Intensive+and+ critical+ care+ medicine

Intensive and Critical Care Medicine Antonino Gullo • José Besso • Philip D Lumb Ged F Williams (Eds.) Intensive and Critical Care Medicine WFSICCM World Federation of Societies of Intensive and Critical Care Medicine Foreword by Frédéric Shuind 123 Editors Antonino Gullo Department and School of Anesthesia and Intensive Care Catania School of Medicine and University-Hospital Catania, Italy José Besso Department of Critical Care Medicine Hospital Centro Medico de Caracas Caracas, Venezuela Philip D Lumb Department of Anesthesiology Keck Medical School Los Angeles, CA, USA Ged F Williams World Federation of Critical Care Nurses C/- Nursing Administration Gold Coast Health Southport, Queensland, Australia ISBN 978-88-470-1435-0 e-ISBN 978-88-470-1436-7 DOI 10.1007/978-88-470-1436-7 Springer Dordrecht Heidelberg London Milan New York Library of Congress Control Number: 2009933285 © Springer Verlag Italia 2009 This work is subject to copyright All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of 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Porpora, Segrate, Italy Printed in Italy Springer-Verlag Italia S.r.l – Via Decembrio 28 – I-20137 Milan Springer is a part of Springer Science+Business Media (www.springer.com) Preface The World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) has reached the age of maturity Physicians, nurses, and many others associated with the field of Intensive and Critical Care Medicine will be coming from all corners of the world to Florence, Italy in August, 2009 to celebrate the 10th quadrennial congress Every years for the last 36 years, congresses in the magnificent venues of London (1973), Paris (1977), Washington (1981), Jerusalem (1985), Kyoto (1989), Madrid (1993), Ottawa (1997), Sydney (2001), and Buenos Aires (2005) have signified an ever-developing process which has resulted in the four pillars of the field of Intensive and Critical Care Medicine, namely partnership, ethics, professionalism, and competence The first pillar is based on a stronger interdisciplinary collaboration and a multiprofessional partnership in the field of Intensive and Critical Care Medicine In recent decades, professional activity in medicine has been regulated by well-defined, universal principles, such as the welfare of the patient, autonomy, social justice, and the patient–physician relationship The second pillar, ethics, has offered welcomed assistance to all these principles in establishing an ethics curriculum The third pillar, professionalism, is based on “the image of the ethical and moral conduct of those who practice the medical profession.” Professionalism aspires to altruism, accountability, excellence, duty, service, honor, integrity, and respect for others In order to maintain the highest level of professionalism, physicians and nurses must be committed to their own continuing education as a means of increasing both their knowledge base and manual skills Equally important for achieving the best results possible is their willingness and ability to collaborate with others as a team with the goal of establishing continuity to assure the patients good medical practice and a better quality of care The fourth pillar, professional competence, is “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and the reflection in daily practice for the benefit of the individual and community v vi Preface being served.” Maintaining competence means continuing to learn as medical understanding and technologies rapidly change Coming from these reflections the Council of the WFSICCM, during the period 2001–2009, has alimented an important debate to develop a global communication network establishing a sort of bridge from the past to the present The way into the future for the affiliated national societies is the planning of common strategies according to the objectives of the WFSICCM: • To assist and encourage the cooperation of national societies for management of acute critical illness • To promote the dissemination of knowledge, education programs, and scientific information • To advise, upon request, national and international organizations • To monitor the needs of the community • To achieve a politically correct collaboration with governments, national health systems, and local authorities • To support countries with limited resources • To achieve equitable resource allocation • To recommend desirable standards of training for intensivists, critical care personnel, emergency physicians, and nurses • To provide information regarding opportunities for postgraduate training and research • To ameliorate health care delivery and to promote the importance of intensive and critical care regionalization • To implement the standards of care • To encourage the establishment of safety measures, including procedures and equipment • To achieve better accuracy regarding patient information • To stimulate research into all aspects of intensive and critical care medicine • To focus the importance of continuing education programs • To consider mandatory the respect for ethics principles, the patient’s welfare, and the quality of care • To promote professional accomplishment by individuals, which will provide not only job satisfaction but also an improvement in the efficiency of the team • To remark that intensive care nursing is younger than most healthcare specialties, but note that it already possesses a wealth of nursing knowledge and experience • To increase the emphasis on the importance of improvement in competence, not only in terms of skills but also in behavior • To maintain awareness about the priority and the mission of the WFSICCM: a good clinical practice From 2001 the development agenda of the World Federation (WF) Council recognized the importance of promoting scientific and cultural integration across the world with prestigious editorial initiatives Much success was achieved in Buenos Aires (2005) when the Council on the occasion of the 9th World Congress decided to publish its first book, from the beginning of the Federation Societies, edited by Springer: Intensive and Critical Care Medicine – Reflections, Recommendations, and Preface vii Perspectives Education and standard of care were the pillars of the book At that time each component of the Council contributed by updating chapter(s) Florence (2009) will represent an important step in improving knowledge in the field of Intensive and Critical Care Medicine and reinforcing communication and good practice in the era of partnership, ethics, professionalism, and competence Everyone believes it is important to take advantage of the opportunity to take a leadership position on clinical decision-making Prevention and management of lifethreatening conditions in intensive and critical care and the importance of putting global strategies in place for surviving during and after natural or man-made disasters have become priorities As chairman of the Scientific Committee of the Florence 2009 meeting I am grateful to the Board and Colleagues of Italian Scientific Society (SIAARTI) and the Italian College of the Anesthesiologists (ICA), the Italian Society of Intensive Care (SITI) and the Italian Society of Nursing (ANIARTI) for their encouraging support during the long period of preparation of the World Congress I would like to keep attention on the role of the Members of the WFSICCM Council for their active participation in assuring a bright future Besides, I wish to mention some distinguished persons for their institutional and active role in the success of the World Federation Prof José Besso is a special person full of humanity and devoted to optimizing the standards of care I like to remember Prof José Besso as superb and courageous President in the last mandate of WF (2005–2009) Further I offer sincere appreciation to the following individuals: Prof Philip Lumb, for taking on the roles of both Editor-in-Chief of the Critical Care Journal and Past President of the WF (2001–2005), and for his very active presence and promotion of intercontinental cooperation; Prof Edgar Jimenez, Treasurer of WF in the last years (2005–2009), for his admirable efforts in pushing strongly for the globalization of WF and for his efforts to impart to everybody an understanding of the importance of maximizing communications between eastern and western countries; Prof Ged Williams, as President of World Federation of Critical Care Nurses in the period 2001–2009, congratulations due, overall, for his important contribution to reinforce the independent, but collaborative role of nurses and the importance of their active cooperation in the care of critical illness Moreover, my sincere gratitude to Phil Taylor, Executive Director of the WF, for his own enormous personal contribution to WFSICCM and for his continuing professional assistance to thousands and thousands of affiliates Particularly, I wish to express my sincere appreciation to the Council’s Members who in the period 2001–2008 have worked intensively on the common project; so we were able to improve friendship, collaboration, and the strategic plan to get to the top in the critical care arena Last but not least, a particular mention regarding Prof Raffaele De Gaudio who had the merit and the power to drive thousands of physicians, nurses, students, and all allied people and companies interested to support the present and the future of the WFSICCM On the other side, the Organizing and Scientific Secretary established a high spirit of cooperation and professionalism My dear Raffaele, thanks a lot for the warm welcome in Florence and for showing us its magnificent heritage viii Preface The working team is ready Considering several assumptions, I think that we are at the right time to reach an exciting and remarkable goal: to continue the mission for serving critically ill patients and the community Prof Antonino Gullo Head and Director Department and School of Anesthesia and Intensive Care Catania School of Medicine and University-Hospital, Catania, Italy Chairman of the Scientific Committee of the WFSICCM, Florence, 2009 Contents Section I - Introduction and Mission History of Critical Care Medicine: The Past, the Present and the Future Giuseppe Ristagno, Max H Weil The Mission of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) Philip D Lumb 19 Section II - Professionalism, Ethics and Evidence-Based Practice Professionalism Antonino Gullo, Paolo Murabito, José Besso 29 Ethics of Decision Making in Critical Care Satish Bhagwanjee 41 Evidence-Based Medicine in Critical Care Premnath F Kotur 47 Section III - Clinical Governance Clinical Governance: Definitions and Recommendations Georges Offenstadt 61 Optimization of Limited Resources and Patient Safety Antonio O Gallesio 69 ix x Contents 08 Improving Quality of Care in ICUs Allan Garland 81 09 Scoring Systems Rui P Moreno, Ana C Diogo, Susana Afonso 93 Section IV - Nursing Perspectives 10 Nursing Workforce Management in Intensive Care 107 Ged F Williams 11 Intensive and Critical Care Nursing Perspectives 119 Ged F Williams, Paul R Fulbrook, Anne W Alexandrov, Wilson Cañón Montañez, Halima M Salisu-Kabara, David W.K Chan Section V - Central Nervous System, Circulation and Kidney 12 Central Nervous System Monitoring 135 Flavio M.B Maciel 13 Definition, Monitoring, and Management of Shock States 143 Jean-Louis Vincent 14 Plasma Volume Expansion: The Current Controversy 151 Christiane Hartog, Konrad Reinhart 15 Predicting the Success of Defibrillation and Cardiopulmonary Resuscitation 163 Giuseppe Ristagno 16 Acute Renal Failure 175 José Besso, Gabriela Blanco, Ruthnorka Gonzalez Section VI - Respiratory System and Protective Ventilation 17 The Evolution of Imaging in Respiratory Dysfunction Failure 195 Luciano Gattinoni, Eleonora Carlesso, Federico Polli 18 ALI, ARDS, and Protective Lung Ventilation 207 Rahul Nanchal, Edgar J Jimenez, F Elizabeth Poalillo 558 41 A A Zin,W A Zin If H0 holds true and a nonsignificant result is obtained, the correct decision has been reached If the null hypothesis is true and a significant result is achieved, the decision to reject H0 is incorrect, yielding a type I or α (alpha) error, i.e., the probability of rejecting the null hypothesis when it is true The significance level of the test must be revised If the null hypothesis is false, and H0 is not rejected, a β or type II error takes place The chances of occurrence of type II errors depend on the true value of the population mean The actual size of the β probability depends on the overlap between the sampling distributions of the mean under: (a) the null hypothesis, and (b) a specific alternative hypothesis for which the type II error is to be calculated Type II errors can be reduced by: (a) decreasing the significance level to a value greater than 5% (this will increase α) and (b) diminishing the spread of the sampling distribution of the mean, thus reducing the overlap between the null and alternative hypotheses distribution curves In other words, type II error can be reduced by increasing the sample size (preferred method) The sample size should be calculated by someone familiar with statistical methods rather than relying on clinical experience or judgment When the sample size is too small, it is impossible to distinguish between real and spurious results Once the appropriate sample size has been calculated, an extra percentage should be added to it to allow for dropouts or withdrawals As a general rule, a loss of up to 10–15% of subjects is acceptable and should not bias the result unless there is a strong confounder present The requirements needed to calculate a sample size are: (a) significance level, (b) the accepted chance to make a type II error, (c) the size of what would be considered an important result, and (d) an estimate of the population variability The power, or sensitivity, of a test (1- β) is the probability of detecting the difference that is looked for when it is present The power depends on: (a) the significance level, (b) the size of the effect or difference to be detected, (c) the underlying population variability, and (d) the sample size It is desirable to have a high power or probability of detecting a difference between treatments to justify the efforts and ethical issues involved in conducting an experiment The power of a significance test increases as the true size of the effect augments Both sample size and power computations are used to determine the parameters for an intended experiment, before it is actually carried out Power or sample sizes can be determined for: (a) paired and unpaired t tests, (b) one-way analysis of variance, (c) z test comparison of proportions, (d) chi-square analysis of contingency tables, and (e) correlation coefficients If the power to detect a true difference is established at 80%, then there is a 20% chance that this real difference could be missed Generally, power levels of 80, 90, or 95% are used, and it is accepted that the size of the type II error should be around four times that of the two-sided significance level chosen It thus follows that 80% power and 5% significance is the most common combination in the determination of the sample size, whereas 95% power is linked with 1% significance 41 How to Plan and Design a Clinical Research Project 559 Analysis Approach Planning the Analysis The analysis strategy to evaluate primary and secondary outcome variables is defined in the study protocol Describe the types of variables collected for outcomes and statistical tests planned The handling of specific situations should be described in advance For example, will there be a subgroup analysis? An interim analysis is a planned analysis conducted at a predetermined time in the study The strategy used for this analysis is defined in the protocol In clinical trials an interim analysis is conducted to (a) assess trends in incidence of adverse events and (b) assess efficacy results Ethical issues and cost are the main justifications for planning interim analyses In drug development trials an independent monitoring group apart from the investigators conducts the interim analysis Conducting the Analysis Statistical analysis of the data collected provides information about the strength of the association between exposure variables and outcome variables It supports the answer to the primary outcomes Descriptive statistical analyses are used to summarize the data using noncomparative techniques such as frequency distributions (proportions), description of averages (mean, mode, and/or median), and description of the spread of the values (standard deviation and standard error) Assess assumption for statistical tests, i.e., if the data has a normal distribution or not Compare baseline characteristics searching for differences that may impact the outcome, like demographic characteristics and prognostic factors Analytic statistical analyses are used to test the primary outcomes (hypotheses) and secondary outcomes Variables are compared to evaluate the pattern and strength of relationships The adequate statistical test depends on a variety of factors (e.g., presence of normal distribution, between/within subjects variation, repeated measures, and so forth) and circumstances (e.g., time line) surrounding data Consult a statistician to plan the appropriate analysis methods in advance, including subgroup analysis The analysis plan is dynamic and additional analysis may be planned before looking at the data Hypotheses can be proven wrong, but they can never be proven correct because the investigator cannot test all the existing subjects with the condition of interest Consider all the specific factors that may have influenced or biased the data and/or the interpretation reached Interpretation begins after the study is completed; the data is collected, edited, and entered into a database; appropriate statistical tests have been performed to analyze the data; and the statistical report providing a permanent and detailed record of 560 41 A A Zin,W A Zin the study is compiled This report allows other investigators to repeat the study using identical design and audit of the results Analyses of data are primarily statistical exercises, whereas interpretation of data is an exercise in discerning the clinical meaning of the data evaluated The researcher is primarily concerned with drawing conclusions to report in publications The goals of interpreting research data include establishing meaning of the data collected with an emphasis on clinical significance, reporting the results of the original objectives of the study by comparing them with results from previous studies, developing hypothesis for future studies, and gaining insight into interpretations of the condition of interest When interpreting the analyses results one should look for factors that may bias the data or affect their interpretation These include characteristics of the study design, subject enrolled, the condition being evaluated, the study intervention, the investigator and staff, and the trial environment Statistical significance, on its own, does not provide information about whether a result is clinically important When considering clinical significance evaluate the relevance of chosen outcomes, the size of the effect observed, the risk/benefit and also cost/benefit Ethical Considerations Three basic ethical principles guide research with human participants: respect for human subjects (autonomy), beneficence (do good), and justice (exclusion) Ethical considerations are important throughout the study: establishment of the research question, decision on the study design, implementation of study protocol, analysis, interpretation, and publication of the results There are also concerns relating to individual study subjects and to scientific novelty and integrity Once a research question has been established and a study protocol developed, the research protocol ought to be reviewed by an independent committee (the Institutional Review Board (IRB) to assess whether any ethical principles have been violated The IRB is a multidisciplinary committee, whose objectives are to protect patients’ rights and to assure that ethical standards are met by the study protocol They review the protocol and any subsequent amendments, expressing their approval (or disapproval) and recommendations However, the IRB does not check if the proposed study procedures are being adequately followed Sponsors and researchers have full responsibility to conduct research in accordance with the guidelines recommended IRBs are established in hospitals and educational institutions carrying out medical research National policies provide the guidelines for the IRB For multicenter studies, the study protocol has to be approved by all involved IRBs The investigator should be aware of the IRB requirements for protocol approval in order to avoid multiple corrections and delay of the study The IRB determines if an Informed Consent Form (ICF) is needed and approves (or disapproves) its content Informed consent should be obtained from all subjects 41 How to Plan and Design a Clinical Research Project 561 entering the study, or their next of kin, and should be retained for future audit The ICF must provide appropriate and adequate information on the study protocol, benefits and risk of harm, clarify that the subject is able to withdraw from the study at any time without suffering consequences, and explain the protection of confidentiality The ICF must be written in nontechnical language so that the subject can clearly understand the potential risks and benefits of entering the study and consciously decide whether to participate in it The IRB must approve the compensation of subjects To avoid undue inducement participants should be compensated for actual expenses and time The sponsors, however, must provide compensation, regardless of legal liability, if the subject suffers deterioration in health or well being caused by participation in the study Once the IRB approves the study protocol and the ICF, the research study can be initiated, not before Ethical considerations are relevant to all individuals and groups involved in the study, the investigator research team, and the sponsor In certain circumstances early study discontinuation is ethically required, for example, when research staff fails to comply with study procedures or an interim analysis may indicate an increase in harmful effects in the group receiving an experimental intervention By the same token, if beneficial effects are disclosed in the interim analysis, ethical concerns are raised for patients not receiving the intervention Suggested Reading Clayton D, Hills M (1993) Statistical models in epidemiology Oxford University Press, United Kingdom Christensen LB (1997) Experimental methodology Allyn and Bacon, United States of America Daly LE, Bourke GJ (2000) Interpretation and uses of medical statistics Blackwell Science, United Kingdom Hulley S, Cummings S, Browner W et al (2007) Designing clinical research Lippincott Williams & Wilkins, United States of America Kirkwood BR, Sterne JAC (2003) Medical Statistics Blackwell Science, United Kingdom Leedy PD (1997) Practical research planning and design Prentice Hall, United States of America Subject Index A Abdominal Compartment Syndrome 212, 320, 321, 356, 361 - Flora 251–253, 256, 262, 267, 277 Accountability 29–31, 85, 230, 408, 543 Acetaminophen 452, 455, 465 Acetylcysteine 182 Acid-Base Balance 175 Acinetobacter 226, 229, 251, 262, 264, 273, 276 - baumannii 229 Activated Partial Thromboplastin Time 442, 473 - Protein C 278, 304, 309, 483, 509, 511 Acute Adrenal Insufficiency 144 - Circulatory Failure 6, 13, 143, 301 - Coronary Syndrome 437, 439 - Interstitial Nephritis 177, 180 - Kidney Injury 176, 384 - Lung Injury 140, 158, 204, 207, 208, 211, 216, 278, 301, 303, 368, 435, 441 - Myocardial Infarction 8, 85, 94, 98, 144, 534 - Physiology And Chronic Health Evaluation 94 - Renal Failure 35, 154, 157, 175–177, 179, 181, 183–185, 189, 287, 383, 385 - In Pregnancy 184 - Respiratory Distress Syndrome 56, 195, 207, 208, 278, 303, 368, 556 - Respiratory Failure 5, 13, 304 - Stress 423, 428, 431 - Tubular Necrosis 175–177, 180, 182–184, 503 Administrative 20, 22, 23, 32, 63, 73, 75, 77, 113, 230 - Personnel 77 Adrenal Cortex 418, 425 - Insufficiency 429 Adrenaline 417, 427–430 Adsorption 20, 189 Adult Respiratory Distress Syndrome 481, 503 Adverse - Effects 43, 153, 155, 159, 221, 238, 242, 246, 321, 355, 400, 440, 441, 459, 516 - Events 30, 61, 65, 69, 75, 77, 83, 88, 109, 152, 157, 213, 242, 293, 526, 530, 559 Agitation 137, 303, 449, 459, 464 Aim 19, 24, 37, 87, 94, 108, 122, 226, 230, 244, 245, 262, 268, 305, 325, 327, 336, 457, 476, 481, 507, 510, 526, 544, 545, 552 Airway 8, 9, 12, 13, 15, 76, 196, 202, 204, 214, 254, 261, 265, 270, 274, 303, 338, 347, 373, 375, 385, 404, 476, 481, 483, 531 - Care 12 - Edema 476 - Pressure Release Ventilation 214 - Suctioning 373 Alcohol 182, 217, 229, 470, 480, 538 Allodynia 448 Allopurinol 185 Altruism 31 Alveolar Infiltration 195 Alveoli 210–214 Aminoglycoside 180, 182, 185, 248 - Nephrotoxicity 180 Amphetamine/s 479, 480, 507 Amphotericin B Deoxycholate 290, 291 Amplitude Spectrum Area 168, 169, 173 Anemia 444 Anaerobiosis 439 Analysis Approach 432, 544, 559 Analytic - Studies 546, 547 - Study Designs 547 564 Anaphylactic Shock 144, 148 Anemia 154, 290, 362, 436, 437, 439, 443– 445, 503, 505, 508, 510 Anesthesiologists 3, 4, 13, 466 Angio-embolization 358–360 Angiotensin Converting Enzyme Inhibitors 179 Antibiotic - Policy 237–239, 241, 243–247, 249, 258 - Resistance 222, 246, 248, 253, 255, 258, 270, 282 - Therapy 243, 248, 305, 307, 316, 320, 323, 326, 483 - Cycling 244, 245, 249, 255 Antidotes 374 Antimicrobial Agents 238, 239, 241, 242, 264, 265 Antithrombin-III 473 Anuric Kidney Failure 175 Anxiolysis 458, 476 Aortic - Coarctation 144 - Stenosis 144, 477 Apgar Score 94 Artemether 507, 510, 512, 513 Arterial - Blood Lactate 9, 15 - Blood Pressare 55, 158, 306, 424, 554 Artesunate 507, 508, 510, 512, 513 Artificial Ventilation 64, 346 Aspergillus Fumigatus 285 Atelectasis 196, 198, 205, 210, 481 Atelectrauma 211, 212, 481 Atropine 49, 53 Audit 61, 66, 86, 87, 90, 95, 99, 101, 103, 328, 330, 560, 561 Australian Triage Scale 346–349 Autonomy 30, 32–34, 41, 42, 44, 45, 69, 78, 85, 496, 516, 517, 560 Azotemia 177–179, 181, 183, 187, 506 B Background Information 544 Barbiturates 10, 138, 141 Barotrauma 195, 205, 481 Battlefield Casualties 336 Beneficente 36, 42–44, 69, 78, 516, 517, 560 Benzodiazepines 460, 480 Beta-Blockers 491 Bias 104, 279, 493, 499, 548-552, 559, 560 Bicarbonato 157, 170, 182, 212, 309, 362, 481, 505 Subject Index Bio-Ethics 42 Bioethics And Rehabilitation 70 Bioimpedance 145 Biological - Agents Disasters 340 - Terrorist Attack 368 Biotrauma 211 Blind Randomised Controlled Trial 551 Blinding 52, 552, 555 Blood Glucose 23, 308, 327, 329, 419, 431, 432 Bloodstream Infections 90, 230, 231, 234, 235, 246, 261, 275, 281, 285, 291, 294, 296, 312 Blunt Trauma 205, 344, 350, 354 Body Composition 452 Bomb Blasts 337, 340, 345 Brain - Edema 135 - Herniation 138 - Oxygenation 440 - Tissue Oxygenation 139 Bronchoscopy 13, 238, 373 Bundles 12, 66, 229–231, 297, 310, 313, 325, 327–331 Bupivacaine 454–456, 465, 466, 479 Burns 157, 178, 224, 242, 269, 277, 344, 394, 403, 405, 426, 444 C Candida - glabrata 251 - Infection 286, 288, 292, 293 - spp 285, 290, 291, 293 - tropicalis 251 Candidaemia 295 Carbon Monoxide Poisoning 401 Cardiac - Arrest 148, 163, 164, 166, 169, 170, 475, 484, 508, 540 - Pacing - Surgical Patients 154, 155 - Tamponade 144 Cardiogenic - Pulmonary Edema 208 - Shock 6, 15, 144, 147, 148 Cardiologists 3, 5, 94 Cardiologo 10, 11, 20 Cardiomyopathy 144, 478 Cardiopulmonary Resuscitation 10, 163, 169, 386, 483 Carriage Classification 264, 268 Subject Index Case Report 50, 508, 509, 543, 547 Case Series 547 Case-Control Study 383, 384, 547 Case-Mix 84, 88, 90, 95, 96, 99, 102 Caspofungin 291–293 Catastrophe 379 Catheter Related Blood Stream Infection 221 Catheterization Laboratory Cefoxitin 264 Ceftazidime 254–256, 275 Cellulitis 397 Central - Venous Catheter 214, 221, 286 - Oxygen Saturation 146, 158, 302, 307, 310, 327, 527 - Pressure 146, 149, 153, 157, 306, 310, 327, 482, 506, 527 Cerebral - Hypoxia 139 - Ischemia 137 - Ischemic Injury 140 - Malaria 503–505, 508–510, 512, 513 - Microdialysis 140 - Oxygenation 137, 140, 440 - Resuscitation 10 Chemical Agent Release 340 Chest - Compression 3, 163, 164, 166, 170, 171 - Radiographs 198, 208 - Tube Insertion 373 - X-Rays 195–198, 200, 205, 225 Chlorhexidine 230, 231, 268, 271, 272 Chloroquine 507 Cholera 384, 400 Chronic - Health Status 93 - Renal Failure 155, 175, 176, 287 Ciprofloxacin 254, 256, 275 Circulation 5, 8, 56, 145, 147, 148, 163–165, 189, 318, 338, 430, 475, 480, 481, 484, 526 Circulatory Shock 9, 14, 143, 147–149, 161, 170 Cisplatin Toxicity 185 Citrobacter 251, 262, 264, 273 Civilian Field Triade 335, 336, 341 Clinical - Decision-Making 48, 136 - Governance 29, 30, 39, 61–63, 65 - Microbiology 241, 243, 262 - Performance 54, 61, 87 - Research 10, 22, 23, 47–49, 55, 56, 63, 176, 453, 546, 553 565 - Risk 61 - Trial 52, 137, 509, 551, 552 Clinician 22, 41, 42, 48–55, 448, 504, 505, 516 Clonidine 456 Clopidogrel 491, 497 Coagulopathy 155, 159, 354, 355, 357, 362, 442, 503, 509 Cocaina 182, 479, 480 Coccidioides spp 290 Cohort Study 50, 209, 440, 548–550 Colloid 75, 148, 151, 153–155, 157–159, 310, 327, 481, 483 Coma 135, 303, 339, 342, 350, 429, 510, Combined Spinal Epidural 478, 479 Comfort Score 463 Co-Morbidities 350 Compassion 25, 31, 36 Competente 29–33, 37, 38 Complicated Intra-Abdominal Infections 316 Computer Ordering System 88 Computerized Clinical ICU Databases 88 Computers 54, 87, 88, 540 Confidentiality 31–34, 40, 65, 222, 561 Confusion 224, 303, 439 Conscious Sedation 458, 459 Contamination 229, 241, 255, 317, 320–322, 373, 392, 393, 397, 441 Continuous - Coupled Plasma Filtration 189 - Extracorporeal Techniques 186 - Renal Replacement Therapy 188, 189, 387 - Veno-Venous Hemodiafiltration 309 Control Group 52, 214, 264, 266, 308, 551 Coronary Care Unit 101 Coronary Perfusion Pressare 164, 165 Corticosteroids 211, 215, 216, 285, 418, 429, 431, 483 Corticotropin 418, 125, 429, 431 Cortisol 417, 422, 426, 428–430, 448, 451 Cost of Health Care 30, 42 Cost of ICU 74 Cost-Containment 62, 495 C-Reactive Protein 300, 301, 436, 437 Creatinine 88, 154, 175–177, 180, 184, 291, 304, 384, 490, 505, 510 Critical Care - Education 22, 127 - Nurse 108–110, 114, 120, 121 - Nursing Organization 119 Critically Ill Patient 42, 43, 70, 71, 73, 93, 94, 96, 97, 151, 155, 187, 243, 305, 322, 437 566 Cross-Sectional Studies 547, 548 Crush Syndrome 383 Cryoprecipitates 435, 443 Cryptococcus spp 285, 290 Crystalloid 18, 151, 153, 154, 157, 158, 310, 327, 355 Crystalloids 75, 149, 151–153, 157, 159, 182, 306, 307, 482, 483 Cyanosis 195, 478 Cyanotic Heart Disease 437 Cytocrome P450 452 Cytokines 95, 183, 188, 209, 317, 318, 425–427, 429–431, 436, 503 Cytomegalovirus 441 D Dalte parin 474 Damage Control Surgery 353, 355, 356, 360 Decision Making 31, 33, 36, 41, 42, 44, 48, 56, 95, 113, 136, 186, 335, 339, 340, 372, 493, 515, 518, 525 Declaration of Rio De Janeiro 23 Decompressive Craniectomy 139 Deep Sedation 458 Deep Venous Thrombosis Prophylaxis 231, 374 De-Escalation Therapy 244 Delirium 303 Delphi Methodology 326 Dengue 153, 157, 158, 384, 400 Dengue Shock Syndrome 153, 157, 158 Descriptive Studies 545, 546, 547 Developing Countries 19, 55, 62, 127, 130, 227, 380, 386, 403, 408, 484, 487, 491, 508 Dexamethasone 454, 506, 510 Dexmedetomidine 452, 459, 460 Dextran 153, 155, 156, 157, 158, 159 Diagnosis of Pneumonia 254 Diarrhoea 410 Diclofenac 454 Digestive Tract Overgrowth 253 Disability 78, 348, 497 Disaster - Planning 406, 407 - Preparedness 368, 371 - Triage 405 Disseminated Intravascular Coagulation 301, 442, 505 Distributive - Justice 496, 516, 517 - Shock 144 Subject Index Dobutamine 148, 149, 307 Dopamine 148, 185, 307, 427, 430 Droperidol 454 Drotrecogin Alfa 43, 95, 147, 310, 327, 329 Drug Abuse 479 Drugs Costs 74 Duraplasty 139 Dying 70, 83, 491, 493, 515, 518, 519 Dyspnoea 195 E Early Goal Directed Therapy 146, 483, 506 Early-Onset Pneumonia 264, 265 Echinocandins 290, 291, 293 Echocardiography 14, 145, 482 Eclampsia 184, 471, 472, 474–476 Elderly 144, 439, 443, 487, 491, 493, 494, 496, 497, 539 Electrocardiogram 5, 14, 144, 166 Embolization 357–360 Emergency - Department Triage 335, 346 - Medical Services 337, 341 - Surgery 184, 336, 342 End Stage Liver Disease 189 Endocarditis 179, 291 End-Of-Life Care 81, 95, 494, 497, 515, 516, 518, 519 Endogenous Infections 239, 261, 264, 273, 279, 280 Endophthalmitis 288, 291 Endotoxin 318, 417, 430 Endotracheal Intubation 166, 373 Endotracheal Tube 231, 265, 266 End-Tidal CO2 145, 165, 166 End-Tidal PCO2 14 Enoxaparin 474 Enteral Nutrition 95, 152, 153, 185, 211, 228, 268, 286, 287, 310, 375 Enterobacter 243, 251, 262, 264, 273 Enterococcus sp 226 Epidemiologists 543 Epidural Anesthesia 455, 474, 479 Epidural Catheter 136, 456 Epinephrine 15, 148, 307 Epstein-Barr Virus 441 Erythrocytes 437, 438, 440, 509, 511 Erythropoietin 436, 437 Escherichia coli 251, 262, 264, 273, 317, 504 Esmolol 476 Subject Index Ethical - Issues 62, 558, 559 - Principles 36, 78, 409, 515, 517, 560 Ethics 27, 30, 31, 34, 36–38, 41, 42, 69, 70, 78, 385, 408, 515, 519 Euthyroid-Sick Syndrome 427 Evidence-Based - Medicine 30, 43, 47, 52, 57, 263, 305 - Practice 13, 23, 61, 127 Exchange Transfusion 509 Exogenous - Infection 228, 261–263, 265, 267, 268, 273, 274, 279, 280 - Pneumonia 263, 264 Experimental Studies 267, 551 Extracellular Volume Depletion 182, 184 Extravascular Lung Water 151, 158 Extrication 341 Extubation 35, 76, 109, 460, 462, 476 F Febrile Illness 502 Fentanyl 137, 454, 455, 460–462, 479 Fetal - Delivery 483 - Hypoxia 481 Fever 180, 181, 183, 225, 238, 243, 290, 292, 301, 302, 318, 384, 435, 440, 441, 443, 501, 503, 504, 506, 508 Fiberoptic Bronchoscopy 13, 238 Field Surgical Hospitals 346 Firefighters 337 First Responders 337, 338, 368 Floods and Storms 380 Fluconazole 252, 290–293 Fluid Therapy 148, 153, 156, 306, 385, 482 Follow-Up of Patients 52, 73 Formaldehyde 401 Frank-Starling Curve 482 Fresh Frozen Plasma 309, 435, 442 Fulminant Glomerulonephritis 179 Fungal - Cell Wall 288, 290, 291 - Infection 286, 287, 289–292, 294 Furosemide 182, 185 G Gamma Amino Butyric Acid 425 Gamma Glutamil Transferase 303 Gas Inhalation 396 Gastric Tonometry 147, 527 567 Gastroesophageal Reflux 231 Gastrointestinal Infections 400 Gelatin 152, 154–159 General - Anesthesia 458, 476–478 - Surgery Gentamicin 88, 254 Geriatric - Curriculum 488 - Patient 487, 488, 491 Glasgow Coma Scale Score 135 Glomerular Filtration Rate 175, 186, 452, 481 Glomerulonephritis 177–179 Glucagon 419, 430 Goodpasture Syndrome 179 Gram-Negative Bacteria 243, 256, 275, 317 Growth Hormone 417, 421, 426, 427, 431 H Haemophilus influenzae 262, 264, 273, 274 Hand Hygiene 65, 228, 229, 255, 373 Handwashing 230, 233, 253, 255, 534, 537, 538 Head Injuries 336, 346, 383 Head Nurse 64, 113 Health - Care Practitioners 45 - Expenditure 63 - Organization 22, 31, 72, 436 - Services 72, 236, 406, 407, 409, 528, 549, 551 Healthcare Providers 379, 498, 531, 551 Heart - Attack 5, 439 - Disease 437, 439, 470, 476, 477, 479, 491, 492, 497 - Failure 12, 147, 178, 189, 207, 242, 439, 476, 479 - Rate 9, 55, 144, 149, 300, 440, 447–450, 463, 464 Hellp Syndrome 184, 474, 475 Hematocrit 158, 307, 436, 443 Hematuria 180, 181 Hemodialysis 3, 64, 186, 187, 189, 287, 290, 309, 508 Hemodilution 151, 153, 156, 436, 438, 443 Hemoglobin 213, 309, 435, 436, 443, 481, 503, 504, 505, 508 Hemolysis 475, 503–505, 508 Hemolytic Uremic Syndrome 180, 181 Hemorrhage 144, 148, 155, 178, 182, 184, 208, 568 238, 239, 318, 347, 353, 356, 358, 363, 393, 435, 437, 439, 442, 443, 470, 472, 474, 475, 540 Heparin 75, 186, 473, 474, 510 Hepatic Encephalopath 503 Hepatorenal Syndrome 179, 180 Heroin 182, 480 Heterogeneous Population 93 High Dependency Care 109, 114 High Risk of Dying 70 Hippocampus 422, 425 Hippocratic Oath 36, 78 Histoplasma 290, 291 Homeostasis 430, 431, 435, 454, 526 Hospital - Critical Care Units 368 - Discharge 368 - Mortality 82, 96, 246, 286, 328, 505, 549 Hospital-Acquired - Arf 179 - Infections 230, 237, 243, 299, 305 Human - Life 70, 370, 379 - Resources 69, 71, 75, 76, 345, 388 - Rights 36 Hydrocortisone 147, 308, 431 Hydrostatic Pulmonary Edema 207 Hydroxyethyl Starch 153 Hypercapnia 211, 212, 308, 481 Hypercarbia 170, 212, 215, 489 Hyperchloremic Acidosis 157 Hyperfibrinolysis 442 Hyperglycemia 285, 301, 428–431 Hyperkalemia 182, 187 Hyperosmolar Therapy 138 Hyperphosphatemia 182 Hypertension 14, 137, 139, 179–181, 207, 210, 212, 383, 474, 478 Hyperventilation 137 Hypervolemic Hemodilution 153 Hypoglycemia 308, 453, 505–508, 510 Hypotension 135, 138, 182, 183, 186, 187, 189, 301, 302, 304, 306–308, 310, 327, 347, 418, 429, 430, 461, 481, 508 Hypothalamic-Pituitary Axis 417 Hypothalamus 418, 419, 425, 426 Hypothesis Testing 556 Hypovolemia 154, 155, 184, 301, 320 Hypovolemic 9, 14, 143, 144, 148, 475 Hypovolemic Shock 9, 143, 144, 148 Subject Index Hypoxemic Respiratory Failure 195, 207, 209 Hypoxia 135, 139, 144, 183, 302, 453, 481, 489, 503 I IA Abscess 315, 321 ICU - Performance 34, 64, 77, 81–84, 86, 88, 89 - Director 70, 73–75, 231 - Discharge 35, 83, 95, 98 - Health Team 71 - Mortality 308, 310 - Organization 63, 86, 96 - Performance 34, 64, 73, 77, 81–84, 86, 88, 89 - Acquired Bloodstream Infections 285 Imaging Techniques 170, 196, 318, 319 Imipenem 256, 275 Immediate Care 336 Immune Function 186, 285, 430, 431, 490 Immunomodulation 440 Industrial Accident 367 Infants 198, 255, 393, 394, 397, 404–406, 440, 447–452, 455, 456, 461, 479 Information System 22, 530 Informed Consent Form 543, 560 Infrared Spectroscopy 147 Inhalational Anesthetic Agents 479 Inspiratory - Plateau Pressure 212, 310, 327 - Pressure 211, 213 Intensive Care - Nursing 64, 72, 108, 127 - Workforce 108 Interferon 181, 436 Interleukin 188, 305, 317, 418, 425, 436 Intermediate Care Unit 86 International Perspectives 19 Interstitial Nephritis 177, 179, 180, 182 Intra-Abdominal Infection 315, 316 Intravascular - Hemolysis 503, 504 - Pressures - Volume 143, 158, 185, 475, 481, 482 Intravenous Lines 404 Intubation 3, 12, 35, 76, 166, 215, 231, 239, 373, 374, 418, 459, 476 Invasive - Candidiasis 285–293 - Measurements 14, 166, 171 Subject Index Investigator 52, 170, 255, 543–546, 548, 550, 552, 557, 559, 560, 561 Ischemic 140, 153, 155, 164, 177, 180, 182, 183, 437, 439, 470, 475, 491, 492 Ischemic Heart Disease 437, 439, 470, 491, 492 Isolation 19, 187, 226, 228, 229, 239, 241, 242, 253–255, 289, 290, 371, 374, 400, 493, 497, 533 Itraconazole 290, 291, 293 J Joint Commission For Accreditation of Hospitals 222 K Ketamine 453, 454, 456, 459 Ketorolac 454, 455, 462 Killip and Kimball Score 94 Klebsiella pneumoniae 256, 275 Klebsiella sp 226 L Lactate Dehydrogenase 384, 506 Lactic Acidosis 437, 443 Laparotomies 354, 356 Laryngoscopy 476 Late-Onset Pneumonia 263, 265 Leak Syndrome 151 Length of Stay 34, 64, 66, 76, 77, 82, 96, 97, 109, 184, 228, 310, 328, 549 Leptin 428 Leptospirosis 400, 503 Lethal Biological Agents 368 Levobupivacaine 455, 456 Levosimendan 149 Life-Threatening Dysrhythmia 13 Limitations and Pitfalls of Triade 341 Liquid Ventilation 214 Locus coeruleus 418, 425, 426 Long Bones 354 Loop Diuretics 183, 185 Loss and End Stage 176 Low Cardiac Output 144, 302, 307 Low Tidal Volume 212, 213, 216, 278, 308, 481, 556, Lumefantrine 507 Lung - Compliance 195, 200 - Injury Score 208 - Parenchyma 195, 198, 202, 203 569 - Protective Ventilation 210, 212, 481 - Recruitability 196, 198, 203, 204 M Malignant Hypertension 180, 181 Malnutrition 177, 408, 428 Managed Care 42, 44, 46 Management Bundle 310, 327, 328, 329 Mannitol 138, 141, 178, 182, 184, 185 Mass Casualty 138, 141, 178, 182, 184, 185, 335, 336, 338, 340, 345, 349, 368, 377, 385, 386, 388, 389, 396, 402, 403, 406, 407, 409, 410, 413, 414 Mass - Casualty Events 392, 402, 407, 409 - Disasters 340, 408 Maternal - Death 469–471, 474 - Resuscitation 481 Mean Arterial Blood Pressare 158 Medical - Education 16, 29, 30, 32, 39, 40, 54, 87, 528 - Equipment 36, 368 - Error 66, 69, 79, 87 - Ethics 36, 38, 46, 80, 515 - Practice 30, 31, 39, 41, 49, 54, 55, 305, 437 - Professionalism 29, 30, 31, 35, 39, 40 - Research 47, 62, 551, 560 - Resources 125, 126, 385, 391, 412 - School 19, 47 - Staff 63, 64, 71, 73, 77, 113, 451, 457 Medication 74, 76, 90, 109, 242, 375, 384, 385, 394, 405, 530, 535, 536, 539 Meline 52 Mental - Health Services 409, 412 - Status 183, 301, 338, 339, 583 Mercalli 379 Metabolic Acidosis 354, 355, 505, 510 Metabolic Oxygen Consumption 439 Micafungin and Anidulafungin 291 Microcephaly 474 Microcirculation 16, 17, 147, 149–151, 156, 170, 171, 173, 190, 304, 311, 440, 502, 503, 511, 512 Microvascular - Flow 170 - Obstruction 503, 509, 511 - Perfusion 440 570 Midazolam 137, 459–461 Mixed Venous Oxygen 150, 306, 327 Moraxella catarrhalis 262, 264, 273 Morbidity 43, 45, 50, 56, 67, 70, 76, 138, 139, 184, 186, 189, 221, 237, 245, 255, 270, 286, 321, 345, 350, 381, 384, 389, 396, 418, 431, 440, 443, 459, 471, 484, 538 Morganella 251, 262, 264, 273 Morphine 137, 452, 454, 455, 460–462, 465, 466, 478 Mosquito 502 Multiple - Organ Dysfunction Syndrome 102, 304, 368, 387, 432 - Organ Dysfunction/Failure 96, 176 - System Organ Failure 383, 384 - Trauma Casualties 368 - Victims 335 Myocardial Dysfunction 164, 171, 302 Mitochondria Dysfunction 302 N National - Critical Care Societies 20, 21, 25, 110, 111, 124, 388 - Health Service 61 - Library of Medicine 52 Neck Trauma 358 Neonatal ICU 254 Nephrosis 155,160, 178 Nephrotoxicity 154, 180, 182, 185, 242, 462 Nephrotoxin 175 Neuroendocrine System 431 Neuroprotection 10 Neurosurgeons 137 Neurosurgical Care Neurotransmitter 452 Neurotrauma 141, 354 Newborns 198, 447, 450, 465 Nitrates 149 Nitric Oxide 183, 215, 311, 418, 425, 432 Nitroprusside 149, 215 Non-Invasive Measurements 173 Nonsteroidal Anti-inflamatory Drugs 179, 184, 460 Noradrenaline 417, 418, 425, 427, 428, 430, 452 Norepinephrine 15, 148, 307, 432 Normal Flora 252, 262, 267 Nosocomial Infections 35, 65, 109, 221, 222, 233, 237, 241, 247, 257, 271, 440, 445, 530 Novovirus 400 Subject Index Nuclear Incidents 340 Nursing - Staff 4, 13, 64, 96, 110, 111, 113, 116, 127, 229, 498, 527 - Workload 94, 110 Nutritional Support 185, 188, 309, 405 Obesity 456, 457, 460, 534 Observational Studies 55, 422, 532, 539 Obstructive Shock 14, 144, 148 Oliguria 165, 171, 173, 174, 176, 177, 290, 460, 461, 489 Online Information Resources 51, 54 Open Treatment 307 Organ Perfusion 468 Organization of Critical Care Delivery 354 Organophosphorous Poisoning 50, 51 Orthopedic Injuries 339, 346, 483 Osmotic Nephropathy 172 Outcome Prediction Models 94–98, 100 Out-of-Hospital Cardiac Arrest 158 Overgrowth 238–242, 248, 251, 263, 264, 266 Oxalate Nephropathy 168 Oxygen - Delivery 58, 285, 288, 293, 424, 466 - Saturimetry 14 - Transport 13, 146, 421, 426, 429 Oxygenation 200–203, 306, 424, 426, 466 P Pseudomonas - aeruginosa 240, 242, 251, 271 - ovale 488 - vivax 488, 491 Pain - Assessment 433, 434, 346 - Measurement 447, 457 - Perception 451 Pandemic Influenza 368 Paracetamol 453, 462, 480 Parasite Infections 440 Parenteral Nutrition 95, 152, 153, 286, 287, 310 Patient - Autonomy 32, 41, 42, 44, 45, 69 - Service 30 - Welfare 32 Pediatric - Care 38, 127, 407 - Mass Casualties 405, 408 Subject Index Pelvic - Fixation and Packing 360 - Fractures 343, 357, 360 Penetrating Trauma 343, 358 Penicillin G 264 Performance Measures 82-84 Peri-Partum Cardiomyopathy 478 Peritoneal - Dialysis 86, 316 - Lavage 319, 321 Permissive Hypercapnia 212, 308, 481 Pharmacy Regulations 375 Phosphodiesterase Inhibitors 149 Physician Charter 31 Physiologic Reserve 93, 494, 497 Piperacillin-Tazobactam 254 Placebo-Controlled Groups 52 Planned Relaparotomy 321 Plasma Expander 151, 159 Plasmodium falciparum 502 Plateletpheresis 442 Platelets 303, 355, 419, 435, 442, 443, 475, 502, 505, 510 Play Therapy 451 Pneumomediastinum 198 Pneumothorax 195, 198, 205 Polyamide Membrane 188 Polyenes 290, 293 Polymyxins 256, 275 Polysulfone 186, 188 Posaconazole 290, 291, 293 Positive Emission Tomography 196 Positive - End-Expiratory Pressure 145, 185, 200, 213, 480 - Pressure Ventilation Postoperative Nausea 454 Postrenal Azotemia 178, 179 Potassium 175, 384, 423, 505 Pralidoxime 49-52 Precordial Injury 343 Pre-Eclampsia 472, 474-476 Pre-Emptive Therapy 244, 245, 292 Preparedness Plans 367 Prerenal - ARF 176, 177 - Azotemia 177, 178, 506 Pressure Control Inverse Ration Ventilation 214 Preterm Neonates 499, 452 Primary Endogenous Pneumonia 263, 264, 267, 274 571 Prions 440, 441 Procalcitonin 300, 301, 305, 505 Prognostic Models 94, 494 Prone Position 200-202, 213, 216, Prophylaxis of Nosocomial Infections 237 Propofol 137, 459, 461 Prospective Studies 546, 549, 550 Prostacyclin 183, 215 Proteus 251, 262, 264, 273 Pruritus 156 Public Health System 72 Pubmed 52 Puerperium 477 Pulmonary - Arterial Hypertension 210 - Artery - Catheter 94, 146, 147, 208, 214, 216, 479 - Flow Directed (Swan-Ganz) Catheter 14 - Occlusion Pressure 145, 149, 482 - Aspergillosis 286, 288-290, 293, 294 - Edema 13, 149, 157, 159, 195, 207, 208, 462, 475, 476, 482, 503, 506, 509, 510 - Embolism 144, 473 - Gas Exchange 303 - Infiltrates 207, 208, 303 Pulse Oximetry 14, 213 Pyelonephritis 180 Pyuria 180, 181 Q Quality - Improvement 34, 61, 64–66, 85, 113, 226, 230, 232 - Processes 34, 61 Quality - of Care 28, 31, 32, 34, 37, 55, 62, 81–91, 128, 226, 525, 530 - of Life 34, 48, 65, 70, 82, 95, 209, 493, 494, 496, 528 Quinine 504, 505, 507, 508, 510 R Rabies 397 Ramsay Score 400 Randomized Controlled Trial 47, 52, 55, 146, 152, 230, 256, 264, 274, 278, 326, 430, 437, 439, 482, 549–551 Rapid Response Team 86, 388 Recruited Alveoli 213 572 Recruitment - Maneuvers 204, 213, 216 - Procedure 553 Rectal Swabs 256, 261, 262, 264, 275 Rectum 253, 274, 280 Remifentanyl 460, 462 Renal - Blood Flow 177, 179, 183 - Function 154, 155, 157, 180, 185, 187, 240, 319, 482 - Hypoperfusion 177, 183 - Infarction 180 - Perfusion 182, 185, 189 - Replacement Therapy 154, 176, 186–189, 309, 375, 387, 503, 506 - Support 187 Rescue Procedure 337 Research Protocol 543, 544, 560 Resource Allocation 69, 75, 78, 79, 408 Resources Consumption in ICU 65 Respiratory Acidosis 481 Respiratory Failure 5, 12, 13, 145, 195, 207, 209, 210, 213, 304, 317, 492 Respiratory Infection 239, 400 Respiratory Paralysis 49 Respiratory Rate 212, 300, 309 Responsibility 25, 30, 31, 41, 42, 44, 54, 62, 63, 70, 73, 74, 78, 127, 130, 238, 244, 369, 388, 389, 560 Resuscitation Bundle 310, 327, 328 Retrospective Study 140 Return of Spontaneous Circulation 164 rhAPC 299, 304, 309 Richter Scale 379 Rights of the Patient 129 Ringer’s Lactate 153, 154, 157, 158 Risk-Adjusted Mortality 95, 96, 99 Risk-Adjusted Use Of Resources 97 Risk/Benefit Analysis 56 Rotavirus 400 S Safety Measures 20, 21 Satisfaction of the Patient 65 Saturation 146, 158, 213, 225, 302, 306, 307, 310, 327, 436, 447–450, 481, 527 Scholarship 31 Secondary Endogenous Pneumonia 263, 264, 275 Selective Digestive Tract Decontamination 231 Subject Index Selective Oropharyngeal Decontamination 256, 265, 275 Sepsis Bundle 310, 327–329 Sepsis Management Bundle 310, 327, 329 Sepsis Syndrome 209, 304 Serratia 251, 254, 262, 264, 273, 280 Serum Creatinine 154, 175, 176, 384, 490, 505 Severe Sepsis 152, 154–157, 159, 293, 300, 301, 303-306, 310, 325–329, 437, 482, 483, 492, 504, 506, 511 Severity Score 65, 94, 95, 97–99, 343, 354 Shigellosis 400 Shortage - of Nurses 72 - of Specialized Staff 368 Significance Test 556-558 Simplified Acute Physiology 94 SIRS 183, 198, 252, 300, 317, 318 Social Justice 33, 44 Society of Critical Care Medicine 10–12, 64, 75, 128, 232, 325, 327, 372, 385 Sodium - Bicarbonate 309 - Nitroprusside 149 Somatostatin 419, 425, 426 Source - Control 307, 319, 321, 322 - of Infection 148, 225, 302, 305, 316, 320, 321 Spinal Injuries 336 Splanchnic Ischemia 304 Stab Wound 354 Staff Satisfaction 65, 82 Staphylococcal Septicemia 179 Staphylococcus aureus 243, 251, 257, 264, 273–275, 277, 280 Statistical Significance Testing 556, 557 Steroids 177, 181, 278, 286, 308, 310 Streptococcus pneumoniae 251, 262, 264, 273, 274, 316 Stress Ulcer Prophylaxis 309, 374 Stroke Volume 146, 482 Subglottic - Drainage 265, 266 - Secretion Drainage 266, 267 Subject Eligibility Criteria 553 Sublingual Capnometry 147 Substance Abuse 470, 479, 480 Sudden - Cardiac Death 163 - Infant Death Syndrome 479 Subject Index 573 Sufentanyl 454 Surfactant 210 Surveillance Sample 253, 262, 263, 276, 277 Surviving Sepsis Campaign 41, 263, 300, 306, 325–329, 437, 483 System of Casualty Evacuation 336 Systems-Oriented Quality Circle 89 Triage 44, 83, 335–348 - Decision 340–342 - Performance 83 Triazoles 290 Tsunamis 367, 379, 383, 384, 392, 396 Tuberculosis 384 T Tachycardia 149, 301, 302, 428, 480 Tachypnea 195, 225, 301, 302 Target Population 553 Teaching Hospital 114, 221, 226, 342, 386, 403 Telemedicine 64, 86, 528 Terrorist Attack 368, 383 Tetanus 384, 400 Tetrastarch 152, 154 Thiopentone 479 Thoracic Compliance 210 Thrombocytopenia 155, 301, 442, 474–476, 505, 509, Thromboembolism 75, 470, 471–473 Thrombophilia 473 Thrombosis 75, 180, 181, 183, 210, 211, 231, 304, 309, 374, 472–474, 503 Time Classification 264, 265 Tissue Capnometry 15 Tissue - Edema 151, 157, 301 - Hypercarbia 170 - Hypoperfusion 14, 437, 443 - Hypoxia 144, 302, 503 - PCO2 14, 171 Tobramycin 256, 262, 275–277, 280 Tornado 370, 392 Total Quality Management 85 Tracheostomy 5, 243 Training Courses 73, 407 TRALI 435, 440, 441 Transesophageal Pressures 212 Transferrin 158, 436 Transfusion-Related Acute Lung Injury 435, 441 Transpulmonary Pressure 202, 203, 212 Trauma - Center 342–344, 354 - System 335, 348 Traumatic Brain Injury 135, 152, 157, 159, 383, 384 U Urinary Catheter 178, 221, 287 V Vancomycin 229, 242, 246, 256, 262, 275, 277, 278, 280 Vascular - Disease 179, 180, 184, 492 - Injuries 353, 355, 356, 358, 359 Vasopressin 149, 417, 418, 425–427, 429, 430 Vasopressors 140, 148, 165, 306–308, 310, 327, 374, 387 Ventilation-Perfusion Mismatch 210 Ventilator Bundle 231 Ventilatory Support 49, 148, 303, 438, 459, 460, 492 Ventricular - Defibrillation 169 - Fibrillation 163, 164, 166, 167 Visceral Abscess 179 Volume Replacement 302 Volutrauma 211, 481 Vomiting 144, 318, 393, 454, 461, 462, 506, 508 Von Willebrand’s Disease 155, 443 Voriconazole 289–291, 293 W Warfarin 473, 474, 491 War 4, 336, 337, 346, 392, 401 WCH 386–388 Weaning 109, 211, 228, 431, 438, 454 Weapon Wound 346 Wildfire 370, 380, 381, 392 Withdrawing 44, 516 Withholding 33, 44, 497, 516, 517, 519 World Health Organization 22, 436