Invasive monitoring and invasive techniques for supporting the circulation have become an integral part of modern intensive care.
Invasive monitoring and invasive techniques for supporting the circulation have become an integral part of modern intensive care.
Hormones mediate much of the body's response to critical illness. As a consequence of this homeostatic function, circulating hormonal levels are often abnormal in critically ill patients. In this chapter the hormonal and metabolic response to acute illness is reviewed. The distinction between the ‘euthyroid-sick syndrome' and hypothyroidism is detailed. Similarly, the response of the adrenal glands to critical illness and illness-induced changes in calcium, phosphorus and magnesium metabolism are reviewed.
Most patients who develop acute renal failure after surgery have acute tubular dysfunction caused by hypotension. Other causes include drug toxicity, renal parenchymal disease and obstruction. The appropriate investigations are considered. It is important to support patients with ARF by dialysis or haemofiltration to keep the plasma biochemistry and circulating blood volume as near normal as possible. These techniques allow adequate nutrition to be given. Tubular dysfunction is a potentially reversible condition and patients should survive unless they develop other complications.
The right ventricle can play an important role in the morbidity and mortality of critically ill patients. Right ventricular (RV) dysfunction is observed frequently in pulmonary embolism, coronary artery disease, cardiac contusion, pulmonary insufficiency and pulmonary artery hypertension.
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