principles of Management
Epidemiology
Life Cycle
Disseminated Infection and Hyperinfection
Diagnosis
Anti-Parasitics
Supportive Care and Follow Up
Evidence Contour
Severe Infections
Hyperinfection Associated with Paralytic Ileus
References
63: Treatment of Viral Hemorrhagic Fever in a Well-Resourced Environment
Case Presentation
Principles of Management
Isolation and Infection Control
Active Screening
Isolation Unit
Protective Equipment
Protocols and Policies
Specimen Collection and Handling
Decontamination
Waste Management
Provisions of Clinical Care
Team Structure
Monitoring
Bedside Assessments
Diagnostic Testing
Blood Analysis
Imaging
Invasive Procedures
Central Venous Catheter(CVC) Placement
Endotracheal Intubation
Emergency Response Teams
Diagnostic Evaluation
Supportive Therapy
Evidence Contour
Prevention
Targeted Therapy
Staffing Model
Provisions of Care
References
64: Management of Severe Malaria
Case Presentation
Principles of Management
Definition of Severe Malaria
Diagnosis
Clinical Management
General Principles
Antimalarial Therapy (See Treatment Table  64.4)
Monitoring Parasite Density
Respiratory System
Neurologic Involvement
Seizure Management
Anemia and Coagulopathy
Blood Products
Hypoglycemia
Volume Management
Nutrition
Fever
Bacterial Infection
Evidence Contour
Other Diagnostic Modalities
Quantitative Buffy Coat
Antigen Rapid Detection Test (RDT)
Serology
Molecular Methods
Exchange Transfusion
References
65: Dengue
Case Presentation
Principles of Management
Classification of Dengue (WHO)
Phases of Illness and Diagnosis
Supportive Treatment
Evidence Contour
Volume Replacement
Other Aspects of Care
References
66: Leptospirosis
Case Presentation
Principles of Management
Epidemiology
Microbiology
Clinical Presentation
Laboratory Testing
Differential Diagnosis
Antibiotic Administration
Outpatients with Mild Disease
Hospitalized Adults with Severe Disease
Evidence Contour
Diagnostic Tools
Reference Standard
Serology
Molecular Tests
Culture
Drug Resistance
Role of Corticosteroids
Prevention
References
Part VIII: Gastrointestinal Disease
67: Management of Acute Upper Gastrointestinal Hemorrhage
Case Presentation
Principles of Management
Fluid Resuscitation and Triage
Blood Transfusion
Proton Pump Inhibitors
Risk Stratification
Evidence Contour
Nasogastric Lavage
Platelet Transfusion
Intubation for Upper Endoscopy
Timing of Upper Endoscopy
References
68: Variceal Hemorrhage
Case Presentation
Principles of Management
Initial Resuscitation
Vasoactive Medications
Hemostasis Interventions
Transjugular Intrahepatic Portosystemic Shunt
Antibiotic Prophylaxis
Evidence Contour
Red Blood Cell Transfusion
Correction of Coagulopathy
Endotracheal Intubation
Acid Suppression
Balloon Tamponade
Esophageal Stent
Transjugular Intrahepatic Portosystemic Shunt
Balloon-Occluded Retrograde Transvenous Obliteration
Surgery
References
69: Acute Pancreatitis
Case Presentation
Principles of Management
Disease Burden, Diagnosis, and Assessment of Severity
Intravenous Fluids
Antibiotics
Pain Control
Etiology
Evidence Contour
Early Nutritional Support
References
70: Management of Acute Liver Failure
Case Presentation
Principles of Management
Etiology of ALF
Correction of Coagulopathy
Hemodynamic Support
Renal Insufficiency
Infection
Neurologic Complications
Evidence Contour
Recombinant Factor VIIa to Correct Coagulopathy
Serial NH3 Levels in ALF Patients
Targeted Temperature Management
Bioartificial Hepatic Support Systems
Criteria for Liver Transplantation
References
71: Acute Lower Gastrointestinal Bleeding
Case Presentation
Principles of Management
Definitions
Initial Evaluation
Initial Resuscitation and Management
Appropriate Patient Disposition
Nasogastric Tube Lavage
Urgent Colonoscopy
Mesenteric Angiography
Surgery
Evidence Contour
Predicting Severity and Outcomes of LGIB
Blood Transfusion Goals
Massive Transfusions
Diagnostic Imaging Modalities
Provocation Testing
References
72: Diagnosis and Management of Clostridium difficile Infection (CDI)
Case Presentation
Principles of Management
Symptoms of C. difficile Infection
Diagnosis
Risk Factors
Severity of Disease
Medical Therapies
Surgical Intervention
Epidemiology and Infection Control
Evidence Contour
Fecal Microbiota Transplant (FMT)
Capsulized Frozen Fecal Microbiota
Probiotics
Monoclonal Antibodies and Vaccines
Nontoxogenic C. Difficile (NTCD) Spores
Investigational Antibiotics
References
73: Principles of Nutrition in the Critically Ill Patient
Case Presentation
Principles of Management
If the Gut Works, Use It
Timing
Determining Gastrointestinal Tolerance: Do Not Withhold EN for Increased Gastric Residuals or Decreased Bowel Sounds
Full Feedings Are Preferred; Trophic Feedings Are Acceptable
Obese Patients Should be Treated like Normal or Underweight Patients
Immunologic Benefits of Enteric Feeding
Evidence Contour
The Importance of Autophagy
The Protein Predicament
The CALORIES Trial Did Not Reliably Support PN Due to Study Design
Actual Caloric Goals Remain an Area of Ongoing Research
Actual Micronutrient Goals Are Not Clear
No Recommendations Can be Made for or Against Specific Lipid Choices in Tube Feeds
References
74: Spontaneous Bacterial Peritonitis
Case Presentation
Principles of Management
Diagnosis
Pathogenesis & Microbiologic Etiology
Treatment
Antibiotics
Albumin
Clinical Diagnosis of Hepatorenal Syndrome
Discontinue Nonselective Beta Blockers (NSBB)
Prophylaxis
Antibiotic Prophylaxis
Evidence Contour
Duration of Therapy
Investigational Diagnostic Tests & Predictors of SBP Infection
Choice of Antibiotics
Patient with Non-neutrocytic Bacterascites
References
75: The ICU Management of Alcoholic Liver Disease
Case Presentation
Principles of Management
Classification of Alcoholic Liver Disease
Prognosis in AH
Standard ICU Management of Alcohol Use Disorders, Including Alcohol Withdrawal Syndrome (AWS) and Delirium Tremens (DTs)
Nutritional and Micronutrient Supplementation
Evidence Contour
Upper GI Bleeding in Patients with Alcoholic Liver Disease
Medical Management of Acute Alcoholic Hepatitis
Management of Hepatorenal Syndrome
References
Part IX: Hematologic Disease
76: Diagnosis and Management of Thrombotic Thrombocytopenic Purpura
Case Presentation
Principles of Management
Diagnosis of Thrombotic Thrombocytopenic Purpura
ADAMTS13 Activity Level and Autoantibody Testing
The ‘PLASMIC Score’ for Rapid Assessment
Therapeutic Plasma Exchange
Fresh Frozen Plasma (FFP)
Immunosuppressive Agents
Discontinuation and/or Treatment of the Offending Agent/Condition
Venous Thromboembolism Prophylaxis
Evidence Contour
Prevention of Relapses with Other Immunosuppressive Agents
Anti-Platelet Agents
Duration and Intensity of TPE
Amount of FFP
Caplacizumab
References
77: Acute Leukemia Presentation with DIC
Case Presentation
Principles of Management
Confirm the Diagnosis of AML
Differential Diagnosis of DIC
Laboratory Profile of DIC
Treat the Underlying Disease
Supportive Care/Blood Product Transfusion for DIC
Evidence Contour
Heparin
Anti-Thrombin III
Recombinant Factor VIIa
References
78: Disseminated Intravascular Coagulation
Case Presentation
Principles of Management
Diagnosis
Treatment of the Underlying Disorder
Management of Acute Coagulopathy in Hemorrhaging Patients
Thrombotic Predominant DIC and Purpura Fulminans
Outcomes
Evidence Contour
Heparin Therapy
Thrombomodulin-α
Antithrombin III (ATIII)
Combination ATIII and Thrombomodulin-α
Conclusion
References
79: Hemophagocytic Lymphohistiocytosis and Other Culture Negative Sepsis-Like Syndromes in the ICU
Case Presentation
Principles of Management
HLH Presentation and Diagnosis
Presentation
Diagnosis
HLH Treatment
Treatment
HLH Outcomes
Outcomes
Evidence Contour
Outcomes and Prognosis
Diagnosis and Biomarker Testing
Treatment
Other Inflammatory Syndromes in the ICU
Macrophage Activation Syndrome (MAS)
Presentation
Diagnosis
Treatment
Cytokine Release Syndrome
Presentation
Diagnosis
Idiopathic Pneumonia Syndrome
Presentation
Diagnosis
Treatment
Conclusion
References
80: ICU Complications of Hematopoietic Stem Cell Transplant, Including Graft vs Host Disease
Case Presentation
Principles of Management
Early Complications of Hematopoietic Stem Cell Transplant
Neutropenic Fever and Neutropenic Sepsis
Respiratory Failure
Neurologic Complications
Acute Kidney Injury
Hepatic Veno-Occlusive Disease
Acute Graft-Versus-Host Disease
Chronic Graft vs Host Disease
Pulmonary Chronic GVHD
Evidence Contour
Biology of Neutropenic Sepsis and Respiratory Failure
Resistant and Multi-Drug Resistant Organisms
Thrombotic Microangiopathy
Cytokine Release Syndrome and Emerging Toxicities of Transplant
Organization of Critical Care: Need for Specialty Hematopoietic Stem Cell Transplant ICUs?
References
81: Tumor Lysis Syndrome
Case Presentation
Principles of Management
There Are Laboratory and Clinical Classifications of Tumor Lysis Syndrome (TLS)
Risk Stratification for Development of Clinical TLS Is Complex, but Useful
Treatment Prephase with Low Intensity Chemotherapy May Prevent TLS in High-Risk Patients
Hydration Is Essential to Prevention and Treatment of TLS
Hypouricemic Agents Are Essential to the Prevention and Treatment of TLS
Close Monitoring Is Essential in TLS
Prevention of Cardiac Arrhythmias
Hyperkalemia
Hypocalcemia
Acute Renal Failure Requiring Renal Replacement Therapy May Develop despite Best Practice
Evidence Contour
Use of IV Diuretics in Addition to IV Hydration Has Conflicting Clinical Outcomes
There Is Unclear Utility of Phosphate Binders in TLS with AKI
Choice of Renal Replacement Therapy Has Variable Outcomes
Tumor Lysis Syndrome in the Era of Novel Cancer Treatments
References
82: Management of Hyperviscosity Syndromes
Case Presentation
Principles of Management
Pathophysiology
Diagnosis
Management
Evidence Contour
How to Measure Viscosity
Lack of Procedural Standardization
Efficacy of Leukapheresis in AML
References
83: Thrombocytopenia in the Intensive Care Unit
Case Presentation
Principles of Management
Platelet Structure and Function
Epidemiology
Implications
Differential Diagnosis and Evaluation
Step 1: Confirm True Thrombocytopenia
Pseudothrombocytopenia
Step 2: Is the Patient Bleeding?
Step 3: Consider a Thrombotic Microangiopathy
TTP
Disseminated Intravascular Coagulation
Step 4: Careful Medication Review
Heparin-Induced Thrombocytopenia
Step 5: Evaluation for Sepsis
Step 6: Consider Hemodilution
Step 7: Evaluate Support Devices
Evidence Contour
Indications for Prophylactic Platelet Transfusion
Platelet Thresholds for Invasive Procedures
References
84: Coagulopathy in the Intensive Care Unit
Case Presentation
Principles of Management
Rotational Thromboelastometry
ROTEM Parameters
Normal Clot Physiology
ROTEM Assay Interpretation and Qualitative Produce Replacement
Transfusion Based on Standard Laboratory Testing
Evidence Contour
Transfusion Based on Viscoelastic Hemostatic Assays
Conclusion
References
Part X: Surgical
85: Thoracic Trauma
Case Presentation
Principles of Management
Pneumothorax
Hemothorax
Rib Fractures
Lung Contusion
Blunt Thoracic Aortic Injury
Evidence Contour
Pneumothorax
Hemothorax
Rib Fractures
Lung Contusion
BTAI
References
86: Blunt Abdominal Trauma
Case Presentation
Principles of Management
Unstable Versus Stable Blunt Abdominal Trauma
Balanced Resuscitation
Imaging and Diagnosis
Nonoperative Management (NOM) of Blunt Solid Organ Injury
Angioembolization for Blunt Solid Organ Injury
Post-splenectomy Vaccinations
Evidence Contour
Who Should Be Managed Nonoperatively?
How Should Nonoperative Management Be Accomplished?
Is Follow-Up Imaging Necessary?
When Should We Initiate Venous Thromboembolism (VTE) Prophylaxis in Solid Organ Injury Patients?
References
87: Abdominal Sepsis and Complicated Intraabdominal Infections
Case Presentation
Principles of Management
Diagnosis
Resuscitation
Source Control
Anti-Infective Therapy
Evidence Contour
Management of the Open Abdomen
Intra-Abdominal Fungal Infections
References
88: Intestinal Obstruction: Small and Large Bowel
Case Presentation
Principles of Management
Evidence Contour
Timing of Operating for SBO
Management Differences Between Small and Large Bowel Obstruction
Management of Acute Small Bowel Obstruction in a Patient with No Prior Abdominal Surgery or Pathology
CT Imaging Findings Indicative of a Need for Exploration
References
89: Management of Acute Compartment Syndrome
Case Presentation
Principles of Management
Diagnosis
Abdomen
Extremity
Management
Abdomen
Extremity
Wound Management
Abdomen
Extremity
Evidence Contour
Abdomen
Abdominal Perfusion Pressure
Fluid Management
Percutaneous Drainage
Extremity
Infrared Spectroscopy
Dermotraction
References
90: Extracorporeal Membrane Oxygenation (ECMO) and Extracorporeal CO2 Removal (ECCO2R)
Case Presentation
Principles of Management
ECMO Indications
ECMO Contraindications
Initial ECMO Management
Weaning off of ECMO
Post-ECMO Considerations
Extracorporeal CO2 Removal (ECCO2R)
Evidence Contour
ECMO
Prolonged ECMO
ECMO Trial Data
ECMO Outcome Prediction
References
91: Management of Acute Thermal Injury
Case Presentation
Principles of Management
Diagnosis
Risk of Pneumonia
Wound Care
Surgical Intervention
Fluid Management
Transfusion Targets
Supportive Care
Evidence Contour
Fluid Resuscitation Monitoring
Scar Management
Conclusion
References
92: Acute Arterial Ischemia
Case Presentation
Principles of Management
Initial Evaluation
Diagnostic Imaging
Intervention and Post-Operative Management
Evidence Contour
Controversial Aspects of Management/Imaging
Endovascular Treatment Approach to Lower Extremity Vascular Trauma
References
93: Management of Necrotizing Soft Tissue Infection
Case Presentation
Principles of Management
Rapid Diagnosis
Empiric Broad Spectrum Antibiotic Therapy and Resuscitation
Surgical Source Control
Evidence Contour
Predicting NSTI Diagnosis and Outcome
Early Amputation
Adjunctive Therapies
IVIG Immunomodulatory Therapy
Hyperbaric Oxygen
New Treatment Strategies
References
94: Biliary Infections
Case Presentation
Priniciples of Management
Diagnosis
Severity Assessment
Medical Management
Surgical and/or Interventional Management
Evidence Contour
Diagnostic Studies
Duration of Antibiotics
Type and Timing of Intervention
References
95: Hemorrhagic Shock
Case Presentation
Principles of Management
Diagnosis of Hemorrhagic Shock
Resuscitation
Vascular Access
Massive Transfusion
Crystalloid
Vasopressors
Laboratory Results
Hematology Labs
Chemistries
Endpoints of Resuscitation
Hemostatic Adjuncts
TXA
Early Hemorrhage Control
Surgical Hemostasis
Angiographic Hemostasis
Evidence Contour
REBOA
Whole Blood
Other Hemostatic Adjuncts
Viscoelastic Testing
Summary
References
96: Management of the Open Abdomen Patient
Case Presentation
Principles of Management
Etiologies
Second Look Laparotomy
Temporary Management of Hemorrhage
Abdominal Compartment Syndrome
Evidence Contour
Temporary Abdominal Closure
Timing of Re-Exploration/Abdominal Closure
Hypothermia
Volume Status
Fluid Loss/Nutrition
Mechanical Ventilation
Adhesions/Frozen Abdomen
Antibiotic Use
Conclusion
References
Part XI: Critical Care in Obstetrics
97: Peripartum Cardiomyopathy
Case Presentation
Principles of Management
Pathophysiology
Presentation and Diagnosis
Treatment of Peripartum Cardiomyopathy
Acute Management
Mechanical Support
Delivery
Chronic Management
Systemic Anticoagulation
Device Therapy
Prognosis in Peripartum Cardiomyopathy
Risk Factors for Poor Recovery
Low EF at Baseline
Hypotension and Tachycardia
Race and Left Ventricular End-Diastolic Dimension
Long-Term Medical Management after LV Recovery
Subsequent Pregnancies
Evidence Contour
References
98: Management of Amniotic Fluid Embolism
Case Presentation
Principles of Management
Pathophysiology
Diagnosis
Management
Initial Assessment
Oxygenation
Hemodynamic Support
Delivery of Fetus
Evidence Contour
Diagnosis
Adjunctive Therapies
References
99: Respiratory Diseases of Pregnancy
Case Presentation
Principles of Management
Physiologic Respiratory Changes Seen in Pregnancy
Respiratory Pathology during Pregnancy
Pulmonary Edema
Pre-eclampsia associated pulmonary edema
Tocolytic Induced Pulmonary Edema
Ovarian Hyperstimulation Syndrome (OHSS)
Aspiration
Peripartum Cardiomyopathy (PPCM)
Airway Disease
Obstructive Sleep Apnea (OSA) in Pregnancy
Pulmonary Infections in Pregnancy
Viral Pneumonia
Bacterial Pneumonia
Neuromuscular Diseases and Central Causes
Pneumothorax
Pulmonary Embolism in Pregnancy
Cystic Fibrosis
Evidence Contour
Ventilation Strategies in the Pregnant Patient
Goals of Ventilation
Extra Corporeal Membrane Oxygenation (ECMO)
Prone Ventilation
Delivery
References
100: Preeclampsia, Eclampsia, HELLP Syndrome
Case Presentation
Principles of Management
Evidence Contour
Appendix
References
Further Re ading
101: Obstetric Hemorrhage
Case Presentation
Principles of Management
Causes of Hemorrhage during Pregnancy
Antepartum/Intrapartum
Postpartum
Management
Medical Management
Uterotonic Agents
Tranexamic Acid
Transfusion Therapy
Massive Transfusion Protocol
Recombinant Factor VII
Tamponade
Surgical
Uterine Compression Sutures
Uterine Embolization
Vascular Ligation (Uterine/Ovarian)
Hysterectomy
Evidence Contour
Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)
Non-Pneumatic Anti-Shock Garment (NASG)
Post-Partum Hemorrhage Response Teams
References
102: Sepsis in Pregnancy
Case Presentation
Principles of Management
Risk Factors for Sepsis in Pregnancy
Background
Definitions
Identification
Management
Initial Assessment
Hemodynamic Support
Source Control
Antimicrobial Therapy
Evidence Contour
Adjunctive Therapies
References
Part XII: Other Conditions
103: Management of Severe Skin Eruptions
Case Presentation
Pathogenesis
Principles of Management
Supportive Care
Wound Care
Management of Facial Involvement
Evidence Contour
Systemic Corticosteroids
Intravenous Immunoglobulins (IVIG)
Cyclosporine
TNF Alpha Inhibitors
Summary
References
104: Management of Alcohol Withdrawal Syndromes
Case Presentation
Principles of Management
Diagnosis
Initial Phase of Care
Evidence Contour
Patient Disposition
Propofol
Phenobarbital
Central Alpha 2 Agonists
Antipsychotics
Anticonvulsants
Other Agents
References
Part XIII: ICU Care Delivery and Medical Ethics
105: Interdisciplinary Care and Communication in the Intensive Care Unit
Case Presentation
Principles of Management and Evidence Contour
Stakeholders of the Interdisciplinary Team
Implementation Barriers
Interdisciplinary Rounds
Interdisciplinary Rounds: The Process
Protocolization
Family Meetings
Interdisciplinary Handoffs and Huddles
Recognition of Errors
Interdisciplinary Debriefing
Training in Interdisciplinary Care and Communication: Creating a Culture of Durable Stakeholders
Conclusion
References
106: End of Life Care in the ICU
Case Presentation
Principles of Management
Making Decisions in the ICU
Prognostication
What Constitutes Good End of Life Care?
Evidence Contour
Code Status and the ICU Patient
Background
Problems with DNR
Who Should Make Decisions about Life Support?
Going Forward with Life-Sustaining Treatment Decisions
Futility and Requests for Inappropriate Treatments
Defining Futility
References
107: Palliative Care in the ICU
Case Presentation
Principles of Management
Background
From Acute to Chronic Critical Illness
Evidence Contour
Communication Interventions
Proactive Palliative Care and Palliative Care Triggers
Spiritual Support
Disparities in Palliative Care Access
Advanced Care Planning
Communication Tools
References
108: Family Involvement in ICU
Case Presentation
Principles of Management
Introduction to Family Involvement in the ICU
Studying Family Involvement
Patient-Centered Visitation
Family Participation in Rounds
Family Involvement at the Bedside
ICU Diaries
Family Impact on Patient Safety
Evidence Contour
Patient-Family Advisory Councils
Peer Support
Burnout
Conclusion
References
109: The Post-Intensive Care Syndrome
Case Presentation
Principles of Management
Diagnosis
Prevention and Rehabilitation
Components of the ABCDEF Bundle
A Recommended Strategy to Mitigate the Risk of Post-intensive Care Syndrome
Evidence Contour
ICU Follow Up Clinic
Cognitive and Physical Rehabilitation
References
Correction to: Undifferentiated Shock
Correction to: R. C. Hyzy, J. McSparron (eds.), Evidence-Based Critical Care, https://doi.org/10.1007/978-3-030-26710-0_3
Index