Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0004
J. R. Sanz, N. Jiramethee, J. Diaz-Gomez
This chapter provides an overview of fundamental pathophysiologic concepts for the diagnosis and management of cardiovascular disorders in critically ill patients. Three major topics are presented: 1) the importance of vascular–cardiac pump coupling as an integrated system, 2) practical considerations of ventricular dysfunction, and 3) systemic vessels as a crucial factor for cardiac output control and fluid responsiveness.
{"title":"Cardiovascular System in the Critically Ill Patient","authors":"J. R. Sanz, N. Jiramethee, J. Diaz-Gomez","doi":"10.1093/MED/9780190862923.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0004","url":null,"abstract":"This chapter provides an overview of fundamental pathophysiologic concepts for the diagnosis and management of cardiovascular disorders in critically ill patients. Three major topics are presented: 1) the importance of vascular–cardiac pump coupling as an integrated system, 2) practical considerations of ventricular dysfunction, and 3) systemic vessels as a crucial factor for cardiac output control and fluid responsiveness.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127131591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0106
C. Watridge
Spinal surgery is a relatively common surgical procedure in the United States. More than 600,000 spinal operations are performed each year, and many are performed as outpatient procedures. Although only a small percentage of spinal surgery patients require intensive care unit (ICU) admission, spinal surgery does carry a risk of death. In addition, the neurologic recovery is often limited by the nature of the condition, and surgical outcomes can be adversely affected postoperatively.
{"title":"Intensive Care After Spinal Surgery","authors":"C. Watridge","doi":"10.1093/MED/9780190862923.003.0106","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0106","url":null,"abstract":"Spinal surgery is a relatively common surgical procedure in the United States. More than 600,000 spinal operations are performed each year, and many are performed as outpatient procedures. Although only a small percentage of spinal surgery patients require intensive care unit (ICU) admission, spinal surgery does carry a risk of death. In addition, the neurologic recovery is often limited by the nature of the condition, and surgical outcomes can be adversely affected postoperatively.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133876855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0054
R. Pruthi
The hemostatic response to vascular injury consists of vascular constriction, platelet activation resulting in platelet adhesion (mediated by von Willebrand factor), and platelet aggregation resulting in an initial platelet plug formation at the site of vascular injury. This platelet plug is stabilized by formation of fibrin, which results from activation of the procoagulant coagulation factors. Congenital or acquired abnormalities of the procoagulant factors result in a bleeding and thrombotic tendency of variable severity. Acquired abnormalities of the procoagulant system are typically associated underlying systemic disorders; however, they may also be idiopathic. Recognition, laboratory diagnosis, and principles of management of acquired coagulopathy are reviewed in this chapter.
{"title":"Diagnosis and Management of Acquired Bleeding Disorders","authors":"R. Pruthi","doi":"10.1093/MED/9780190862923.003.0054","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0054","url":null,"abstract":"The hemostatic response to vascular injury consists of vascular constriction, platelet activation resulting in platelet adhesion (mediated by von Willebrand factor), and platelet aggregation resulting in an initial platelet plug formation at the site of vascular injury. This platelet plug is stabilized by formation of fibrin, which results from activation of the procoagulant coagulation factors. Congenital or acquired abnormalities of the procoagulant factors result in a bleeding and thrombotic tendency of variable severity. Acquired abnormalities of the procoagulant system are typically associated underlying systemic disorders; however, they may also be idiopathic. Recognition, laboratory diagnosis, and principles of management of acquired coagulopathy are reviewed in this chapter.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114978058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0048
P. Fitzpatrick
Renal replacement therapy is frequently used in the intensive care unit, primarily for the management of acute kidney injury, but it is also indicated for removal of some toxins and medications. Additionally, patients with dialysis-dependent chronic kidney failure who are admitted to the intensive care unit require their therapy to be continued. This chapter reviews the mechanisms by which renal replacement therapy operates and the types of replacement therapies that are available. Access for renal replacement and anticoagulation are also discussed.
{"title":"Principles of Renal Replacement Therapies","authors":"P. Fitzpatrick","doi":"10.1093/MED/9780190862923.003.0048","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0048","url":null,"abstract":"Renal replacement therapy is frequently used in the intensive care unit, primarily for the management of acute kidney injury, but it is also indicated for removal of some toxins and medications. Additionally, patients with dialysis-dependent chronic kidney failure who are admitted to the intensive care unit require their therapy to be continued. This chapter reviews the mechanisms by which renal replacement therapy operates and the types of replacement therapies that are available. Access for renal replacement and anticoagulation are also discussed.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115155105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0136
J. Pulido
Pharmacologic manipulation of the cardiovascular system is considered one of the cornerstones of day-to-day management of critically ill patients. For formulation of an adequate hemodynamic plan, it is crucial 1) to have a thorough understanding of cardiovascular physiology and its intricate relationship with the autonomic nervous system and 2) to identify a clear hemodynamic goal, such as maintenance of oxygen delivery and perfusion in shock, permissive hypertension in acute stroke, or blood pressure control in hypertensive emergencies.
{"title":"Inotropes, Vasopressors, and Antihypertensive Agents","authors":"J. Pulido","doi":"10.1093/MED/9780190862923.003.0136","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0136","url":null,"abstract":"Pharmacologic manipulation of the cardiovascular system is considered one of the cornerstones of day-to-day management of critically ill patients. For formulation of an adequate hemodynamic plan, it is crucial 1) to have a thorough understanding of cardiovascular physiology and its intricate relationship with the autonomic nervous system and 2) to identify a clear hemodynamic goal, such as maintenance of oxygen delivery and perfusion in shock, permissive hypertension in acute stroke, or blood pressure control in hypertensive emergencies.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115284491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0036
J. Moss
Thyroid disorders are relatively uncommon among patients in the intensive care unit (ICU) but may lead to serious morbidity and death. A working knowledge of these disorders is essential to their recognition and treatment, and an intensivist should be able to recognize and treat the 3 most common thyroid disorders in the ICU: myxedema coma, thyroid storm, and euthyroid sick syndrome.
{"title":"Thyroid Disorders in the Intensive Care Unit","authors":"J. Moss","doi":"10.1093/MED/9780190862923.003.0036","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0036","url":null,"abstract":"Thyroid disorders are relatively uncommon among patients in the intensive care unit (ICU) but may lead to serious morbidity and death. A working knowledge of these disorders is essential to their recognition and treatment, and an intensivist should be able to recognize and treat the 3 most common thyroid disorders in the ICU: myxedema coma, thyroid storm, and euthyroid sick syndrome.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115657404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0114
A. Murray
One of the greatest responsibilities in managing an airway is to maintain a continuously patent airway. Any loss of patency of the patient’s airway is critical, and if the ability to provide ventilatation is lost, brain damage can rapidly develop potentially lead to brain death. The definition of difficult airway is not standardized in the anesthesiology literature, but it has been described as the situation when “a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both”
{"title":"Basics of Airway and Oxygen Delivery Devices","authors":"A. Murray","doi":"10.1093/MED/9780190862923.003.0114","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0114","url":null,"abstract":"One of the greatest responsibilities in managing an airway is to maintain a continuously patent airway. Any loss of patency of the patient’s airway is critical, and if the ability to provide ventilatation is lost, brain damage can rapidly develop potentially lead to brain death. The definition of difficult airway is not standardized in the anesthesiology literature, but it has been described as the situation when “a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both”","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122670082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0074
Ayan Sen
Intestinal transplant (ITx) is becoming a valid option for patients with intestinal failure who are receiving long-term parenteral nutrition and have associated complications. Since then the number of intestinal transplants performed in the United States has increased dramatically (from 5 in 1990 to 146 in 2016). Furthermore, 1-year graft and patient survival rates are similar to those for solid abdominal organ transplants (up to 80%). Short gut syndrome and functional bowel problems are the most common clinical conditions leading to intestinal failure and subsequent eligibility for ITx.
{"title":"Small Intestinal Transplant","authors":"Ayan Sen","doi":"10.1093/MED/9780190862923.003.0074","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0074","url":null,"abstract":"Intestinal transplant (ITx) is becoming a valid option for patients with intestinal failure who are receiving long-term parenteral nutrition and have associated complications. Since then the number of intestinal transplants performed in the United States has increased dramatically (from 5 in 1990 to 146 in 2016). Furthermore, 1-year graft and patient survival rates are similar to those for solid abdominal organ transplants (up to 80%). Short gut syndrome and functional bowel problems are the most common clinical conditions leading to intestinal failure and subsequent eligibility for ITx.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114894918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0107
K. Gassie, Belinda G. Bradley, R. Wharen, Betty S Kim
Technologic advances and a better understanding of the pathophysiologic basis of neurologic diseases have greatly improved the care of critically ill patients after neurosurgical procedures. Risk factors for the development of adverse events have been identified, and early identification and treatment of complications are essential. This chapter provides an overview of the initial evaluation of patients for intensive care unit admission after intracranial procedures, general care of those patients, and specific management strategies for early detection and treatment of complications.
{"title":"Intensive Care After Craniotomy","authors":"K. Gassie, Belinda G. Bradley, R. Wharen, Betty S Kim","doi":"10.1093/MED/9780190862923.003.0107","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0107","url":null,"abstract":"Technologic advances and a better understanding of the pathophysiologic basis of neurologic diseases have greatly improved the care of critically ill patients after neurosurgical procedures. Risk factors for the development of adverse events have been identified, and early identification and treatment of complications are essential. This chapter provides an overview of the initial evaluation of patients for intensive care unit admission after intracranial procedures, general care of those patients, and specific management strategies for early detection and treatment of complications.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"237 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130621316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1093/MED/9780190862923.003.0108
M. Sattur, C. Krishna, B. Bendok, B. Chong
Endovascular therapy for cerebrovascular disease is widespread. Patients with brain aneurysms, acute stroke, brain vascular malformations, and tumors are treated with endovascular techniques primarily or in conjunction with other traditional surgical and medical approaches. Postprocedural concerns unique to endovascular treatment include complications related to access or arterial puncture, contrast nephrotoxicity, and radiation dose complications (eg, alopecia and skin burns). Other complications, such as stroke and hemorrhage, that are not unique are discussed below.
{"title":"Intensive Care After Neuroendovascular Procedures","authors":"M. Sattur, C. Krishna, B. Bendok, B. Chong","doi":"10.1093/MED/9780190862923.003.0108","DOIUrl":"https://doi.org/10.1093/MED/9780190862923.003.0108","url":null,"abstract":"Endovascular therapy for cerebrovascular disease is widespread. Patients with brain aneurysms, acute stroke, brain vascular malformations, and tumors are treated with endovascular techniques primarily or in conjunction with other traditional surgical and medical approaches. Postprocedural concerns unique to endovascular treatment include complications related to access or arterial puncture, contrast nephrotoxicity, and radiation dose complications (eg, alopecia and skin burns). Other complications, such as stroke and hemorrhage, that are not unique are discussed below.","PeriodicalId":308040,"journal":{"name":"Mayo Clinic Critical and Neurocritical Care Board Review","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122285621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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