Clinical Intensive Care Medicine P640_9781848163881_tp.indd 14/7/14 4:55 pm May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory This page intentionally left blank PST˙ws Introductory Series in Medicine Vol Series Editor: Nadey Hakim Clinical Intensive Care Medicine Editor Carlos M H Gómez St Mary’s Hospital and Hammersmith Hospital, UK ICP P640_9781848163881_tp.indd Imperial College Press 14/7/14 4:55 pm Published by Imperial College Press 57 Shelton Street Covent Garden London WC2H 9HE Distributed by World Scientific Publishing Co Pte Ltd Toh Tuck Link, Singapore 596224 USA office: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601 UK office: 57 Shelton Street, Covent Garden, London WC2H 9HE Library of Congress Cataloging-in-Publication Data Clinical intensive care medicine / edited by Carlos M.H Gómez p ; cm (Introductory series in medicine ; volume 1) Includes bibliographical references and index ISBN 978-1-84816-388-1 (hardcover : alk paper) ISBN 978-1-84816-389-8 (electronic) I Gómez, Carlos M H., editor II Series: Introductory series in medicine ; v [DNLM: Intensive Care Clinical Medicine Critical Illness therapy WX 218] RC86.7 616.02'8 dc23 2014026685 British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library Copyright © 2015 by Imperial College Press All rights reserved This book, or parts thereof, may not be reproduced in any form or by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system now known or to be invented, without written permission from the Publisher For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA In this case permission to photocopy is not required from the publisher Typeset by Stallion Press Email: enquiries@stallionpress.com Printed in Singapore JQuek - Clinical Intensive Care Medicine.indd 14/7/2014 1:36:38 PM b1739 Clinical Intensive Care Medicine To Carlos, Luis and Tomás Wonderful, glorious boys: my soul, my spirit, my life b1739_FM.indd v 14-07-2014 19:36:46 May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory This page intentionally left blank PST˙ws b1739 Clinical Intensive Care Medicine Contents Foreword from the Series Editor Foreword Preface List of Authors xix xxi xxiii xxvii History of Intensive Care Jennifer Jones References Cardiovascular Physiology Ian Webb and David Treacher 2.1 Introduction 2.2 The Cardiac Cycle 2.3 Ventricular Performance and the Determinants of Cardiac Output 2.4 Coronary Blood Flow 2.5 Peripheral Circulation 2.6 The Microcirculation 2.7 Clinical Case References 10 16 26 30 34 36 38 vii b1739_FM.indd vii 14-07-2014 19:36:46 b1739 Clinical Intensive Care Medicine viii Contents Respiratory Physiology Nicholas Lees and Neil Soni 3.1 3.2 3.3 3.4 3.5 3.6 Introduction Regulation of Respiration Mechanics of Ventilation Work of Breathing Ventilation–Perfusion Carbon Dioxide and Interpretation of Expired Alveolar Gas 3.7 Blood Gases 3.8 Physiological Effects of Positive-Pressure Ventilation References Cellular Physiology in Critical Care David Brealey and David Howell 4.1 Oxygen Delivery and Cellular Utilisation 4.2 Cell Death in Critical Care 4.3 Conclusion 4.4 Clinical Scenario References Cardiovascular Monitoring Parind Patel 5.1 Purpose of Monitoring 5.2 Clinical Examination and Non-Invasive Monitoring 5.3 Pulse Oximetry 5.4 Venous Saturations 5.5 Pulmonary Artery Flotation Catheter 5.6 Pulse Contour Analysis 5.7 Oesophageal Doppler 5.8 Echocardiography 5.9 Current Approach to Monitoring the Critically Ill Patient 5.10 Clinical Case References b1739_FM.indd viii 41 41 41 45 46 49 55 56 57 63 71 71 83 87 87 90 93 93 94 95 96 97 99 101 103 104 106 108 14-07-2014 19:36:46 b1739 Clinical Intensive Care Medicine Contents Vasoactive Agents Gayathri Satkurunath, Raha Rahman West and Andrew Rhodes 6.1 6.2 6.3 6.4 6.5 6.6 Definitions The Pressure versus Flow Dilemma Tissue Oxygen Consumption and Supply Vasodilators: Rationale and Current Treatments Vasoconstrictors: Rationale and Current Agents Cardiac Output: Advantages and Disadvantages of Pharmacological Augmentation 6.7 A Rational Evidence-Based Approach to Inotropes 6.8 Clinical Case References b1739_FM.indd ix ix 113 113 113 114 117 121 126 129 130 131 Mechanical Ventilation Amisha V Barochia, Charles Natanson and Peter Q Eichacker 137 7.1 Overview 7.2 Acute Lung Injury (ALI)/Acute Respiratory Distress Syndrome (ARDS) 7.3 Asthma 7.4 Chronic Obstructive Pulmonary Disease 7.5 Weaning 7.6 Clinical Case References 137 137 146 153 157 160 162 Non-Invasive Ventilation Borja G Cosío and José M Echave Sustaeta 179 8.1 Principles of Non-Invasive Ventilation 8.2 Procedures in Non-Invasive Ventilation 8.3 Modes and Equipment 8.4 Special Indications 8.5 Summary References 179 181 186 188 199 200 14-07-2014 19:36:46 b1739 Clinical Intensive Care Medicine Evidence-Based Intensive Care 929 [31] Wikes, M.M and Navickis, R.J (2001) Patient survival after human albumin administration: a meta-analysis of randomized, controlled trials, Ann Intern Med, 135, 149–164 [32] Finfer, S., Bellomo, R., Boyce, N et al (2004) Comparison of albumin and saline for fluid resuscitation in the intensive care unit, N Engl J Med, 350, 2247–2256 [33] Martin, G.S., Moss, M., Wheeler, A.P et al (2005) A randomized, controlled trial of frusemide with or without albumin in hypoproteinemic patients with acute lung injury, Crit Care Med, 33, 1681–1687 [34] Bradley, R.D (1964) Diagnostic right heart catheterisation with miniature catheters in severely ill patients, Lancet, 2, 941–942 [35] Branthwaite, M.A and Bradley, R.D (1968) Measurement of cardiac output by thermodilution in man, J Appl Phys, 24, 434–438 [36] Swan, H.J.C., Ganz, W., Forrester, J et al (1970) Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter, N Engl J Med, 283, 447–451 [37] Goldenheim, P.D and Kazemi, H (1984) Cardiopulmonary monitoring of critically ill patients, N Engl J Med, 311, 776–780 [38] Gimosair, Y and Sprung, C.L (1996) The Swan-Ganz catheter Twenty five years of monitoring, Crit Care Clin, 12, 771–776 [39] Dalen, J.E and Bone, R.C (1996) Is it time to pull the pulmonary artery catheter? JAMA, 276, 916–918 [40] Gomez, C.M.H., and Palazzo, M.G (1998) Pulmonary artery catheterisation in anaesthesia and intensive care, Br J Anaesth, 81, 945–956 [41] Hinds, C and Watson, D (1995) Manipulating hemodynamics and oxygen transport in critically ill patients, N Engl J Med, 333, 1074–1075 [42] Shoemaker, W., Montgomery, E., Kaplan, E et al (1973) Physiologic patterns in surviving and nonsurviving shock patients, Arch Surg, 106, 630–636 [43] Yu, M., Levy, M., Smith, P et al (1993) Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study, Crit Care Med, 21, 830–838 [44] Boyd, O., Grounds, R.M and Bennett, E.D (1993) A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high risk surgical patients, JAMA, 270, 2699–2707 [45] Hayes, M.A., Timmins, A.C., Yau, E.H.S et al (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients, N Engl J Med, 330, 1717–1722 [46] Gattinoni, L., Brazzi, L., Pelosi, P et al (1995) A trial of goal-orientated hemodynamic therapy in critically ill patients, N Engl J Med, 333, 1025–1032 b1739_Ch-32.indd 929 14-07-2014 19:36:30 b1739 Clinical Intensive Care Medicine 930 S Grover and C M H Gómez [47] Rivers, E., Nguyen, B., Havstad, S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock, N Engl J Med, 345, 1368–1377 [48] National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wheeler, A.P., Bernard, G.R et al (2006) Pulmonary artery versus central venous catheter to guide treatment of acute lung injury, N Engl J Med, 354, 2213–2224 [49] Sandham, J.D., Hull, R.D., Brant, R.F et al (2003) A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients, N Engl J Med, 348, 5–14 [50] Harvey, S., Harrison, D.A., Singer, M et al (2005) Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): a randomised controlled trial, Lancet, 366, 472–477 [51] Connors Jr, A.F., Speroff, T., Dawson, N.V et al (1996) The effectiveness of right heart catheterization in the initial care of critically ill patients, JAMA, 276, 889–897 [52] Vincent, J.L (2003) Nosocomial infections in adult intensive care units, Lancet, 361, 2068–2077 [53] Bergmans, D.C., Bonten, M.J., Gaillard, C.A et al (2001) Prevention of ventilator-associated pneumonia by oral decontamination: a prospective, randomized, double-blind, placebo-controlled study, Am J Respir Crit Care Med, 164, 382–388 [54] Baxby, D., van Saene, H.K.F., Stoutenbeek, C.P et al (1996), Selective decontamination of the digestive tract: 13 years on, what it is and what it is not, Intens Care Med, 22, 699–706 [55] Stoutenbeek, C.P., van Saene, H.K.F., Miranda, D.R et al (1984) The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients, Intens Care Med, 10, 185–192 [56] Garrouste-Orgeas, M., Chevret, S., Arlet, G et al (1997) Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients: a prospective study based on genomic DNA analysis, Am J Respir Crit Care Med, 156, 1647–1655 [57] Krueger, W.A., Lenhart, F.P., Neeser, G et al (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomized, double-blind, placebo-controlled clinical trial, Am J Respir Crit Care Med, 166, 1029–1037 b1739_Ch-32.indd 930 14-07-2014 19:36:30 b1739 Clinical Intensive Care Medicine Evidence-Based Intensive Care 931 [58] de Jonge, E., Schultz, M., Spanjaard, L et al (2003) Effects of selective decontamination of the digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial, Lancet, 362, 1011–1016 [59] de la Cal, M.A., Cerdá, E., Garcia-Hierro, P et al (2005) Survival benefit in critically ill burned patients receiving selective decontamination of the digestive tract: a randomized, placebo-controlled, double-blind trial, Ann Surg, 241, 424–430 [60] Van Nieuwenhoven, C.A., Buskens, E., van Tiel, F.H et al (2001) Relationship between methodological trial quality and the effects of selective digestive decontamination on pneumonia and mortality in critically ill patients, JAMA, 286, 335–340 [61] D’Amico, R., Pifferi, S., Leonetti, C et al (1998), Effectiveness of antibiotic prophylaxis in critically ill adult patients: systemic review of randomised controlled trials, BMJ, 316, 1275–1285 [62] De Smet, A.M.G.A., Kluytmans, J.A.J.W., Cooper, B.S et al (2009) Decontamination of the digestive tract and oropharynx in ICU patients, N Engl J Med, 360, 20–31 [63] Heininger, A., Meyer, E., Schwab, F et al (2006) Effects of long-term routine use of selective digestive decontamination on antimicrobial resistance, Intens Care Med, 32, 1569–1576 [64] Al Naiemi, N.N., Heddema, E.R., Bart, A et al (2006) Emergence of multidrug-resistant, Gram negative bacteria during selective decontamination of the digestive tract on an intensive care unit, J Antimicrob Chemother, 58, 853–856 [65] Verwaest, C., Verhaegen, J., Ferdinande, P et al (1997), Randomized, controlled trial of selective digestive decontamination in 600 mechanically ventilated patients in a multidisciplinary intensive care unit, Crit Care Med, 25, 63–71 [66] Misset, B., Kitzis, M.D., Mahe, P et al (1993) Bacteriological side effects of gut decontamination with polymyxin E, gentamicin, and amphotericin B, Infect Control Hosp Epidemiol, 14, 62–64 [67] Lingnau, W., Berger, J., Javorsky, F et al (1998) Changing bacterial ecology during a five year period of selective intestinal decontamination, J Hosp Infect, 39, 195–206 b1739_Ch-32.indd 931 14-07-2014 19:36:30 May 2, 2013 14:6 BC: 8831 - Probability and Statistical Theory This page intentionally left blank PST˙ws b1739 Clinical Intensive Care Medicine Index Abdominopelvic abscess (imaging of) 308 Acalculous Cholecystitis 271 Accordion sign (in colitis) 305 Acetyl-coenzyme A (ACo-A) 75 Acid-base chemistry 330 Acidaemia lactic 337 metabolic 44, 330 respiratory 56 Acinetobacter 230 Action potential 11 Activated charcoal 822 Activated protein C (APC) 446, 732, 736, 922 Acute lung injury 137, 552 Acute pancreatitis 220, 296, 298 Acute phase proteins 436 Acute poisoning 816 Acute renal failure 649 Acute Respiratory Distress Syndrome (ARDS) 53, 137, 261, 294, 551, 585, 767, 771, 921 Adenosine triphosphate (ATP) 73 Adrenaline (Epinephrine) 124, 127, 441 Adrenocorticotrophic hormone (ACTH) 406Afterload 20 Advanced directive 896 Agitation 416 Air bronchogram 260 Air-fluid level (in colitis) 306 Airway pressure release ventilation (APRV) 143 Alcohol poisoning 829 Alcoholic liver disease 637 Algorithims for critical care enteral and parenteral therapy (ACCEPT) 205, 208 Alveolar gas equation 52 hypoventilation 150 ventilation equation 55 Amanita phalloides poisoning 866 American Society of Anesthesiology (ASA) physical status score 377 Aminoglycosides 239 Ammonia 635 Amniotic fluid embolism 705 Amp C β-lactamase enzyme 242 Amphetamine overdose 851 Amphotericin 246 933 b1739_Index.indd 933 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine 934 Index Anaerobic respiration 74 threshold 72, 382 Anion gap (AG) 332 Antibodies to disintegrin and metalloproteinase with thrombospandin motifs (ADAMTS 13) 363 Antibody to factor VIIIc activity 370 Antidepressant overdose 838 Antidiuretic hormone (ADH) 323 receptor inhibitors 323 Aortic aneurysm ruptured abdominal (imaging) 311 SIRS after surgery 600 Aortic dissection 292, 695 Aorto-enteric fistula 607 Apoptosis 84, 438 Arteria radicularis magna of Adamkiewcz (ARM) 612 Aseptic technique 235, 236 Aspirin 528 Asthma 146, 568 Astrup Atrial natriuretic peptide (ANP) 62 Atypical bacteria 240 Audit (clinical) 914 Autoregulation 28 Basal metabolic rate (BMR) 210 β-blockers in vascular surgery 598 Bilevel positive airway pressure (BiPAP) 188 β-lactam antibiotics 239 Body mass index (BMI) And intubation 458 Bogotá bag 779 b1739_Index.indd 934 Brain stem death 756 Bronchoalveolar lavage (BAL) Burn (extent of) 800 Burn thickness 799 232 C-reactive protein 343, 436 Calcium 329 Calorimetry indirect 210 Candida 231, 244 bloodstream infection 235 colonisation index 245 disseminated 245 Can’t intubate, can’t ventilate (CICV) scenario 464 Capacity (mental) 895 Capillary pressure 53 Carbapenems 239, 242 Carbon dioxide 55 Carbon monoxide (CO) 794, 858 Cardiac contractility (myocardial or ventricular) 16, 22, 126 Cardiac cycle 14, 30 Cardiac failure 130 Cardiac index 130 Cardiac output by oesophageal Doppler 101, 385 by pulse contour analysis 99, 385 by Vigileo 101 determinants of 16 in labour 688 low 521 manipulation of 126 thermodilution measurement of 98, 384, 924 Cardiogenic pulmonary oedema 261 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine Index Cardiogenic shock 127, 741 Cardiopulmonary bypass (CPB) 521 pulmonary oedema in 531 Cardiopulmonary exercise (CPX) testing 382, 597 Caspase 85 Ceftriaxone 735 Cell death 83 Central line placement (ultrasound guided) 273 Central venous pressure (CVP) 94, 729 in sepsis 440 Central venous saturation (ScvO2) 96, 440, 774 Cephalosporins 242 Cerebral abscess 283 blood flow 496 microdialysis 494 oxygenation 494 perfusion pressure 494, 497, 775 venous sinus thrombosis 506 Cervical spine (in trauma) 769 Chemoreceptors 41, 43 Chest radiograph 254 Chest trauma 776 Chest tube (intercostal) 294 Chlamydia 239, 240, 562 Chloride 328 Cholangitis (acute) 298 Chronic obstructive pulmonary disease (COPD) 153, 572 Ciprofloxacin 240 Circulatory failure 113 Cirrhosis 629 b1739_Index.indd 935 935 Citrate 670 Clarithromycin 240 Clinical governance 912 Clonidine 415 Clopidogrel 528 Clostridium difficile 216, 239 Clotting abnormalities (after CPB) 529 activation 356 assays 357 factors 356 Cocaine overdose 853 Colony forming units (CFU) 232 Conflict (management of) 911 Congenital heart disease in pregnancy 693, 696 Continuous positive airway pressure (CPAP) 188, 191, 560 Contrast induced nephropathy 652 Prevention 655 Convection 657 Coronary artery bypass grafts (CABG) 519, 525, 601 Coronary artery disease in pregnancy 693 in vascular surgery 596, 601 Coronary perfusion 27 Corticosteroid therapy for septic shock (CORTICUS) 445, 921 Costophrenic angle 263 Court of Protection 896 Craniectomy 498 Crimean war Critical illness neuro-myopathy 511 Crycothyroidotomy 466 CT pulmonary angiographt (CTPA) 290 Cyanide poisoning 860 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine 936 Cyanosis (in childhood) Cytokines 436 Cytomegalovirus 231 Index 742 Damage control surgery 770 Danaparoid 368 Danger associated molecular patterns (DAMPs) 435 Depolarisation 11 Dexamethasone 735 Dexmedetomidine 415 Diabetic ketoacidosis 328 Diastasis 15 Diastole (ventricular) 13 Diastolic dysfunction Diffuse axonal injury 748 Diffusion 657 Disseminated intravascular coagulatiojn (DIC) 358, 731 Diverticulitis (imaging of) 307 Dobutamine 127 and stress echocardiography 381 in sepsis 440 Dopamine 123, 128 Dopexamine 127 Doppler oesophageal 101, 385 renal artery 273 Duke activity status index (functional capacity) 381 Dysnatraemia 323 Ecstasy overdose 852 Ejection fraction 14 reduced 13 Electrical burns 806 Electroneutrality concept (acid-base) 331 b1739_Index.indd 936 Empyema 286 Encephalitis imaging 282 Encephalopathy hepatic 635 End of life 751 Endoleak 610 Endoscopic retrograde cholangio-pancreatography (ERCP) 298 Endovascular aneurysm repair (EVAR) 608 Energy requirements 209 Enoximone 128 Enteral nutrition 208, 214 complications 216 vs parenteral 211 Enterobacter pneumonia 232 Enterobacteriaceae bloodstream infections 234 in SDD 926 Enterococcus bloodstream infections 235 vancomycin resistant enterococcus (VRE) 241, 243 Ephedrine 126 Epidural 411 Eschar 789, 804 Escherichia coli nosocomial 230 sepsis 434 Esmolol 120 European system for cardiac operative risk score (EUROSCORE) 377 Expiratory positive airway pressure (EPAP) 187 Extended prevalence of infection in intensive care (EPICII) study 432 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine Index Extended spectrum β-lactamases (ESBL) 241 Extracorporeal membrane oxygenation (ECMO) 145, 527 Extubation 418, 472 Factor VII (recombinant) 359, 370, 692 Fat-stranding (large bowel) 306 Feeding vessel sign 287 Fluconazole 246 Fluid balance and sodium 326 in trauma 773 Fluoroquinilones 240 Focused assessment with somography for trauma (FAST) 272, 748, 780 Fondaparniux 368 Frank–Starling 16 Fresh frozen plasma (FFP) 357 Fulminant hepatic failure (feeding in) 220 Galen Gamma hydroxybutyric acid (GHB) overdose 856 Gastric lavage 824 Gastric residual volume 215 Gastrostomy 216 Gene polymorphisms (in sepsis) 436 G forces 874 Glasgow coma scale 492, 749 Glucose 334 Glutamine 221 Glutathione peroxidase 222 Glycerol trinitrate (GTN) 119 Glycolysis 74 b1739_Index.indd 937 937 Glycopeptides 239 Goal directed therapy 72, 98, 404, 774, 924 peri-operative 383 Growth hormone 407 Guillain–Barré syndrome (GBS) 509 Gut associated lymphoid tissue (GALT) 212 Haemodiafiltration 659 Haemodynamic equations 21 syndrome 522 Haemofiltration 659 Haemolytic anaemia 363 Haemolytic uraemic syndrome 363, 675 Haemophylus influnzae 233, 562, 735 Haemoptysis 574 Harvey, William Heliox 152, 721 Heparic encephalopathy 635 Heparin induced thrombocytopaenia (HITT) 365 low molecular weight (LMWH) 360, 703 Hepatitis (alcoholic) 636 High frequency oscillatory ventilation (HFOV) 142, 719 Hormonal response to surgery 406 Hospital acquired pneumonia (HAP) 560, 564 Human immunodeficiency virus (HIV) 566 Hydralazine 121 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine 938 Index Hydrogen ion 330 Hydronephrosis 301 Hypoxia cellular 74 tissue 73 Hypoxic vasoconstriction 53 Immunocompromise (pneumonia in) 566 Independent mental capacity advocate (IMCA) 897 Indicators of pain 410 Inhalation injury 794 Inspiratory positive airway pressure (IPAP) 187 Insulin 321, 335, 389, 923 Intensive Care Society Intercellular cell adhesion molecules (ICAMs) 437 Intracerebral haemorrhage 276, 277, 503 Intracranial pressure 732 Intubation complications of 462 confirmation 460 difficulty 458 fibreoptic 468 Invasive lung assist 585, 772 Iron lung Isoprenaline 129 Isovolumic contraction 12 Isovolumic relaxation 13 Jet ventilation 464, 483 Keratinocytes 802 Ketamine 149 Klebsiella 230 Kreb’s (tricarboxylic acid) cycle b1739_Index.indd 938 75 Labetalol 120 Lactate 336 Lactate-pyruvate ratio 383 Lactic acidaemia (acidosis) 73, 113 Laplace (law of) 24, 58 Laryngeal mask airway 462 Left ventricular tract obstruction (LVOTO) 525 Legionella 240, 562 Levofloxacin 240 Levosimendan 128 Linezolid 240 Listeria monocyogenes 716 Lithium cardiac output (LiDCO) 99 intoxication 842 Liver abscess (imaging of) 309 Liver transplantation 627, 639 Living will 896 Lower limb revascularisation 608 Lumbar ouncture 733 Lung assist device 772 Lung isolation 482 Lymphatics macrolides 240 pulmonary 61 Magnesium 330 Magnetic resonance cholangiopancreatography (MRCP) 298 Major histocompatibility complex (MHC) class II molecules 434 Mallampati grade 458 Malnutrition 206 Mannitol 498 Mean arterial pressure 113, 441 Mechanical ventilation in asthma 148 in COPD 153 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine Index Meningitis imaging in 281 in children 724 Meningococcal disease (in children) 722 Mesenteric ischaemia (imaging) 310 Metabolic acidaemia hyperchloraemic 219 Metabolic equivalent (MET) 381, 596 Metabolism aerobic 71 anaerobic 72 Metaraminol 126 Methylprednisolone 585 Metronidazole 240 Microvascular function 35 Middle cerebral artery (MCA) 506 Middle (molecular weight) molecules 658 Milrinone 128 Minimum inhibitory concentration (MIC) 239 Mitochondria 73 respiratory chain 76 Mitral stenosis in pregnancy 697 Mixed venous saturation 96, 424 Molecular adsorbent recirculating system (MARS) 633 Monoamine oxidase inhibitors (overdose) 841 Moraxella catarrhalis 233 Mushroom poisoning 866 Mycoplasma 239, 240, 562 Myocardial infarction 339 oxygen comsumption in sepsis 442 b1739_Index.indd 939 939 N-acetyl cysteine 628 Narrowed airway 469 Nasogastric tube 255 Nasojejunal tube 215 Natural killer (NK) cells 435 Necrosis 86 Necrotising enterocolitis (NEC) 718 Negative pressure ventilation 720 Neisseria meningitides 735 Neonatal sepsis (organisms) 715 Nesiritide 119 Neuraxial blockade 388 Neuromuscular disease 509 Neutrophil gelatinase-associated lipocalin (NGAL) Neutrophilia in asthma 147 Nicardipine 120 Nifedipine 120 Nightingale, Florence Nitric oxide 78, 144, 527, 571, 701, 720 Nitrogen balance 206 intake 210 Nitroprusside 119 Non-accidental injury (NAI) 749, 814 Non-invasive mechanical ventilation after extubation 418 in asthma 148 in COPD 154 Non-steroidal anti-inflammatory drugs (NSAIDS) 414 Noradrenaline (Norepinephrine) 122 Nosocomial infections definition 229 obesity (and surgical risk) 379 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine 940 Novalung 772 Nuclear factor-kB (NF-kB) Index 436 Obstetric haemorrhage 691 Oesophageal varices 635 Ohm (law of) 21, 32 Opioid toxicity 836 Outreach Oxidative phosphorylation 73, 75 Oxygen consumption 71, 96, 116, 382 cylinders 886 debt 71 delivery 96, 115 extraction ratio 71 supply 115 Pain after surgery 408 Pancreatitis feeding in 220 imaging 296 necrotising 296 Paracentesis 271 Paracetamol analgesia 414 liver toxicity 638, 833 overdose 832 Paraplegia in vascular surgery 613 Paraquat poisoniong 862 Parenteral nutrition (total: TPN) 212, 217 complications 217 Partial liquid ventilation 144 Pathogen associated molecular patterns (PAMPs) 435 Patient controlled analgesia 411 Peak expiratory flow ratio (PEFR) 571 b1739_Index.indd 940 Pelvic trauma 779 Pericardial effusion 270 tamponade 524 Pericolonic stranding (in colitis) 305 Perioperative cardiac events 380, 525, 597, 601 Peripartum cardiomyopathy 699 Permanent vegetative state (PVS) 751 Permissive hypercapnia 56 Phentolamine 121 Phenylephrine 125 Phosphatononin fibroblast growth factor 23 (FGF-23) 334 Physiological and operativeseverity score for the enumeration of mortality and morbidity (POSSUM) 377 PiCCO 100 Piperacillin-tazobactam 233, 243 Pleural effusion 263, 268, 286, 533 Pneumatosis intestinalis 311 Pneumocystis carinii 566 Pneumocystis jirovecii 232, 566 Pneumomediastinum 288 Pneumonectomy 264 Pneumonia aspiration 258 community acquired (CAP) 561 hospital acquired 564 nosocomial 231 ventilator associated 231 Pneumothorax 264, 265, 266, 267, 288, 290, 533 Point of care testing 318 Poiseuille (law of) 21, 22 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine Index Polio epidemic (Copenhagen), Polymerase chain reaction (PCR) 443 Porto-pulmonary syndrome 630 Positive end expiratory pressure (PEEP) 59 in ARDS 141 in children 730 in COPD 156 in head injury 497 intrinsic (iPEEP) 148, 151 Potassium 327 Preload 16 Pressure support ventilation 187 Pressure-volume relationship left ventricle 15 lungs 47, 53 Procalcitonin 343 Progesterone 688 Promoting global excellence in severe sepsis study (PROGRESS) 432 Prone ventilation 144 Propofol infusion syndrome 71 Prothrombin complex concentrate (PCC) 361 Pseudomonas aeuruginosa nosocomial 230 pneumonia 232, 563 Pulmonary artery cather 93, 97, 257, 386, 553, 924 occlusion (wedge) pressure 98, 106 pressure 630 Pulmonary contusion 288 Pulmonary embolism 262, 290, 535, 576, 703 septic 287 Pulmonary hypertension 526, 630, 700 b1739_Index.indd 941 941 Pulmonary oedema cardiogenic 261, 534 non-cardiogenic 534 Pulse oxumetry 95 Pulse pressure 31 Purkinje fibre 10, 12 Pyelonephritis (acute) 299 Pyruvate 74 QT interval (prolonged) 820 Rapid shallow breathing index (RSBI) 419 Refeeding syndrome 219 Regional anarsthesia 387 Reintubation 419 Renal replacement therapy 658 anticoagulation 670 dose 662 in intoxication 668 modalities 661 non-renal indications 664 Repolarisation 11 Resistive index (RI) 273 Respiration cellular 77 Respiratory centre 42 Respiratory failure in aneurysm surgery 604 neurological causes 510 post-operative 556 Resting energy expenditure (REE) 210 Reynold’s number 23, 24 RIFLE criteria (renal failure) 538, 647 Right atrial pressure (RAP) 104 Right main bronchial intubation 254 Right ventricular failure 527 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine 942 Index Saline versus albumin fluid evaluation (SAFE) study 440 Salycilate overdose 830 Secondary brain injury 492 Secondary survey 770 Sedation 415 in sepsis 448 Selective decontamination of the digestive tract (SDD) 234, 925 Sengstaken–Blakemore (Minnesota) tube 635 Sepsis 420 Septic screen 237 Septic shock 130 Servetus, Miguel Severe acute respiratory syndrome (SARS) 567 Shock (in children) 727 Shunt 50 Sodium channels 11, 12 Spinal cord injury 506 protection (in vascular surgery) 612 Spinal syndrome Spontaneous bacterial peritonitis (SBP) 633 Staphylococcus aureus bloodstream infections 234 meningitis 735 methicillin resistant (MRSA) 232, 240, 926 nosocomial 230 Panton–Valentine leukocidin (PVL)-positive 585 pneumonia 232, 563 screening 247 b1739_Index.indd 942 Status epilepticus 508 Steroids in sepsis 445 Stewart 331 Streptococcus β-haemolytic in neonates 716 pneumonia 233, 735 String of beads appearance (in bowel obstruction) 304 Stroke (ischaemic) 504 Stroke work 22 Strong ion difference 328, 331 Subarachnoid haemorrhage 277, 279, 500 Subdural haemorrhage 278 Suicide 813 Surfactant 59, 145 Surviving sepsis campaign (SSC) 439 Syndrome of inappropriate antidiuretic hormone (SIADH) 323 Systemic inflammatory response syndrome (SIRS) 431, 599 Systemic response to surgery 406, 420, 599 Target sign (in colitis) 305 Tazocin (Piperacillintazobactam) 243 Terlipressin 634 Tetraparesis Thermodilution 98 Thiopental (thiopentone) in brain injury 498 Thromboembolic disease 702 Thromboembolism 369 Thromboprophylaxis 390 14-07-2014 19:37:04 b1739 Clinical Intensive Care Medicine Index Tidal volume 140 Tigecycline 241 Tight glycaemic control 321, 335, 389, 923 Toll-like receptors (TLRs) 435 Total body surface area (TBSA) in burns 790 Total parenteral nutrition (TPN) 212 TOXBASE 815 Toxic megacolon 306 Tracheostomy 161, 255, 464, 472, 475 Transfusion for perioperative patients 391 Transition (point in bowel obstruction) 304 Transjugular intrahepatic porto-systemic shunt (TIPS) 634 Traumatic brain injury (TBI) 491, 748, 776 Triglycerides long chain 215 medium chain 216 Troponin 338 Tuberculosis multi-drug resistant (MDR-TB) 248 Tumour necrosis factor (TNF) 436 b1739_Index.indd 943 943 Ultrafiltration 657 Urinary biomarkers 342 Valsalva manouver 18,19 Vancomycin resistant enterococcus (VRE) 241, 243 Vasoconstrictors 121 Vasodilators 117 Vasopressin 124, 440 Ventilation guidelines in ARDS 554 Ventilator induced lung injury (VILI) 140 Ventricular assist devices 542 Ventricular interdependence 25 Vesalius Video-laryngoscopes 464 Vigileo 101 Von Willebrand factor 359 Voriconazole 246 Weaning failure (of mechanical ventilation) 158 Wernicke’s encephalopathy Whipple’s procedure 423 Withdrawal (of life support) 751 World Congress of Intensive Care 1, 14-07-2014 19:37:04 ... enquiries@stallionpress.com Printed in Singapore JQuek - Clinical Intensive Care Medicine. indd 14/7/2014 1:36:38 PM b1739 Clinical Intensive Care Medicine To Carlos, Luis and Tomás Wonderful, glorious... intentionally left blank PST˙ws b1739 Clinical Intensive Care Medicine Foreword It is a great pleasure for me to write the foreword to Clinical Intensive Care Medicine and to congratulate Carlos... Healthcare London June 2014 b1739_FM.indd xxii 14-07-2014 19:36:47 b1739 Clinical Intensive Care Medicine Preface The book is intended as an authoritative guide to practical intensive care medicine