e P e K o is gchi Jo hi , E k rm nn rn1n1 S d q A Our • h SIXTH EDITION Critical Care Handbook of the Massachusetts General Hospital SIXTH EDITION Critical Care Handbook of the Massachusetts General Hospital Senior Editor Jeanine P Wiener-Kronish Associate Editors Aranya Bagchi Jonathan E Charnin J Perren Cobb Matthias Eikermann Sadeq A Quraishi Acquisitions Editor: Keith Donnellan Product Development Editor: Nicole Dernoski Editorial Assistant: Kathryn Leyendecker Marketing Manager: Dan Dressler Production Project Manager: Priscilla Crater Design Coordinator: Teresa Mallon Manufacturing Coordinator: Beth Welsh Prepress Vendor: S4Carlisle Publishing Services 6th edition Copyright © 2016 Wolters Kluwer 5th Edition Copyright © 2010 Lippincott Williams & Wilkins, a Wolters Kluwer business All rights reserved This book is protected by copyright No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews Materials appearing in this book prepared by individuals as part of their official duties as U.S government employees are not covered by the above-mentioned copyright To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at lww.com (products and services) 1-4511-9510-9 978-1-4511-9510-1 eISBN 978-1-4963-3069-7 Library of Congress Cataloging-in-Publication Data available upon request This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient The publisher does not provide medical advice or guidance and this work is merely a reference tool Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work LWW.com I would just thank the authors, the residents, the faculty, and above all, our patients who have given us the privilege of allowing us to care for them We will engage in continuous learning to ensure that our care for our patients is optimal Jeanine P Wiener-Kronish, MD CONTRIBUTORS Young Ahn, MD Medical Director Department of Anesthesiology Perioperative Services—District of Columbia/Suburban Maryland Kaiser Permanente: Mid-Atlantic Permanente Medical Group Largo, Maryland Aranya Bagchi, MBBS Assistant in Anesthesia Massachusetts General Hospital Instructor in Anesthesia Harvard Medical School Boston, Massachusetts Ednan K Bajwa, MD, MPH Medical ICU Director Division of Pulmonary and Critical Care Medicine Massachusetts General Hospital Boston, Massachusetts Peter L Bekker, MD Resident Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Clinical Fellow Harvard Medical School Boston, Massachusetts Lorenzo Berra, MD Anesthesiologist and Critical Care Physician Assistant Professor Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Edward A Bittner, MD, PhD, MS Ed, FCCP, FCCM Program Director Critical Care Medicine-Anesthesiology Fellowship Associate Director, Surgical Intensive Care Unit Assistant Professor of Anaesthesia Harvard Medical School Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Kevin Blackney, MD Resident in Anesthesiology Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Sharon Brackett, RN, BS, CCRN Attending Nurse, Surgical ICU Massachusetts General Hospital Boston, Massachusetts Jeffrey Bruckel, MD, MPH, HMS Fellow in Quality and Safety Edward Lawrence Center for Quality and Safety Massachusetts General Hospital Boston, Massachusetts Richard N Channick, MD Director, Pulmonary Hypertension and Thromboendarterectomy Program Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Boston, Massachusetts Jonathan E Charnin, MD Instructor in Anesthesia Harvard Medical School Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Sanjeev V Chhangani, MD, MBA, FCCM Assistant Professor of Anaesthesia Harvard Medical School Associate Anesthetist Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Hovig V Chitilian, MD Assistant Professor of Anesthesiology Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Alexandra F M Cist, MD Instructor Harvard Medical School Pulmonary and Critical Care Unit Massachusetts General Hospital Boston, Massachusetts J Perren Cobb, MD, FACS, FCCM Vice-Chair for Critical Care Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Associate Professor of Surgery and Anesthesiology Harvard Medical School Boston, Massachusetts Gaston Cudemus, MD Clinical Instructor Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Brian M Cummings, MD Pediatric Critical Care, Assistant in Pediatrics MassGeneral Hospital for Children Instructor in Medicine Harvard Medical School Boston, Massachusetts Marc A de Moya, MD Medical Director, Blake 12 ICU Fellowship Director, Surgical Critical Care Massachusetts General Hospital Assistant Professor of Surgery Harvard Medical School Boston, Massachusetts Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia Harvard Medical School Clinical Director, Critical Care Division Massachusetts General Hospital Boston, Massachusetts Peter J Fagenholz, MD Attending Surgeon, Division of Trauma, Emergency Surgery, and Critical Care Massachusetts General Hospital Instructor in Surgery Harvard Medical School Boston, Massachusetts David W Fink, MD Instructor Trauma, Emergency Surgery, Surgical Critical Care Massachusetts General Hospital Boston, Massachusetts Michael G Fitzsimons, MD, FCCP Director, Cardiac Anesthesia Assistant Professor Harvard Medical School Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Eugene Fukudome, MD Clinical Fellow in Surgery Department of Surgery Brigham and Women’s Hospital Boston, Massachusetts Jose P Garcia, MD Surgical Director, Cardiothoracic Transplantation Artificial Heart and Lung Program Massachusetts General Hospital Harvard Medical School Boston, Massachusetts Klaus Goerlinger, MD Department of Anesthesiology and Intensive Care Medicine University Hospital Essen Essen, Germany Jessica Hahn, MD Mass General Hospital for Children Boston, Massachusetts R Scott Harris, MD Associate Physician Massachusetts General Hospital Associate Professor of Medicine Harvard Medical School Boston, Massachusetts Dean R Hess, PhD, RRT Assistant Director of Respiratory Care Massachusetts General Hospital Associate Professor of Anesthesia Harvard Medical School Boston, Massachusetts Kathryn A Hibbert, MD Instructor in Medicine, Division of Pulmonary and Critical Care Parenteral nutrition (PN), 157–159 complications of, 163 Parkinson’s disease, 477 Paroxysmal vocal cord motion, 261 Partial CO2 rebreathing method, 11 Partial pressure of carbon dioxide arterial, 22 end-tidal, 20 venous, 15 of oxygen, 13, 17f alveolar calculation of, 23 arterial, 22 oxygen concentration, 23 vs saturation, 17 venous, 15 Partial ventilation vs full ventilation, 69 Passive humidifiers, 67 Pathogen-associated molecular patterns (PAMPs), 431 Patient position, prior to transporting critically ill patients, 188 PBPs See Penicillin binding proteins (PBPs) PCC See Poison control centers (PCC) PCI See Percutaneous coronary intervention (PCI) PCR See Polymerase chain reaction (PCR) PDSA See Plan-Do-Study Act cycle (PDSA) PEA See Pulseless electrical activity (PEA) Peak expiratory flow (PEF), 263 Pediatric patient, transporting critically ill patients, 190 PEEP See Positive end-expiratory pressure (PEEP) PEF See Peak expiratory flow (PEF) Pelvic fracture, 139 Penetrating trauma, 544 Penicillin binding proteins (PBPs), 169 Penicillin G, 404 for botulism, 467 Penicillins, 169–170 considerations of, 169–170 dosage of, 170 resistance of, 169 spectrum of, 169 Penumbra effect, 17–18 Peptic ulcer disease (PUD), 356, 359 Percussion wave (P1), 145, 145f Percutaneous balloon dilation, 218 Percutaneous coronary intervention (PCI), for acute coronary syndromes, 207 Perfusion index, 18 Pericardial tamponade, 40 Pericarditis, 209–210 Perinephric abscesses, 414 Perioperative myocardial ischemia and infarction angiotensin-converting enzyme inhibitors for, 212 aspirin for, 212–213 beta-blockade for, 211–212 calcium-channel blockers for, 212 ischemia management, 214–215 monitoring and diagnosis, 211 patients management, with coronary stents, 214 preventive strategies for, 211–214 statins for, 212 Perioperative torsades de pointes, 229 Peripartum cardiomyopathy (PPCM), 536–537 Peripherally inserted central venous catheter (PICC), 182 Peripheral nervous system (PNS) acute weakness causes in, 461–464 critical illness polyneuropathy, 462–463 Guillain-Barré syndrome, 462 Peripheral parenteral nutrition (PPN), 157 Peritonitis, 405–407 See also Spontaneous bacterial peritonitis (SBP); Secondary peritonitis, 406 Permanent unit-to-unit handoff, 549f Permissive hypercapnia, 269, 499 Permissive hypotension, 136 Personal protective equipment (PPE), 180–181 in ICU, 585 PET See Positron emission tomography (PET) Petrous bone fracture, 137 Pharmacologic stress perfusion imaging, 200–201 Pharmacologic therapy, 519 Phenobarbital, for status epilepticus, 458f Phenoxybenzamine, 395 Phenylephrine, 95 for aortic stenosis, 218 for SAH, 453 Phenytoin, for status epilepticus, 458f Pheochromocytoma, 394–395 Phlebitis, 170 Phosphodiesterase-III (PDE-III) inhibitors, 96 Phosphorus, electrolyte abnormalities, 125–126 pH-stat, 15 pHTN See Pulmonary hypertension (pHTN) Physician Order for Scope of Treatment (POST), 596 Physician Orders for Life-Sustaining Treatment (POLST), 596 PICC See Peripherally inserted central venous catheter (PICC) PiCCO device, 496, 499 Piperacillin/tazobactam, 398, 402, 404, 405 Pituitary apoplexy, 384 Placenta accrete, 539 Placental abruption, 538, 543 Placenta previa, 538 Plan-Do-Study Act cycle (PDSA), 576, 577f Plasma-diluted thrombin time (dTT), 334 Plasma volume deficit, 115–116 Plateau pressure, 24, 24f Platelets, 442t, 517–518 ABO-compatible, 517–518 count, 340 function analysis, 340–341 Plethysmographic variability index, 18–19 Pleural effusion, 39f, 41 Pleural effusion drainage, 253 PN See Parenteral nutrition (PN) Pneumocystis jirovecii, 316 Pneumonia, 319 See also Community-acquired pneumonia Pneumothorax, 41, 138 PNF See Primary nonfunction (PNF) PNS See Peripheral nervous system (PNS) Point-of-care blood gas analyzers, 16 Point of Care (POC) ultrasound exam See also Critical care ultrasonography (CCUS) line patterns in, 38f, 41 seashore sign, 41 stratosphere sign, 41 Poison control centers (PCC), 470 POLST See Physician Orders for Life-Sustaining Treatment (POLST) Polyarteritis nodosa (PAN), 439 Polymerase chain reaction (PCR), 432 Polymixin-B, 427 hemoperfusion, 436 Polymyxins, 175–176, 402 considerations of, 175–176 dosage of, 176 resistance of, 175 spectrum of, 175 PoPH See Portopulmonary hypertension (PoPH) Portal vein thrombosis (PVT), 318 Portopulmonary hypertension (PoPH), 309–310 Posaconazole, 422 Positive end-expiratory pressure (PEEP), 187 titration technique, for ARDS, 252 Positron emission tomography (PET), 147 POST See Physician Order for Scope of Treatment (POST) Posterior reversible encephalopathy syndrome, 148 Postpartum hemorrhage, 539 Postpyloric tubes, 157 Posttraumatic stress disorder (PTSD), 103 Potassium (1+), 521 Potassium effects of, 302 electrolyte abnormalities, 121–123 PPCM See Peripartum cardiomyopathy (PPCM) PPE See Personal protective equipment (PPE) PPN See Peripheral parenteral nutrition (PPN) pRBCs See Packed red blood cells (pRBCs) Prednisone, 270t, 317, 383 Preeclampsia, 528–530 diagnostic criteria for mild and severe, 529t management of, 530 pharmacologic therapy for, 530 Pregnancy See also Obstetric critical care blood gas measurements during, 528t physiologic changes of, 526, 527t Premature ventricular contractions (PVCs), 229 Pressure control ventilation, 72t, 73–75, 74f Pressure support ventilation (PSV), 69, 76–77, 77f, 78f, 289 Pressure ulcers, 510–513, 512f definition of, 510 diagnosis of, 511 epidemiology of, 510–511 etiology of, 510 postoperative care for, 513 prevention of, 511 soft tissue infections, 513 treatment for, 511 wound dressings, 511, 513 Pressure ventilation negative vs positive, 68 PRF See Pulse repetition frequency (PRF) Primary brain injury, 285 Primary hyperparathyroidism, 390–391 Primary hypothyroidism, 387 Primary immune response, 250 Primary nonfunction (PNF), 318 Prinzmetal’s angina, 196 PRIS See Propofol-Related Infusion Syndrome (PRIS) Proactive approach, to ethical issues in ICU, 589–591, 590t Procainamide, 490–491 Prophylactic transfusion, of FFP and platelets, 325 Prophylaxis, 317 See also specific Prophylaxis in DVT and PE, 277 Propofol, 104, 269, 287, 602 for endotracheal intubation, 58 for status epilepticus, 458f Propofol-related infusion syndrome (PRIS), 104, 478 Proportional assist ventilation, 72t, 77–78 Propranolol, 356, 388, 390, 489 Propylthiouracil, 388, 390 Prostacyclin, 537 Prostaglandins, 295 Prostatitis, 414 Prosthetic valve endocarditis (PVE), 415 Prosthetic valve thrombosis, 223 Protamine, 448, 450 Protein electrophoresis, 124 Prothrombin complex concentrate, 325 Prothrombin time (PT), 334 Proximal vessel occlusion (PVO), 147 PS See Pulmonic stenosis (PS) Pseudoaneurysms, 362–363 Pseudo-hyperadrenalism, 122 Pseudomonas, 168 PSV See Pressure support ventilation (PSV) Psyllium, 369 PTH See Parathyroid hormone (PTH) PTSD See Posttraumatic stress disorder (PTSD) PUD See Peptic ulcer disease (PUD) Pulmonary angiography, for pulmonary embolism, 278 Pulmonary arterial hypertension (PAH), 537 Pulmonary artery catheters (PAC), 8–10, 8f, 90, 499 complication of, 10 contraindications, to placement of, 10 controversy on, 10 indications for, 8 occlusion pressure in, 9 physiologic data for, 9 techniques in, 8–9 waveforms, during placement, 9 Pulmonary artery occlusion pressures, 220 Pulmonary artery rupture, 10 Pulmonary contusion, 138 Pulmonary embolism (PE), 43 anticoagulation for, 281, 283 diagnosis of, 277–279 incidence of, 277 initial evaluation of, 279, 279f overview of, 276 risk factors, 276–277 treatment of, 280–282 Pulmonary embolus, 263–264 Pulmonary hypertension, in mitral stenosis, 221 Pulmonary hypertension (pHTN), 537 Pulmonic stenosis (PS), 535 Pulmonic valve disease, 223 Pulsatile pumps, 242–243 Pulse contour analysis, 12 Pulseless arrest, 492f Pulseless electrical activity (PEA), 225 Pulse oximetry, 16–18, 19f, 45 limitations of, 17–18 principles of, 16–17 Pulse pressure, 2 Pulse repetition frequency (PRF), 33–34 Pulse wave Doppler (PWD), 34 Pulsus paradoxus, 18 Pupillary asymmetries, 142 PVCs See Premature ventricular contractions (PVCs) PVE See Prosthetic valve endocarditis (PVE) PVO See Proximal vessel occlusion (PVO) PVT See Portal vein thrombosis (PVT) PWD See Pulse wave Doppler (PWD) Q QI See Quality improvement (QI) QT syndromes, abnormal, 229 Quality care, 563 components of, 575–576 definition of, 575 Quality improvement (QI), 575–577 focus on process in, 576 impact of, 576–577 Quetiapine, 288 Quinupristin, 174 R Radionuclide imaging, for GI bleeding, 354–355 Radionuclide perfusion imaging, 200–201 Radionuclide ventriculography, 200 Range ambiguity, for CWD, 34 Rapid sequence intubation (RSI), 59 Rapid shallow breathing index (RSBI), 288 RAS See Renal artery stenosis (RAS) RASS See Richmond agitation sedation scale (RASS) Readmissions penalty program, 566 Recipient blood, 516 Recruitment maneuvers, acute respiratory distress syndrome and, 252 Recurrent infarction, 208–209 Recurrent ischemia, 208–209 Red blood cells, 517, 518t Red man syndrome, 173 REE See Resting energy expenditure (REE) Reflection coefficient (σ), 115 Refractory ascites, defined, 309 Remifentanil, 108 Remote electronic monitoring systems, in ICU, 569–573 Renal abscesses, 414 Renal artery stenosis (RAS), 296, 301 Renal candidiasis, 422 Renal failure acute liver failure and, 312 nutritional modifications in, 160 Renal replacement therapy (RRT), 182 for acute kidney injury, 303–305 Renal tubular acidosis (RTA) renal failure, 131 type 1 RTA, 131 type 2 (proximal) RTA, 131 type 4 (hyperkalemic) RTA, 131 Reperfusion therapy, for myocardial infarction, 205–206 Resonance, 3–4 Respiration, 13 Respiratory acidosis, 128t, 133 Respiratory alkalosis, 128t, 133 Respiratory failure, nutritional modifications in, 160 Respiratory monitoring, 13–31 gas exchange, 13–22 lung function, 23 lung mechanics, 24–31 Respiratory patterns, 45–46 Respiratory rate (RR), 45 Respiratory system compliance, 26–27 Resting energy expenditure (REE), 22 Retained placenta, 539 Reteplase (rPA), 206t, 207 Return of spontaneous circulation (ROSC), 484 rFVIIa See Activated recombinant factor VII (rFVIIa) Rheumatic heart disease, antibiotic prophylaxis, 223 Rh surface antigens, 516 Rib fracture, 138 Richmond Agitation Sedation Scale (RASS), 103, 287 Rifampin, 416 Rifaximin, 308 RIFLE See Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (RIFLE) criteria Right ventricular assist device (RVAD), 244 Ringer’s solution, 149 Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (RIFLE) criteria, 293, 319 Rivaroxaban, 281, 333, 342 Rocuronium, for endotracheal intubation, 58 ROSC See Return of spontaneous circulation (ROSC) Rotary pumps, 243 ROTEM See Thromboelastometry (ROTEM) rPA See Reteplase (rPA) RRT See Renal replacement therapy (RRT) RSBI See Rapid shallow breathing index (RSBI) RSI See Rapid sequence intubation (RSI) RTA See Renal tubular acidosis (RTA) Rumack-Matthew nomogram, 471, 472f RVAD See Right ventricular assist device (RVAD) S SA See Sinoatrial (SA) node abnormality SAH See Subarachnoid hemorrhage (SAH) Salbutamol, 269 Salicylates, 471–473 Salmeterol, 270t Salvage techniques, blood conservation and, 520 Sarcoidosis, 460 SAS See Sedation Agitation Scale (SAS) SAT See Spontaneous awakening trial (SAT) SBAR tool, 550 SBO See Small bowel obstruction (SBO) SBT See Spontaneous breathing trial (SBT) SCA See Sudden cardiac arrest (SCA) SCCM See Society of Critical Care Medicine (SCCM) Secondary hyperparathyroidism, 391 Secondary peritonitis, 406 Secondary pulmonary hypertension, 537 Sedation, 101–111 commonly used drugs for, 106–107 guideline for treating, in ICU patients, 101, 102f for mechanically ventilated patients, 101 medications for, 104–107 benzodiazepines, 105–107 dexmedetomidine, 104–105 propofol, 104 prior to transporting critically ill patients, 188 titration, 103–107 Sedation Agitation Scale (SAS), 479 Seizure prophylaxis, 530 Seizures, 453–455 acute evaluation of, 454–455 acute treatment of, 455 clinical syndrome, 454 differential diagnosis of, 454 disorders, 532–533 EEG monitoring for, 455, 456f etiologies of, in ICU, 454t vs stroke, 438–439 Senna, 369 Sepsis, 93, 384, 429–436, 540 definition of, 429, 430t diagnosis and management of, 432–435 emotional disturbances in ICU, 557 epidemiology of, 429–430 innovative/experimental therapies of, 435–436 long-term outcomes of ICU patients, 557–558 pathophysiology of, 430–432 SEPSISPAM trial, 300 Septic shock, adrenal insufficiency in, 384–385 Sequential Organ Failure Assessment (SOFA), 306 Serotonin syndrome (SS), 142, 477 Serum ketones, measurement of, 375 Serum lactate, 91 Serum osmolal gap, 129 Serum pH, 90–91 Serum theophylline, 263 SGAs See Supra-glottic airway (SGAs) Sheehan’s syndrome See Pituitary apoplexy Shift-to-shift handoff, 549 Shock, 88–93 clinical presentation of, 89–90 hemodynamic parameters in, 89t management of, 91–93 metabolic parameters, 90t monitoring in, 90–91 pharmacologic therapies of, 93–96, 94t types of, 88–89 Shunt fraction, 23 SIADH See Syndrome of inappropriate ADH secretion (SIADH) Sick euthyroid syndrome, 387 Sickle cell disease in, 331–332 Sick sinus syndrome (SSS), 227 Sildenafil, 310, 537 Silver nitrate, 508 Silver sulfadiazine, 508 SIMV See Synchronized intermittent mandatory ventilation (SIMV) Sinoatrial (SA) node abnormality, 227 Sinusitis, 419 Sinus tachycardia, 227 SIRS See Systemic inflammatory response syndrome (SIRS) SJS See Stevens Johnson syndrome (SJS) Skin and soft tissue infections necrotizing soft tissue infections, 412–413 postoperative wound infections, 411–412 SMA emboli, 365 Small bowel obstruction (SBO), 366, 367f SMA thrombosis, 365 Society of Critical Care Medicine (SCCM), 155 Sodium bicarbonate, 491 Sodium, electrolyte abnormalities, 118–121 Sodium nitrite, 98 Sodium nitroprusside, 98 Sodium thiosulfate, 98 SOFA See Sequential Organ Failure Assessment (SOFA) Somatostatin, 306, 355, 394 Sotalol, 491 Spatial resolution, 33 Specialized supraglottic airways, 56 Spironolactone, 308 Splanchnic vasoconstrictors, 306 Splenectomy, for GI bleeding, 356 Splenic abscess, 363, 409 Splenic vein thrombosis, 363 Spontaneous awakening trial (SAT), 285 Spontaneous bacterial peritonitis (SBP), 307 diagnosis of, 405 microorganisms, 405 treatment of, 405–406 Spontaneous breathing trial (SBT), 285 factors contributing to failed, 290 technical approaches to, 289–290 Spontaneous hyperventilation, 151 Spontaneous intermittent mandatory ventilation (SIMV), 289 SSC See Surviving Sepsis Campaign (SSC) SSS See Sick sinus syndrome (SSS) Stable angina, 196 Standardization of practice care bundles, 578–579 checklists, 577, 578f Staphylococcus aureus, 522 Starling’s equation, 114 Starvation ketoacidosis, 130 Static pressure-volume curve, 29–31 Statin for acute coronary syndromes, 204 for angina, 201 for perioperative myocardial ischemia and infarction, 212 Status asthmaticus, 256 See also Asthma Status epilepticus, 453 generalized convulsive, 457t nonconvulsive, 457t STEMI See ST-segment elevation myocardial infarction (STEMI) Sterile cockpit rule, 548 Steroids, 149 in septic shock, 384–385 Stevens Johnson syndrome (SJS), 509–510 Stewart approach, acid–base physiology, 133 Stewart-Hamilton equation, 11 Stimulants, 369 Stool softeners, 369 Streptokinase, 206t, 207 Stress-dose glucocorticoid therapy, 389 Stress-related erosive syndrome, 356 Stress ulceration, 359 Stress ulcer prophylaxis, 317, 584 Stroke, 437–453, 461, 531–532 acute ischemic, 437–446 vs amyloid angiopathy, 439 cerebral venous thrombosis, 450 conditions mimicking, 438–439 primary intracerebral haemorrhage, 446–450 subarachnoid haemorrhage, 450–453 toxic-metabolic states, 439 ST-segment elevation myocardial infarction (STEMI), 197 Subarachnoid haemorrhage (SAH), 450–453 acute evaluation of, 452 acute treatment for, 452–453 classification of, 451t clinical syndromes, 451 subsequent evaluation, 452 Subarachnoid hemorrhage (SAH), 142 Subdural hemorrhage, 147 Substituted judgment, 590–591 Succinylcholine, for endotracheal intubation, 58 Sudden cardiac arrest (SCA), 484–485 Sulbactam, 398, 402 Sulfamethoxazole, 420 Sulfamylon, 508 Supra-glottic airway (SGAs), 48, 56–57, 57f Supra-glottic suction tubes, 61 Supraventricular tachycardia (SVT), 486 Surgical cricothyrotomy, 57 Surgical drain salvage devices, 520 Surgical embolectomy, for pulmonary embolism, 282 Surviving Sepsis Campaign (SSC), 433 observational study, 384 SVR See Systemic vascular resistance (SVR) SVT See Supraventricular tachycardia (SVT) Synchronized intermittent mandatory ventilation (SIMV), 78–79, 79f Syndrome of inappropriate ADH secretion (SIADH), 119, 149 Systemic inflammatory response syndrome (SIRS), 181, 429 Systemic oxygen consumption (Vo2), 91 Systemic oxygen delivery (Do2), 91 Systemic thrombolysis, 281–282 Systemic vascular resistance (SVR), 88 Systolic blood pressures, 97, 147 T T3 See Triiodothyronine (T3) Tachycardia, 493f Tachyphylaxis, 98, 392 Tachyrrhythmias, 227–229 TACO See Transfusion-associated circulatory overload (TACO) Tacrolimus, 317 TAH See Total artificial heart (TAH) TAPSE See Tricuspid annular plane systolic excursion (TAPSE) Tazobactam, 398, 402 TBI See Traumatic brain injury (TBI) TBSA See Total body surface area (TBSA) burns TBW See Total body water (TBW) TCA See Tricyclic antidepressants (TCA) TCDs See Transcranial doppler (TCDs) TDABC See Time-Driven Activity-Based Costing (TDABC) TeamSTEPPS, 548–549 TEG See Thromboelastography (TEG) Telehealth, 569 Tele-ICU models, 569–570 Tele-ICU service barriers and challenges to, 573 organization of, 570–572 outcomes and quality metrics, 572 workflow, 572f Telemedicine, defined, 569 Temperature regulation, 150 prior to transporting critically ill patients, 188 Temporal resolution, 33 Temporary unit-to-unit handoff, 549 Tenecteplase (TNK), 206t, 207 TENS See Toxic Epidermal Necrolysis Syndrome (TENS) Teratogens, 526 Terbutaline, 270t Terlipressin, 306 Tertiary hyperparathyroidism, 391 Tertiary survey, reduce rate of missed injuries, 141 THAM See Tris-Hydroxymethyl-Amino-Methane (THAM) Theophylline, 175, 270t Thermal burns, morbidity and mortality associated with, 501–503 Thermodilution cardiac output, 9 Thoracic epidural analgesia, 230 Thoracic infections community-acquired pneumonia, 397–399 empyema, 403 hospital-acquired pneumonia, 400–402 lung abscess, 402–403 mediastinitis, 403–404 Thoracic ultrasound, 40–41 Thrombin time (TT), 334 Thrombocytopenia, 312, 516 Thromboelastography (TEG), 336, 337f, 338, 340t Thromboelastometry (ROTEM), 336, 337–339f, 338, 340t Thromboembolism, 583–584 Thrombolysis, 206 systemic, 281–282 Thrombolytics, 344 Thromboprophylaxis, 140, 317 mechanical, 584 medication, 583 Thrombosis, 298 Thymoma, 464 Thyroid hormone functions and symptoms and signs of dysfunction, 385–387 functions in critical illness, 387–389 Thyroid hormone (continued) physiology of, 385 regulation of, 386f treatment of dysfunction, 388–389 Thyroid-stimulating hormone (TSH), 124 interpretation of elevated, 387 interpretation of low, 387 Thyroid storm, 389 Thyrotropin-regulating hormone (TRH), 385 TIAs See Transient ischemic attacks (TIAs) TIC See Trauma-induced coagulopathy (TIC) TICACOS See Tight Calorie Control Study (TICACOS) Ticarcillin/clavulanate, 404, 405 Ticlopidine, 343 Tidal volume (TV), 45 Tidal wave (P2), 145, 145f Tigecycline, 169, 427 Tight Calorie Control Study (TICACOS), 155 Time-Driven Activity-Based Costing (TDABC), 564 Tiotropium, 270t TIPS See Transjugular intrahepatic portosystemic shunt (TIPS) Tissue oxygenation, 12, 19 Tissue perfusion, 1 monitors of, 12, 90–91 TKM-Ebola, 183 TM See Transverse myelitis (TM) TNK See Tenecteplase (TNK) Tonicclonic seizures, 454 Total artificial heart (TAH), 245 Total body surface area (TBSA) burns, 499 Total body water (TBW), 113, 113t Total parenteral nutrition (TPN), 157, 182 additives to, 159t calculation of, 158–159, 158t components of, 158 Toxic Epidermal Necrolysis Syndrome (TENS), 509–510 tPA See Alteplase (tPA) TPN See Total parenteral nutrition (TPN) Tracheal intubation, 181 Tracheostomy, 63–64 for mechanical ventilation, 292 Tracheostomy tubes, 61–62 changing of, 64 maintenance of, 62–63 mal-positioned, 63 TRALI See Transfusion-related acute lung injury (TRALI) Tranexamic acid, 344 Transcranial doppler (TCDs), 147 Transesophageal pacer, 487 Transfusion-associated circulatory overload (TACO), 523 Transfusion, of blood products, 341 Transfusion-related acute lung injury (TRALI), 522–523 Transfusion therapy, indications for, 515–516 anemia, 515 thrombocytopenia, 516 Transient ischemic attacks (TIAs), 440, 441f Transjugular intrahepatic portosystemic shunt (TIPS), 307, 356 Transmission, of infection, control in ICU, 584–587 Transpulmonary indicator dilution, 11–12 Transpulmonary pressure, 27 Transpulmonary thermodilution, 11–12 Transthoracic echocardiogram (TTE), 202, 280, 440 Transthoracic ultrasound, 10 Transverse myelitis (TM), 468–469 Trauma, 135–141, 543–544 considerations for, 140–141 initial evaluation and primary survey, 135–136 airway, 135–136 breathing, 136 circulation, 136 long-term outcomes of ICU patients, 554–555 nutritional modifications in, 160 resuscitation, 136–137 specific injuries, 137–140 Trauma-induced coagulopathy (TIC), 327 Traumatic brain injury (TBI), long-term outcomes of ICU patients, 558–560 Traumatic SAH, 147 TRH See Thyrotropin-regulating hormone (TRH) Tricuspid annular plane systolic excursion (TAPSE), 40 Tricuspid regurgitation, 223 Tricuspid stenosis, 222 Tricyclic antidepressants (TCA), 474 Trigger asynchrony, 85 Trigger variable, 71 Triiodothyronine (T3), 385 Trimethoprim, 420 Tris-Hydroxymethyl-Amino-Methane (THAM), 132 Trophic enteral nutrition, acute respiratory distress syndrome, 251 Troponin, 200 Trousseau’s sign, 124 TSH See Thyroid-stimulating hormone (TSH) TTE See Transthoracic echocardiogram (TTE) Tube exchanger, in endotracheal and tracheostomy tube, 63 Two-hit phenomenon, 432 Tylenol, 471 U UAG See Urinary anion gap (UAG) UFH See Unfractionated heparin (UFH) Ulcerative colitis, 358 Ultrasound critical care airway, 43 cardiac, 34–40 FAST exam, for trauma, 41–43 thoracic, 40–41 for deep venous thrombosis, 277 guided procedures for, 43 -guided paracentesis, 541 physics, 33–34 Umeclidinium, 270t Unasyn, 169 Unfractionated heparin (UFH), 205, 281, 333, 445, 535, 536, 583 University of Nebraska Medical Center (UNMC), 178 UNMC See University of Nebraska Medical Center (UNMC) Unstable angina, 196–197 Uremia, abnormal platelet function in, 327 Uremic encephalopathy, 302–303 Uremic pericarditis, 303 Ureterosigmoidostomy, 131 Urinary anion gap (UAG), 129 Urinary tract infections (UTIs), 413–414 diagnosis of, 413 microbiology of, 413 predisposing factors of, 413 treatment of, 414 Urine evaluation, for acute kidney injury, 298, 299t Urine osmolal gap, 129 Urine urea nitrogen (UUN), 155 US Department of Transportation (DOT), 183 Uterine atony, 539 Uterine inversion, 539 Uterine rupture, 538–539 UTIs See Urinary tract infections (UTIs) UUN See Urine urea nitrogen (UUN) V VAC See Ventilator-associated condition (VAC) VADs See Ventricular assist devices (VADs) VAE See Ventilator-associated events (VAE) V-agents, 481 Valacyclovir, 425 Valproic acid, for status epilepticus, 458f Value-based purchasing (VBP), 566 Valvular heart disease, 217–224, 533–535 aortic regurgitation, 218–219 aortic stenosis, 217–218 endocarditis/rheumatic heart disease, 223 infective endocarditis, 223 mitral regurgitation, 220–222 mitral stenosis, 219–220 prosthetic valve thrombosis, 223 pulmonic valve disease, 223 tricuspid regurgitation, 223 tricuspid stenosis, 222 Vancomycin, 173–174, 297, 307, 402, 410, 411, 412, 416, 420 considerations of, 173 dosage of, 174 resistance of, 173 spectrum of, 173 Vancomycin-resistant enterococci (VRE), 173, 174 VAP See Ventilator-associated pneumonia (VAP) Vaptans, 120 Variant angina, 196 Variceal bleeding, 355–356 Varicella zoster virus (VZV) infection, 425 Vasculitis, 439 Vasodilators, 98, 149 Vasopressin, 150, 306–307, 312, 355, 491 Vasopressors, 59, 265, 434–435, 527–528, 599 Vasospasm, 452 VBP See Value-based purchasing (VBP) Vena cava filters, for pulmonary embolism, 282 Venoarterial ECMO, 234–236, 235f indication for, 233–234 selecting form of, 236 Venous partial pressure of carbon dioxide, 15 of oxygen, 15 Venous pH, 15 Venous thromboembolic event (VTE) See Deep venous thrombosis (DVT); Venous thromboembolic event (VTE) Venous thromboembolism (VTE), 537–538 Venous thrombosis, 43 Venovenous ECMO, 234–236, 235f cannulas for, 237, 237f indication for, 234 selecting form of, 236 Ventilation See also Noninvasive positive-pressure ventilation (NPPV) adaptive control, 72t, 75 airway pressure release, 79–80, 80f assist-control, 76 continuous mandatory, 76, 76f continuous spontaneous, 76 defects, 259 high-frequency, 81 invasive, 69 invasive vs noninvasive, 69 negative-vs positive-pressure, 68 noninvasive, 66 partial vs full, 69 positive-pressure, 68 pressure control, 72t, 73–75, 74f pressure support, 69, 72t, 76–77, 78f prior to transporting critically ill patients, 187–188 proportional assist, 72t, 77–78 synchronized intermittent mandatory, 78–79, 79f volume control, 71, 72t, 73f mechanical, 600 for asthma and COPD, 266, 267 in patients with ARDS, 251–253 in prone position, 253 Ventilation/perfusion (V/Q), for pulmonary embolism, 278 Ventilator, 67–68, 67f specific settings of, 81–84 Ventilator-associated condition (VAC), 582 Ventilator-associated events (VAE), 582–583 Ventilator-associated pneumonia (VAP), 250, 399, 503, 582–583 Ventilator-induced lung injury (VILI), 250 Ventricular aneurysm, 209 Ventricular assist devices (VADs), 242 anticoagulation therapy in, 245 classification of, 244–245 different types of, 243f Ventricular fibrillation (VF), 123, 484 Ventricular septal defect (VSD), 209 Ventricular tachycardia (VT), 486 Ventricular tachyrrhythmias, 229 Verapamil, 203, 453, 491 Verbal handoff, 549–550 VF See Ventricular fibrillation (VF) Video-assisted laryngoscopy, 47, 53 Vilanterol, 270t VILI See Ventilator-induced lung injury (VILI) Viral encephalitis, 459 Viral infections cytomegalovirus, 423–424 herpes simplex virus I and II, 424–425 influenza A and B viruses, 425–426 varicella zoster virus, 425 Vitamin K deficiency, 326–327 Volume control ventilation, 71, 72t, 73f Volutrauma, 84 von Willebrand’s disease, 332, 343 Voriconazole, 422, 423 VRE See Vancomycin-resistant enterococci (VRE) VSD See Ventricular septal defect (VSD) VT See Ventricular tachycardia (VT) VTE See Venous thromboembolism (VTE) VZV See Varicella zoster virus (VZV) infection W Warfarin, 175, 281, 342, 344 Warfarin-related nephropathy (WRN), 297 Wavelength, 33 Weakness See Acute weakness Weaning, 285 Wernicke’s encephalopathy, 455 West Nile virus, 522 Wind-up phenomenon, 108 Wolf-Parkinson-White (WPW), 489 Work of breathing, 29 WPW See Wolf-Parkinson-White (WPW) Written handoff, 550 WRN See Warfarin-related nephropathy (WRN) Y Yankauer or tonsil-tip suction, 48 Yersinia enterocolitica, 522 Z Zafirlukast, 273 Zanamivir, 426 Zileuton, 273 ZMapp, 183 Zoledronic acid, 392 Zosyn, 169 ...SIXTH EDITION Critical Care Handbook of the Massachusetts General Hospital SIXTH EDITION Critical Care Handbook of the Massachusetts General Hospital Senior Editor Jeanine P... Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Marcos Vidal Melo, MD, PhD Associate Professor of Anesthesia Department of Anesthesia, Critical Care and Pain Medicine... Department of Anesthesia, Critical Care and Pain Medicine Massachusetts General Hospital Boston, Massachusetts Daniel W Johnson, MD Division Chief, Critical Care, Director Critical Care Anesthesiology Fellowship