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(BQ) Part 1 book Marino’s the ICU book has contents: Vascular catheters, central venous access, the indwelling vascular catheter, occupational exposures, alimentary prophylaxis, venous thromboembolism, arterial pressure monitoring,.... and other contents.
Marino’s The ICU Book FOURTH EDITION Paul L Marino, MD, PhD, FCCM Clinical Associate Professor Weill Cornell Medical College New York, New York Illustrations by Patricia Gast Marino’s The ICU Book FOURTH EDITION Health Philadelphia • Baltimore • New York • London Buenos Aires • Hong Kong • Sydney • Tokyo Acquisitions Editor:] Brian Brown Product Development Editor: Nicole Dernoski Production Project Manager: Bridgett Dougherty Manufacturing Manager: Beth Welsh Marketing Manager: Dan Dressler Creative Director: Doug Smock Production Services: Aptara, Inc © 2014 by Wolters Kluwer Health/Lippincott Williams & Wilkins Two Commerce Square 2001 Market St Philadelphia, PA 19103 LWW.com 3rd Edition © 2007 by Lippincott Williams & Wilkins - a Wolters Kluwer Business 2nd Edition © 1998 by LIPPINCOTT WILLIAMS & WILKINS All rights reserved This book is protected by copyright No part of this book may be reproduced in any form or by any means, including photocopying, 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 Printed in the USA Library of Congress Cataloging-in-Publication data available on request from the publisher ISBN-13: 9781451188691 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication Application of this information in a particular situation remains the professional responsibility of the practitioner The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with current recommendations and practice at the time of publication However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions This is particularly important when the recommended agent is a new or infrequently employed drug Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in their clinical practice To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 223-2320 International customers should call (301) 2232300 Visit Lippincott Williams & Wilkins on the Internet: at LWW.com Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6pm, EST 10 To Daniel Joseph Marino, my 26-year-old son, who has become the best friend I hoped he would be I would especially commend the physician who, in acute diseases, by which the bulk of mankind are cut off, conducts the treatment better than others HIPPOCRATES Preface to Fourth Edition The fourth edition of The ICU Book marks its 23rd year as a fundamental sourcebook for the care of critically ill patients This edition continues the original intent to provide a “generic textbook” that presents fundamental concepts and patient care practices that can be used in any adult intensive care unit, regardless of the specialty focus of the unit Highly specialized topics, such as obstetrical emergencies, burn care, and traumatic injuries, are left to more qualified specialty textbooks This edition has been reorganized and completely rewritten, with updated references and clinical practice guidelines included at the end of each chapter The text is supplemented by 246 original illustrations and 199 original tables, and five new chapters have been added: Vascular Catheters (Chapter 1), Occupational Exposures (Chapter 4), Alternate Modes of Ventilation (Chapter 27), Pancreatitis and Liver Failure ( Chapter 39), and Nonpharmaceutical Toxidromes ( Chapter 55) Each chapter ends with a brief section entitled “A Final Word,” which highlights an insight or emphasizes the salient information presented in the chapter The ICU Book is unique in that it represents the voice of a single author, which provides a uniformity in style and conceptual framework While some bias is inevitable in such an endeavor, the opinions expressed in this book are rooted in experimental observations rather than anecdotal experiences, and the hope is that any remaining bias is tolerable Acknowledgements Acknowledgements are few but well deserved First to Patricia Gast, who is responsible for all the illustrations and page layouts in this book Her talent, patience, and counsel have been an invaluable aid to this author and this work Also to Brian Brown and Nicole Dernoski, my longtime editors, for their trust and enduring support FIGURE 30.1 The power of diaphragmatic contractions (equivalent to the product of contractile force and velocity) during spontaneous breathing (control) and after days of assisted (i.e., patient-triggered) mechanical ventilation (AMV) or controlled mechanical ventilation (CMV) Note that CMV (but not AMV) was associated with a significant reduction in the power output of the diaphragm Data from Reference Observations like those in Figure 30.1 indicate that allowing patients to trigger ventilator breaths (e.g., by avoiding controlled ventilation and neuromuscular paralysis) will help to preserve the strength of the diaphragm, and this should facilitate the transition from ventilatory support to spontaneous breathing (The role of diaphragm weakness in weaning from the ventilator is described later in the chapter.) Physical Rehabilitation Prolonged bed rest and physical inactivity during mechanical ventilation often leads to deconditioning and generalized muscle weakness, and this is considered a contributing factor in ventilator-dependent patients who have difficulty in the transition to unassisted breathing Supporting this contention are studies showing that early physical rehabilitation, including ambulation, is associated with a shorter duration of mechanical ventilation (7) Therefore, early and regular physical rehabilitation (including ambulation in patients who are awake and hemodynamically stable) is encouraged in selected patients to facilitate the transition to spontaneous breathing Sedation Practices Several studies have shown that both deep sedation (where the patient is not arousable) and sustained use of benzodiazepines (midazolam and lorazepam) for sedation are associated with delays in discontinuing mechanical ventilation (8) As a result of these studies, the most recent guidelines on sedation in ventilator-dependent patients (8) include the following recommendations: Maintain a light level of sedation, where patients are easily aroused Avoid or minimize the use of benzodiazepines for sedation Non-benzodiazepine sedatives include propofol and dexmedetomidine, which are described in Chapter 51 Table 30.1 Checklist for Identifying Candidates for a Trial of Spontaneous Breathing Readiness Criteria The management of ventilator-dependent patients requires constant vigilance for signs that ventilatory support may no longer be necessary These signs are listed in Table 30.1 Candidates for possible removal of mechanical ventilation should have adequate gas exchange in the lungs (i.e., PaO 2/FIO2 >150–200 mm Hg and a normal or baseline arterial PCO2) while breathing non-toxic concentrations of oxygen (FIO2