OXFORD MEDICAL PUBLICATIONS Oxford Desk Reference Critical Care Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product informa- tion and clinical procedures with the most up-to-date pub- lished product information and data shee ts provided by the manufacturers and the most recent codes of conduct and safety regulation s. The authors and the publishers do not accept responsibility or legal liability for any e rrors in the text or for the misuse or misapplication of material in this work. 2 Except where otherwise stated, drug doses and recom- mendations are for the non-pregnant adult who is not breast-feeding. Oxford Desk Reference Critical Care Carl Waldmann Consultant in Anesthesia and Intensive Care Royal Berkshire Hospital Reading Neil Soni Honorary Clinical Senior Lecturer Division of Surgery, Oncology, Reproductive Bio logy and Anesthetics Imperial College London and Andrew Rhodes Consultant in Intensive Care St George s Hospital London 1 1 Great Clarendon Street, Oxford OX2 6DP Oxford University Press is a department of the University of Oxford. It furthers the Univer sity \200\231s objective of excellence in research, scholarship, and education by publishin g worldwide in Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico Cit y Nairobi New Delhi Shanghai Taipei Toronto With of \201 ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan P oland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries Published in the United States by Oxford University Press Inc., New York Oxford University Press 2008 The moral rights of the author have been asserted Database right Oxford University Press (m aker) First published 2008 All rights reserved. No part of this publication may be reproduced, stored in a retrieval s ystem, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, or under terms agreed with t he appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, a t the address above You must not circulate this book in any other binding or cover and you must impose this sam e condition on any acquirer British Library Cataloging in Publication Data Data available Library of Congress Cataloging in Publication Data Data available Typeset by Cepha Imaging Private Ltd., Bangalore, India Printed in Great Britain on acid-fr ee paper by CPI Antony Rowe, Chippenham, Wiltshire ISBN 978 \200\2230 \200\22319 \200\223922958 \200\2231 10 9 8 7 6 5 4 3 2 1 v Preface Intensive care medicine is an evolving specialty in which the amount of available informa- tion is growing daily and increasingly, textbooks re \202 ect this in terms of their size. Size and immediate clinical utility are often inversely related and \200\230bottom line \200\231 practicality is drowned in comprehensive discussion. The natural habitat of this n ew textbook of critical care and emergency medicine is on the desktops of Intensive Care un its, High Dependency units, acute medical or surgical wards, Accident & Emergency departmen ts and maybe even operating theaters where it is easily accessible with useful and relevant information. While aimed primarily at a specialist readership including clinicians, nurses, and other al lied health professionals in Critical Care, Anesthesia and the acute specialities, we hope it will \201 nd a niche with anyone involved in care of the critically ill, whether in sp ecialist areas or in the wards. It is intended that the key feature of this book is ease of access to up-to-date relevant e videnced-based information regarding the management of commonly encountered condi- tions, t echniques, and problems in those who are critically ill. Most importantly that it is practi cal and useful. The content of the book is based, wherever possible and useful, upon the la test sets of guidelines from national or international bodies (e.g. Society of Critical Car e Medicine, European Society of Intensive Care Medicine). We hope the book will be useful n ot only in the United Kingdom, but to anyone using international guidelines. Indeed, the ra nge of invited authors incorporates a large number of countries but for all, the com- mon t heme is management of the critically ill. To facilitate the key aim of rapid and easy access to information, the book is designed suc h that each subject will form a self-contained topic in its own right, laid out across two (or, for larger subjects, up to four) pages. This format facilitates the use of the book as a desk reference and we envisage that it will be consulted in the clinic or ward setting f or information on the optimum management of a particular condition. It is the fervent wish of the editors that this book, one in a series of desk top books fro m Oxford University Press, becomes a valuable tool in the management of critically ill pa- tients. CW, NS, and AR This page intentionally left blank viivii Brief contents Detailed Contents ix Abbreviations xiii Contributors xix 1 Respiratory therapy techniques 1 2 Cardiovascular therapy techniques 51 3 Renal therapy techniques 63 4 Gastrointestinal therapy techniques 73 5 Nutrition 81 6 Respiratory monitoring 89 7 Cardiovascular monitoring 97 8 Neurological monitoring 129 9 Fluids 141 10 Respiratory drugs 153 11 Cardiovascular drugs 165 12 Gastrointestinal drugs 193 13 Neurological drugs 205 14 Hematological drugs 219 15 Miscellaneous drugs 227 16 Resuscitation 239 viii BRIEF CONTENTS PRELIM RUNNING HEAD 17 Respiratory disorders 247 18 Cardiovascular disorders 283 19 Renal disorders 311 20 Gastrointestinal disorders 317 21 Hepatic disorders 347 22 Neurological disorders 359 23 Hematological disorders 387 24 Metabolic disorders 409 25 Poisoning 439 26 Shock 445 27 Infection and in \202 ammation 461 28 Trauma and burns 481 29 Physical disorders 497 30 Pain and post-operative intensive care 507 31 Obstetric emergencies 517 32 Death and dying 529 33 ICU organization and management 541 Appendix 591 Index 593 ix Detailed contents 4 Gastrointestinal therapy Abbreviations xiii Contributors xix techniques 73 Insertion of a Sengstaken \200\223Blakemore tube in critical care 74 Upper ga strointestinal endoscopy 76 Nasojejunal feeding in critical care patients 78 1 Respiratory therapy techniques 1 Oxygen therapy 2 Ventilatory support: indications 6 IPPV \200\224description o f ventilators 8 IPPV \200\224modes of ventilation 10 IPPV \200\224adjusting the ventilator 12 IPPV \200\224barotrauma 14 IPPV \200\224weaning techniques 16 High-frequency ventilation 18 Positive end-respiratory pressure 22 Continuous positive airway pressure ventilation (C PAP) 24 Recruitment maneuvers 26 Prone position ventilation 28 Non-invasive positive pressu re ventilation (NIPPV) 30 Extracorporeal membrane oxygenation (ECMO) for adults in respirat ory failure 32 Tracheostomy 34 Aftercare of the patient with a tracheostomy 36 Chest drain insertion 38 Pleural aspiration 40 Flexible bronchoscopy 42 Chest physiotherapy 44 Humidi \201 cation 46 Heart \200\223lung interactions 48 5 Nutrition 81 Enteral nutrition 82 Parenteral nutrition 84 Immune-enhancing nutrition 86 6 Respiratory monitoring 89 Pulmonary function tests in critical illness 90 End-tidal CO2 monitoring 92 Pulse oximetry 94 7 Cardiovascular monitoring 97 ECG monitoring 98 Arterial pressure monitoring 102 Insertion of central venous catheters 10 4 Common problems with central venous access 106 Pulmonary artery catheter: indications and use 108 Pulmonary artery catheter: insertion 110 Echocardiography 112 Clinical application of echocardiography in the ICU 116 Doppler 118 Pulse pressure algorithms 120 Non-invasive methods 122 Measurement of preload status 124 Detection of \202 uid responsiveness 126 2 Cardiovascular therapy techniques 51 De \201 brillation 52 Temporary cardiac pacing 54 Intra-aortic balloon count erpulsation pump 56 Cardiac assist devices 58 Therapeutic cooling 60 8 Neurological monitoring 129 Intracranial pressure monitoring 130 Intracranial perfusion 1 32 EEG and CFAM monitoring 134 Other forms of neurological monitoring 138 3 Renal therapy techniques 63 Haemodialysis 64 Haemo(dia) \201 ltration 68 Peritoneal dialysis (PD) 70 x DETAILED CONTENTS 9 Fluids 141 Antiviral agents 232 N-Acetylcysteine 234 Activated protein C 236 Crystalloids 142 Colloids 144 Sodium bicarbonate 146 Blood 150 16 Resuscitation 239 Basic and advanced resuscitation 240 Post-cardiac arrest management 242 Fluid challenge 244 10 Respiratory drugs 153 Bronchodilators 154 Nitric oxide 156 Mucolytics 158 Surfactant 160 Helium \200\223oxygen ga s mixtures 162 17 Respiratory disorders 247 Upper airway obstruction 248 Respiratory failure 250 Pulmonary collapse and atelectasis 252 Chronic obstructive pulmonary disease (COPD) 254 ARDS: diagno sis 256 ARDS: general management 258 ARDS: ventilatory management 260 Asthma 262 Asthma: ve ntilatory management 264 Pneumothorax 266 Empyema 268 Haemoptysis 270 Inhalation injury 272 Pulmonary embolism 274 Community-acquired pneumonia 276 Hospital-acquired pneumonia 278 Pu lmonary hypertension 280 11 Cardiovascular drugs 165 B-Adrenergic agonists 166 Phosphodiesterase inhibitors 168 Vasodilators 170 Vasopressors 17 4 Antiarrhythmic agents 176 Chronotropes 178 Antianginal agents 182 Antiplatelet agents 184 Diuretics and the critically ill 186 Levosimendan 190 12 Gastrointestinal drugs 193 H2 blockers and proton pump inhibitors 194 Antiemetics 196 Gut motility agents 198 Antidiar rhoeals 200 Constipation in critical care 202 18 Cardiovascular disorders 283 Hypertension 284 Tachyarrhythmias 288 Bradyarrhythmias 290 Myocardial infarction: diagnosis 292 NSTEMI 294 STEMI 296 Acute heart failure: assessment 300 Acute heart failure: manageme nt 304 Bacterial endocarditis 308 13 Neurological drugs 205 Opioid and non-opioid analgesics in the ICU 206 Sedation manageme nt in ICU 208 Muscle relaxants 210 Anticonvulsant drugs 212 Cerebroprotective agents 214 Ma nnitol and hypertonic saline 216 19 Renal disorders 311 Prevention of acute renal failure 312 Diagnosis of acute renal failure 314 14 Hematological drugs 219 Anticoagulants and heparin-induced thrombocytopenia 220 Thrombol ysis 224 Anti \201 brinolytics 226 20 Gastrointestinal disorders 317 Vomiting and gastric stasis/gastroparesis 318 Gastric ero sions 320 Diarrhea 322 Upper gastrointestinal hemorrhage (non-variceal) 324 15 Miscellaneous drugs 227 Antibiotics 228 Antifungals 230 xi DETAILED CONTENTS Bleeding varices 326 Intestinal perforation 328 Intestinal obstruction 330 Lower gastrointe stinal bleeding 332 Colitis 334 Intra-abdominal sepsis 336 Pancreatitis 338 Acute acalculou s cholecystitis 340 Splanchnic ischaemia 342 Abdominal hypertension (IAH) and abdominal com partment syndrome 344 Glycaemic control in the critically ill 426 Diabetic ketoacidosis 428 Hyperosmolar diabetic emergencies 430 Thyroid emergencies: thyroid crisis/thyrotoxic storm 432 Thyroid emergenci es: myxoedema coma 434 Hypoadrenal crisis 436 25 Poisoning 439 Management of acute poisoning 440 21 Hepatic disorders 347 26 Shock 445 Jaundice 348 Acute liver failure 350 Hepatic encephalopathy 352 Chronic liver failure 354 A bnormal liver function tests 356 Shock: de \201 nition and diagnosis 446 Hypovolaemic shock 450 Cardiogenic shock 452 Anaph ylactic shock 456 Septic shock: pathogenesis 458 22 Neurological disorders 359 27 Infection and in \202 ammation 461 Pathophysiology of sepsis and multi-organ failure 46 2 Infection control \200\224general principles 464 HIV 466 Severe falciparum malaria 468 Va sculitides in the ICU 470 Source control 472 Selective decontamination of the digestive tra ct (SDD) 474 Markers of infection 476 Adrenal insuf \201 ciency and sepsis 478 Agitation and confusion 360 Status epilepticus 362 Meningitis 364 Intracerebral hemorrhage 366 Subarachnoid hemorrhage 368 Ischaemic stroke 370 Guillain \200\223Barre syndrome 372 My asthenia gravis 374 ICU neuromuscular disorders 376 Tetanus 378 Botulism 380 Neurorehabilit ation 382 Hyperthermias 384 28 Trauma and burns 481 Initial management of major trauma 482 Head injury 484 Spinal trauma 486 Chest trauma 488 P elvic trauma 490 Burns \200\224 \202 uid management 492 Burns \200\224general management 4 94 23 Hematological disorders 387 Bleeding disorders 388 Anemia in critical care 392 Sickle cell anemia 394 Haemolysis 396 Di sseminated intravascular coagulation 398 Neutropenic sepsis 400 Hematological malignancies in the ICU 404 Coagulation monitoring 406 29 Physical disorders 497 Hypothermia 498 Drowning and near-drowning 500 Rhabdomyolysis 502 Pressure sores 504 24 Metabolic disorders 409 Electrolyte disorders 410 Hyponatraemia 414 Hypernatraemia 416 Categorizing metabolic acido ses 418 Metabolic acidosis etiology 420 Metabolic alkalosis 422 30 Pain and post-operative intensive care 507 Pain management in ICU 508 xii DETAILED CONTENTS Intensive care for the high risk surgical patient 510 The acute surgical abdomen in the ITU 512 The medical patient with surgical problems 514 ICU layout 546 Medical staf \201 ng in critical care 548 ICU staf \201 ng: nursing 550 IC U staf \201 ng: supporting professions 554 Fire safety 556 Legal issues and the Coroner 56 0 Patient safety 564 Severity of illness scoring systems 568 Comparison of ICUs 570 Critica l care disaster planning 572 Health technology assessment 574 Transfer of the critically il l patient 576 Aeromedical evacuation 580 Outreach 582 Medical emergency teams 584 Critical care follow-up 586 Managing antibiotic resistance 588 31 Obstetric emergencies 517 Pre-eclampsia 518 Eclampsia 520 HELLP syndrome 522 Postpartum hemorrhage 524 Amniotic \202 uid embolism 526 32 Death and dying 529 Con \201 rming death using neurological criteria (brainstem death) 530 Withdrawing and wit hholding treatment 532 The potential heart-beating organ donor 534 Non-heart-beating organ donation 538 Appendix 591 Respiratory physiology 592 Index 593 33 ICU organization and management 541 Consent on the ICU 542 Rationing in critical care 544 xiii Abbreviations ARDS ARF ARV AS ASA aSAH AST ATLS ATP AV AVP AXR BAE BAL BAEP BBB bd BiPAP BLS BMI BMP BMPR 2 BMS BP BPF bpm BNP BTF CABG CAD cAMB CAP CAPD CBF CCB CCC CCCP CCN CDAD CDT CEA CEMCH acute respiratory distress syndrome acute respiratory failure antiretroviral aortic stenosi s acetylsalicylic acid (aspirin) aneurysmal subarachnoid hemorrhage aspartate aminotransfer ase Advanced Trauma Life Support adenosine triphosphate atrioventricular arginine vasopress in abdominal X-ray bronchial artery embolization bronchoalveolar lavage brainstem auditory evoked potential blood \200\223brain barrier twice a day bilevel positive airway pressure b asic life support body mass index bone morphogenetic protein bone morphogenetic protein rec eptor II bone marrow suppression blood pressure bronchopleural \201 stula beats per minut e brain natriuretic peptide Brain Trauma Foundation coronary artery bypass graft coronary a rtery disease conventional amphotericin B community-acquired pneumonia continuous ambulator y peritoneal dialysis cerebral blood \202 ow calcium channel blocker Comprehensive Critic al Care Critical Care Contingency Planning critical care nurse Clostridium dif \201 cile-a ssociated disease Clostridium dif \201 cile toxin cost-effective analysis Con \201 dentia l Enquiry into Maternal and Child Health cerebral function analyzing monitor color \202 o w mapping chronic heart failure con \201 dence interval critical illness myopathy contrast -induced nephropathy \211 \211 \210 \206\221 \206\223 \200\223ve +ve AAC AAFB ABG ABPA AC ACS ACT H ACE AChR ACTH ADH AECOPD plus or minus less than or equal to more than or equal to approximatley degrees increase de crease negative positive acute acalculous cholecystitis acid- and alcohol-fast bacilli arte rial blood gas allergic bronchopulmonary aspergillosis activated charcoal acute coronary sy ndrome adrenocorticotrophic hormone angiotension-converting enzyme acetylcholine receptor a drenocorticotrophic hormone antidiuretic hormone acute exacerbations of chronic obstructive airways disease automated external de \201 brillator/ antiepileptic drug atrial \201 br illation amniotic \202 uid embolism anion gap acute heart failure acoustic impedance acut e in \202 ammatory demyelinating polyneuropathy autoimmune de \201 ciency syndrome acute kidney injury acute lung injury advanced life support acute motor axonal neuropathy acute m yocardial infarction acute motor sensory axonal neuropathy absolute neutrophil count antine utrophil cytoplasmic antibody atrial natriuretic peptide Acute Physiology and Chronic Healt h Evaluation activated protein C antepartum hemorrhage abdominal perfusion pressure activat ed partial prothrombin time aortic regurgitation angiotensin II receptor blocker AED AF AFE AG AHF AI AIDP AIDS AKI ALI ALS AMAN AMI AMSAN ANC ANCA ANP APACHE APC APH APP aPPT AR ARB CFAM CFM CHF CI CIM CIN xiv ABBREVIATIONS CINM CIP CK CMAP CMR CMV critical illness neuromyopathy critical illness polyneuropathy creatine kinase compound mus cle action potential cerebral metabolic rate conventional mechanical ventilation/ cytomegal ovirus constitutive nitric oxide synthase central nervous system catechol-o-methyltransfera se chronic obstructive pulmonary disease cyclo-oxygenase continuous positive airway pressur e Clinical Pulmonary Infection Score cerebral perfusion pressure cardiopulmonary resuscitat ion chest physiotherapy cryptococcal antigen catheter-related bloodstream infection C-react ive protein respiratory compliance cerebrospinal \202 uid Churg \200\223Strauss syndrome computed tomography CT angiogram CT venogram chemoreceptor trigger zone cerebrovascular acc ident central venous catheter central venous pressure compression:ventilation ratio continu ous venovenous haemo \201 ltration continuous venovenous haemodialysis continuous venoveno us haemodia \201 ltration chest X-ray diastolic blood pressure direct current cardioversio n diffuse alveolar hemorrhage diffuse axonal injury deep dermal 1-deamino-D-arginine vasopr essin di-homo- -linolenic acid docosohexanoic acid disseminated intravascular coagulation delayed ischaemic neurological de \201 cit diabetic ketoacidosis direct muscle stimulation do not attempt resuscitation 2,3-diphosphoglycerate dipalmitoylphosphatidylcholine drotrec ogin alfa (activated) digital subtraction angiogram deep vein thrombosis -aminocaproic acid Epstein \200\223Barr virus electrocardiograph extracorporeal membrane oxygenation end-diastolic area end-diastolic volume electroencephalograph ejection fraction enzyme-linked immunosorbent assay electromyograph enteral nutrition ear, nose and throat e icosopentanoic acid endothelial protein C receptor erythropoietin European Pressure Ulcer A dvisory Panel endoscopic retrograde cholangiopancreatography extended-spectrum -lactamase end-systolic volume end-stage renal disease erythrocyte sedimentation rate end-tidal CO2 e ndotracheal tube extravascular lung water full blood count Food and Drug Administration \201 brinogen degradation product forced expiratory volume fresh frozen plasma fractional i nspired oxygen concentration \201 ne needle aspiration functional residual capacity full thickness corrected \202 ow time forced vital capacity -aminobutyric acid gastric antra l vascular ectasia Guillain \200\223Barre syndrome Glasgow Coma Score (Scale) granulocyte c olony-stimulating factor Gross Domestic Product global end-diastolic volume index glomerula r \201 ltration rate gastrointestinal gastrointrestinal stromal tumor -linolenic acid G eneral Medical Council granulocyte \200\223macrophage colony-stimulating factor gastro-oeso phageal junction glucose-6-phospate dehydrogenase -glutamyltransferase EACA EBV ECG ECMO EDA EDV EEG EF ELISA EMG EN ENT EPA EPCR EPO EPUAP ERCP cNOS CNS COMT COPD COX CPAP CPIS CPP CPR CPT CrAg CR-BSI CRP Crs CSF CSS CT CTA CTV CTZ CVA CVC CVP CV ratio CVVH CVVHD CVVHDF CXR DBP DCCV DAH DAI DD DDAVP DGLA DHA DIC DIND DKA DMS DNAR 2,3-DPG DPPC DrotAA DSA DVT ESBL ESD ESRD ESR ETCO2 ETT EVLW FBC FDA FDP FEV FFP FiO2 FNA FRC FT FTc FVC GABA GAVE GBS GCS G-CSF GDP GEDVI GFR GI GIST GLA GNC GM-CSF GOJ G-6-PD GT xv ABBREVIATIONS GTN GvHD HAART HAP HAS HAV Hb H2B HBO HBV HCA HCT HCV HDU HELLP glyceryl trinitrate graft vs host disease highly active antiretroviral therapy hospital-acq uired pneumonia human albumin solution hepatitis A virus hemoglobin histamine receptor 2 bl ocker hyperbaric oxygen hepatitis B virus healthcare assistant haematopoetic cell transplan tation hepatitis C virus High Dependency Unit haemolysis, elevated liver enzymes, low plate lets high ef \201 ciency particulate air haemo \201 ltration/heart failure high-frequency jet ventilation high-frequency oscillatory ventilation high-frequency ventilation heparin- induced thrombocytopenia human immunode \201 ciency virus human leucocyte antigen heated m embrane exchange hyperosmolar non-ketotic state heterotopic ossi \201 cation hypertrophic obstructive cardiomyopathy hypothalamo-pituitary \200\223adrenal high resolution CT hepator enal syndrome haematopoietic stem cell transplantation herpes simplex virus 5-hydroxytrypta mine ICU IE IEN I:E ratio IGF-1 IL ILMA IM iNO iNOS INR IPPV IPV IRDS IRIS Intensive Care Unit infective endocarditis immune-enhancing nutrition inspiratory:expirator y ratio insulin-like growth factor-1 interleukin intubating laryngeal mask airway intramusc ular inhaled nitric oxide inducible nitric oxide synthase international normalized ratio in termittent positive pressure ventilation intrapulmonary percussive ventilator infant respir atory distress syndrome immune reconstitution in \202 ammatory syndrome incentive spyromet ry intrathoracic blood volume index intrathoracic pressure intention-to-treat Intensive The rapy Unit intravenous inferior vena cava intravenous immunoglobulin jugular venous pressure left atrium long-acting 2 agonist left bundle branch block lactate dehydrogenase Lambert \200\223Eaton myasthenia syndrome liver function test lower in \202 ection point laryngea l mask airway low molecular weight heparin L-ornithine l-aspartate length of stay lumbar pu ncture Lasting Power of Attorney lipopolysaccharide leukotriene B long-term oxygen therapy left ventricle left ventricular assist device left ventricular hypertrophy left ventricular out \202 ow tract monoamine oxidase monoamine oxidase inhibitor mean arterial pressure mi ddle cerebral artery metered-dose inhalation multiple drug-resistant monoethylglycinxylidid e medical emergency team HEPA HF HFJV HFOV HFV HIT HIV HLA HME HNS HO HOCM HPA HRCT HRS HSCT HSV 5-HT HT HTS HU HUS HVAC HVHF IABP IAH IAP IBD IBTICM IS ITBVI ITP ITT ITU IV IVC IVIG JVP LA LABA LBBB LDH LEMS LFT LIP LMA LMWH LOLA LOS LP LPA LPS LTB LTOT LV LVAD LVH LVOT MAO MAOI MAP MCA MDI MDR MEG-X MET health technology assessment hypertonic saline hydroxyurea haemolytic \200\223uraemic syndrome heating, ventilation and air conditioning high volume haemo \201 ltration intra-aortic balloon pump intra-abdominal hypertension intra-abdominal pressure irritable bowel disease Intercollegiate Board for Tr aining in Intensive Care Medicine ideal body weight indocyanine green intracranial (intrace rebral) hemorrhage Intensive Care Nursing Scoring System intracranial pressure inhaled cort icosteroid/Intensive Care Society IBW ICG ICH ICNSS ICP ICS xvi ABBREVIATIONS PAH PAMP PAN Pao PaO2 PAoP PAR1 PAWP PBV PBW PCA PCC PCI PCP PCR PCT PD PDE PDH PE PEA PECO 2 PEEP PEFR PEG PEJ PEP PET PetCO2 PG PIE PIP PLR PN PO PONV PP PPA PPH PPHN pulmonary arterial hypertension pathogen-associated molecular pattern polyarteritis nodosa pressure at airway opening arterial partial pressure of oxygen pulmonary artery occlusion p ressure protease-activated receptor 1 pulmonary artery wedge pressure pulmonary blood volum e predicted body weight patient-controlled anesthesia prothrombin complex concentrate percu taneous coronary intervention Pneumocystis carinii pneumonia polymerase chain reaction proc alcitonin peritoneal dialysis phosphodiesterase pyruvate dehydrogenase pulmonary embolism p ulseless electrical activity partial pressure of expired CO2 positive end-expiratory pressu re peak expiratory \202 ow rate percutaneous endoscopic gastrostomy percutaneous endoscop ic jejunostomy positive expiratory pressure positron emission tomography end-tidal CO2 part ial pressure prostaglandin pulmonary interstitial emphysema positive inspiratory pressure p assive leg raising parenteral nutrition per os post-operative nausea and vomiting partial p ressure plexogenic pulmonary arteriopathy postpartum hemorrhage persistent pulmonary hypert ension of the newborn proton pump inhibitor potentially pathogenic microorganism pulse pres sure variation proteinase 3 plasma renin activity pulse repetition frequency pressure suppo rt ventilation prothrombin time percutaneous transhepatic cholecystotomy percutaneous trans luminal coronary angioplasty MetHb MG MH MHI MI MOD MODS MOF MPA MPM MPO MR MRCP methaemoglobin myasthenia gravis malignant hyperthermia manual hyperin \202 ation myocardi al infarction multi-organ dysfunction multi-organ dysfunction syndrome multi-organ failure microscopic polyangitis Mortality Probability Model myeloperoxidase mitral regurgitation ma gnetic resonance cholangiopancreatography magnetic resonance imaging methicillin-resistant Staphylococcus aureus mitral stenosis muscle-speci \201 c receptor kinase N-acetylcysteine nicotinic acetylcholine receptor North American \200\223European Consensus Conference N-ac etylglucosaminidase N-acetyl-p-benzoquinone imine National Con \201 dential Enquiry into P atient Outcome and Death non-convulsive status epilepticus nuclear factor- B nasogastric n on-heart-beating donor National Institute for Health and Clinical Excellence non-invasive p ositive pressure ventilation near-infrared spectroscopy non-invasive ventilation nasojejuna l neurokinin N-methyl-D-aspartate nitric oxide nitric oxide synthase nicotine replacement t herapy non-steroidal anti-in \202 ammatory drug non-ST-segment elevation myocardial infarc tion new variant Creutzfeld \200\223Jacob disease New York Heart Association once daily out -of-hospital cardiac arrest Of \201 cial Journal of the European Union opening pressure od ds ratio obstructive sleep apnoea hypopnoea syndrome arterial partial pressure of carbon di oxide MRI MRSA MS MuSK NAC nAChR NAECC NAG NAPQI NCEPOD NCSE NF- B NG NHBD NICE NIPPV NIRS NIV NJ NK NMDA NO NOS NRT NSAID NSTEMI PPI PPM PPV PR3 PRA PRF PSV PT PTC nv-CJD NYHA od OHCA OJEU OP OR OSAHS PTCA PaCO2 xvii ABBREVIATIONS PTSD PUFA P/V PVR QALY qds RA RAAS Raw RBBB RCT RDS REM RH ROSC post-traumatic stress disorder polyunsaturated fatty acid pressure \200\223volume pulmonary vascular resistance quality-adjusted life year four times a day right atrium renin \200 \223angiotensin \200\223aldosterone system airway resistance right bundle branch block rand omized controlled trial respiratory distress syndrome rapid eye movement relative humidity return (restoration) of spontaneous circulation rapidly progressive glomerulonephritis rela tive risk respiratory resistance renal replacement therapy right ventricle right ventricula r assist device right ventricular end-diastolic volume index regional wall motion abnormali ty sinoatrial short-acting agonist subarachnoid hemorrhage severe acute pancreatitis Sim pli \201 ed Acute Physiology Score spontaneous breathing standard base excess systolic blo od pressure spontaneous breathing trial single breath test for CO2 subcutaneous/seiving coe f \201 cient sickle cell disease spinal cord injury slow continuous ultra \201 ltration s uper \201 cial dermal sleep-disoderded breathing selective decontamination of the digestiv e tract status elipticus sensory evoked potential syndrome of inappropriate ADH secretion s trong ion difference strong ion gap synchronized intermittent mandatory ventilation systemi c in \202 ammatory response syndrome systemic lupus erythematosus SLED SNP SOFA SP SRH SSEP STEMI SV SVC SVR SVT SVV T3 T4 TB TBI TBSA TCA TCD Tds TED TEG TE NS sustained low ef \201 ciency dialysis sodium nitroprusside Sequential Organ Failure Assess ment surfactant protein stigmata of recent hemorrhage somatosensory evoked potential ST-seg ment elevation myocardial infarction stroke volume superior vena cava systemic vascular res istance supraventricular tachycardia stroke volume variation triiodothyronine thyroxine tub erculosis traumatic brain injury total body surface area tricyclic antidepressant transcran ial Doppler three times a day thromboembolism deterrent thromboelastogram transcutaneous el ectrical nerve stimulation transforming growth factor transient ischaemic attack transjugul ar intrahepatic portosystemic shunt thymidine kinase total lung capacity Toll-like receptor tumor lysis syndrome transmembrane pressure tumor necrosis factor target organ damage tran soesophageal echocardiography tissue plasminogen activator total parenteral nutrition tricu spid regurgitation thyroid-stimulating hormone thrombin time transthoracic echocardiography thrombotic thrombocytopenic purpura transurethral resection of prostate unstable angina up per airway obstruction ulcerative colitis urea and electrolyte ultra \201 ltration unfract ionated heparin upper in \202 ection point UK Obstetric Surveillance System urea reduction ratio RPGN RR Rrs RRT RV RVAD RV EDVI RWMA SA SABA SAH SAP SAPS SB SBE SBP SBT SBT-CO2 SC SCD SCI SCUF SD SDB SDD TGF TIA TIPS TK TLC TLR TLS TMP TNF TOD TOE tPA TPN TR TSH TT TTE TTP TURP UA UAO UC U&E UF UFH UIP UKOS S URR SE SEP SIADH SID SIG SIMV SIRS SLE xviii ABBREVIATIONS UTI VA ECMO urinary tract infection venoarterial extracorporeal membrane oxygenation venovenous extraco rporeal membrane oxygenation ventricular assist device ventilator-associated pneumonia vide o-assisted thoracoscopy vital capacity visual evoked potential ventricular \201 brillatio n ventilator hyperin \202 ation vacuum-insulated evaporator ventilator-induced lung injury V/Q VRE VSD VT VTEC vWF VZV WA WBC WCC WG WOB WPW ventilation/perfusion vancomycin-resistant enterococci ventricular septal defect ventricula r tachycardia verocytotoxin-producing Escherichia coli von Willebrand factor varicella-zost er virus Welfare Attorney white blood cell white cell count Wagner \200\231s granulomatosis work of breathing Wolff \200\223Parkinson-White VV ECMO VAD VAP VATS VC VEP VF VHI VIE VILI xix Contributors Dr. Jane Adcock Consultant Neurologist John Radcliffe Hospital, Oxford Royal Berkshire Hosp ital, Reading Dr Anna Batchelor Consultant in Anesthesia and Intensive Care Medicine Royal Victoria In \201 rmary Newcastle Newcastle Dr Imran Ahmad Specialist Registrar in Anesthesia John Radcliffe Hospital Oxford Dr Ra \201 k Bedair Department of Critical Care Manchester Royal In \201 rmary Manchester Dr Peter Anderson Specialist Registrar in Critical Care St. Georges Hospital London Dr Geoff Bellingan Director of Intensive Care University College Hospital London Professor Peter JD Andrews Anesthetics, Intensive Care & Pain Medicine University of Edinbu rgh & Lothian University Hospitals Division Dr Dennis CJJ Bergmans Intensive Care Center Maastricht Maastricht University Medical Cente r+ The Netherlands Professor Djillali Annane General Intensive Care Unit, Department of Acute Medicine Raymond Poincar hospital (AP-HP) University of Versailles SQY (UniverSud Paris) 104 boulevard Ra ymond Poincar , 92380 Garches, France Professor Julian Bion Professor of Intensive Care Medicine University Department of Anesthe sia & Intensive Care Medicine, N5 Queen Elizabeth Hospital, Edgbaston, Birmingham Dr Andrew Bodenham Anesthetic Department Leeds General In \201 rmary Leeds Dr Tarek F Antonios Senior Lecturer & Consultant Physician Blood Pressure Unit, St. George \200\231s, University of London London Dr Jonathan Booth Consultant Gastroenterologist Royal Berkshire Hospital Reading Dr Elizabeth Ashley The Intensive Care Unit The Heart hospital, Westmoreland Street, London Mr Michael Booth FRCS Consultant Upper GI Surgeon, Royal Berkshire Hospital Reading Dr Jonathan Ball Consultant in Intensive Care General Intensive Care Unit St George \200 \231s Hospital London Mr Mark Borthwick, Consultant Pharmacist, Critical Care John Radcliffe Hospital Oxford Dr Nicholas Barrett Consultant in Intensive Care Medicine Guy \200\231s and St Thomas \200 \231 Hospital Westminster Bridge Road London Mr Richard Bourne, Lead Critical Care Pharmacist Shef \201 eld Teaching Hospital Shef \201 eld Ms Gillian Bradbury Matron, Intensive Care Unit The Royal London Hospital Whitechapel Road London Dr Anthony Bastin Specialist Registrar in Intensive Care Medicine Royal Brompton Hospital L ondon xx CONTRIBUTORS Dr Aimee Brame Specialist Registrar in Intensive Care Medicine Adult Intensive Care Unit, R oyal Brompton Hospital London Professor Christine Collin Neurorehabilitation Royal Berkshire Hospital Reading Ms Catherine Collins Dept of Nutrition and Dietetics St Georges Hospital London Dr Stephen Brett Consultant in Intensive Care Medicine Imperial College London Hammersmith Hospital Du Cane Road, London Mr P Conaghan Specialist Registrar John Radcliffe Hospital Oxford Dr Kate Brignall, Specialist Registrar in critical care Guy \200\231s and St Thomas \200 \231 Hospital Trust London Dr Daniel Conway Dept of Anesthesia Manchester Royal In \201 rmary Manchester Dr Matthew A Butkus The CRISMA (Clinical Research, Investigation, and Systems Modeling of A cute Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, P ittsburgh, PA, USA Dr Jeremy Cordingley Consultant in Intensive Care Medicine Royal Brompton Hospital London Dr Luigi Camporota Specialist Registrar in Intensive Care Medicine Department of Adult Inte nsive Care Guy \200\231s and St Thomas \200\231 NHS Foundation Trust London, UK Dr Matthew Cowan, Specialist Registrar & NIH Research Fellow St. George \200\231s, Universi ty of London, London Dr Jean Carlet Directeur m dical, Direction de l \200\231Am lioration et de la Qualit e t de la S curit des Soins (DAQSS) HAS, 2 avenue du Stade de France 93218 Saint-Denis La Plaine Cedex France Dr Agnieszka Crerar-Gilbert Consultant in Cardiothoracic Intensive Care & Anesthesia St Geo rge \200\231s Cardiothoracic Intensive Care Unit London Dr Chris Danbury Consultant Intensivist Royal Berkshire Hospital Reading Dr Susana Afonso de Carvalho Unidade de Cuidados Intensivos Polivalente Hospital de St. Ant nio dos Capuchos Centro Hospitalar de Lisboa Central, E.P.E. Lisboa Portugal Dr Craig Davidson Director Lane Fox Respiratory Unit Guys & St Thomas \200\231 Foundation T rust London Dr Maurizio Cecconi Consultant in Anesthesia and Intensive Care Medicine Dept. of Anesthesi a and Intensive Care, University of Udine Italy Dr Rebecca Davis Microbiology department Chelsea and Westminster Hospital Fulham Road Londo n Dr. Felix Chua Consultant in Respiratory Medicine St. George \200\231s Healthcare NHS Trust Blackshaw Road London Dr Jamil Darrouj Pulmonary/Critical Care Division Cooper University Hospital Robert Wood Jo hnson Medical School 393 Dorrance Camden USA Dr Jerome Cockings Consultant in Intensive Care Medicine and Anesthesia Royal Berkshire Hos pital Reading Dr Andrew Cohen Consultant, Anesthesia and Intensive Care Medicine St James \200\231s Unive rsity Hospital Leeds Dr Daniel De Backer Dpt of Intensive Care Erasme University Hospital Universit Libre de B ruxelles 808 Route de Lennik B-1070 Brussels (Belgium) xxi CONTRIBUTORS Dr Kayann Dell John Radcliffe Hospitals Oxford Dr Phil Gillen Specialist Registrar in Anesthesia and Intensive Care Royal Berkshire Hospit al Reading Prof. Giorgio Della Rocca Professor of Anesthesia and Intensive Care Chair of the Dept of A nesthesia and Intensive Care University of Udine. Udine, Italy Dr David Goldhill Consultant, Department of Anesthesia and Critical Care The Royal National Orthopedic Hospital Stanmore Middlesex Dr Phil Dellinger Critical Care Division Cooper University Hospital Robert Wood Johnson Med ical School 393 Dorrance Camden USA Dr Andrew Gratrix Consultant in Intensive Care and Anesthesia Hull Royal In \201 rmary Hul l Dr Mark Grif \201 ths Consultant in Intensive Care Medicine The Royal Brompton Hospital Lo ndon Dr James Down Consultant in Intensive care and Anesthesia University College Hospital Londo n Prof Richard D Grif \201 ths Professor of Medicine (Intensive Care), Unit of Pathophysiolo gy School of Clinical Science University of Liverpool Liverpool Dr Martin Dresner Consultant Obstetrics Leeds Royal In \201 rmary Leeds Dr Robert T Duncan Senior Trainee in Burns Wythenshawe Hospital Manchester Dr Mark Hamilton Consultant in Anesthesia & Intensive Care Medicine St. George \200\231s Ho spital, London, Miss N Dunne Specialist Registrar John Radcliffe Hospital, Oxford Dr Olfa Hamzaoui R animation m dicale CHU Bic tre Universit Paris-Sud, 11 France Dr Andy Eynon Director of Neurosciences Intensive Care Wessex Neurological Center Southampt on General Hospital Southampton Dr Jonathan M Handy Consultant in Intensive Care Medicine Chelsea & Westminster Hospital Ho norary Senior Lecturer Imperial College London Dr Paul Ferris Advanced Trainee in Intensive Care Wythenshawe Hospital Manchester Dr Derek Hausenloy Clinical Lecturer, The Hatter Cardiovascular Institute, University Colle ge London Hospital, London Dr Simon Finney Consultant in Intensive Care Medicine The Royal Brompton Hospital London Dr Robert Galland Royal Berkshire Hospital Reading Professor Ken Hillman Professor of Intensive Care, University of New South Wales Sydney Aus tralia Dr Magnus Garrioch Dept of Anesthesia and Critical Care, Manchester Royal In \201 rmary, M anchester Dr Steven Hollenberg Professor of Medicine Robert Wood Johnson Medical School/UMDNJ Directo r, Coronary Care Unit Cooper University Hospital Camden, NJ Anis el Ghorch D partement d \200\231Anesth sie et R animation H pital Lariboisi re Pa ris France xxii CONTRIBUTORS Dr Simon Hughes RAF Consultant in Intensive Care Medicine and Anesthesia John Radcliffe Hos pital, Oxford Dr Richard Keays Consultant in Intensive Care Medicine Chelsea & Westminster Hospital Londo n Dr John A Kellum The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acut e Illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pitt sburgh, PA, USA Professor Beverley J Hunt Consultant, Depts of Hematology, Pathology & Rheumatology Lead in Blood Sciences, Guy \200\231s & St Thomas \200\231 Trust London Dr Shabnam Iyer Dept Microbiology Royal Berkshire Hospital Dr Chris Kirwan Clinical Research Fellow, Intensive Care Medicine St George \200\231s NHS T rust Dr Ana Luisa Jardim Unidade de Cuidados Intensivos Polivalente Hospital de St. Ant nio dos Capuchos Centro Hospitalar de Lisboa Central, E.P.E. Lisboa Portugal