BOOK
Optimizing Hemodynamic Support in Severe Sepsis and Septic Shock, An Issue of Critical Care Clinics - E-Book
(2010)
Additional Information
Book Details
Abstract
Guest Editor Dane Nichols, MD, has assembled a panel of experts focusing on Hemodynamic Support in Septic Shock. Topics include: Oxygen Delivery and Consumption: A Macro-Circulatory Perspective; Mean Arterial Pressure: Therapeutic Goals and Pharmacologic Support,Mechanisms; Detection and Potential Management of Microcirculatory Disturbances; Detection of Hypoxia at the Cellular Level; Type A & B Lactic Acidosis: Recognition, Kinetics, and Associated Prognosis; Venous blood gases: What Can They Tell Us About the State of the Circulation; Noninvasive Assessment of Cardiac Preload and Performance through CO2 Rebreathing/ETCO2 Monitoring.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Contributors | iii | ||
| Contents | vii | ||
| Preface | xiii | ||
| Chapter 1. Oxygen Delivery and Consumption: A Macrocirculatory Perspective | 239 | ||
| CONVECTIVE TRANSPORT AND THE DELIVERED OXYGEN–OXYGEN CONSUMPTION RELATIONSHIP | 241 | ||
| THE ISSUE OF MATHEMATICAL COUPLING | 242 | ||
| THE ‘‘CRITICAL’’ DO2 | 243 | ||
| TRIALS OF DO2-VO2–GUIDED THERAPY | 245 | ||
| DOBUTAMINE AND DO2-VO2 | 247 | ||
| EGDT | 248 | ||
| SURVIVING SEPSIS CAMPAIGN GUIDELINES | 249 | ||
| SUMMARY | 250 | ||
| REFERENCES | 250 | ||
| Chapter 2. Lactic Acidosis: Recognition, Kinetics, and Associated Prognosis | 255 | ||
| LACTATE HISTORY | 255 | ||
| LACTATE METABOLISM | 256 | ||
| ROLE AS A PROGNOSTIC MARKER IN CRITICALLY ILL PATIENTS | 258 | ||
| LACTATE:PYRUVATE RATIOS | 259 | ||
| LACTATE CLEARANCE | 260 | ||
| ARTERIAL VERSUS VENOUS LACTATE | 261 | ||
| LACTATED RINGER SOLUTION | 262 | ||
| TYPE B LACTIC ACIDOSIS | 262 | ||
| TYPE B UNDERLYING DISEASES | 262 | ||
| TYPE B2—DRUGS AND TOXINS | 265 | ||
| TYPE B3—INBORN ERRORS OF METABOLISM | 271 | ||
| D-LACTIC ACIDOSIS | 272 | ||
| REFERENCES | 272 | ||
| Chapter 3. Mean Arterial Pressure: Therapeutic Goals and Pharmacologic Support | 285 | ||
| DEFINING MAP | 286 | ||
| MONITORING THE MAP | 287 | ||
| MAP AND THE PHYSIOLOGY OF SEPSIS | 289 | ||
| PHARMACOLOGIC SUPPORT OF MAP IN SEPSIS | 289 | ||
| REFERENCES | 292 | ||
| Chapter 4. Static Measures of Preload Assessment | 295 | ||
| PRESSURE MEASUREMENTS: CVP AND Ppao | 296 | ||
| VOLUMETRIC MEASUREMENTS: CONTINUOUS RVEDV AND GEDV | 301 | ||
| SUMMARY | 303 | ||
| REFERENCES | 303 | ||
| Chapter 5. Dynamic Indices of Preload | 307 | ||
| PHYSIOLOGIC RATIONALE OF DYNAMIC INDICES | 308 | ||
| SUMMARY | 318 | ||
| REFERENCES | 318 | ||
| Chapter 6. Optimizing Hemodynamic Support in Septic Shock Using Central and Mixed Venous Oxygen Saturation | 323 | ||
| VENOUS OXYGEN SATURATION PHYSIOLOGY | 324 | ||
| RELATIONSHIP BETWEEN SVO2 AND SCVO2 | 326 | ||
| CLINICAL USES | 327 | ||
| CLINICAL USES OF CENTRAL VENOUS OXYGEN SATURATION MONITORING IN SEPTIC SHOCK | 327 | ||
| BLEEDING | 329 | ||
| CENTRAL VENOUS-TO-ARTERIAL CARBON DIOXIDE DIFFERENCE | 329 | ||
| SUMMARY | 330 | ||
| REFERENCES | 330 | ||
| Chapter 7. The Optimal Hematocrit | 335 | ||
| PRINCIPLES OF OXYGEN TRANSPORT | 336 | ||
| CAUSES OF TISSUE HYPOXIA | 337 | ||
| MEASUREMENT OF TISSUE OXYGENATION | 337 | ||
| PHYSIOLOGIC RESPONSE TO ACUTE ANEMIA | 338 | ||
| LIMITS OF ACUTE ANEMIA TOLERANCE | 339 | ||
| ANEMIA AND THE HEART | 339 | ||
| RED CELL PHYSIOLOGY | 340 | ||
| BLOOD AND THE MICROCIRCULATION | 341 | ||
| THE STORAGE LESION | 342 | ||
| TRANSFUSION-RELATED IMMUNOMODULATION | 343 | ||
| CLINICAL TRIALS | 346 | ||
| SUMMARY | 347 | ||
| REFERENCES | 348 | ||
| Chapter 8. Techniques for Determining Cardiac Output in the Intensive Care Unit | 355 | ||
| MEASURING CARDIAC OUTPUT | 356 | ||
| NONINVASIVE TECHNIQUES | 360 | ||
| SUMMARY | 362 | ||
| REFERENCES | 363 | ||
| Chapter 9. The Role of Echocardiography in Hemodynamic Assessment of Septic Shock | 365 | ||
| FUNDAMENTALS OF ECHOCARDIOGRAPHY | 366 | ||
| ECHOCARDIOGRAPHY EQUIPMENT | 366 | ||
| EXAMPLE OF A FOCUSED ECHOCARDIOGRAPHY STUDY FOR HEMODYNAMIC ASSESSMENT | 366 | ||
| PRELOAD/PREDICTION OF VOLUME RESPONSIVENESS | 370 | ||
| ECHOCARDIOGRAPHIC DIAGNOSIS OF SEPSIS-INDUCED MYOCARDIAL DYSFUNCTION | 372 | ||
| PRACTICAL EVALUATION OF LV SYSTOLIC FUNCTION | 374 | ||
| ECHOCARDIOGRAPHIC IDENTIFICATION OF ACUTE RV FAILURE | 374 | ||
| TAMPONADE, AN ALTERNATIVE DIAGNOSIS TO SEPSIS IN ACUTE HEMODYNAMIC INSTABILITY OF UNKNOWN CAUSE | 376 | ||
| ECHO TRAINING FOR INTENSIVISTS | 376 | ||
| TRAINING RESOURCES FOR INTENSIVISTS | 378 | ||
| RELIABILITY OF FOCUSED ICU ECHO USING HAND-HELD AND COMPACT PORTABLE DEVICES | 378 | ||
| SUMMARY | 379 | ||
| REFERENCES | 379 | ||
| APPENDIX 1: RESOURCES FOR ECHOCARDIOGRAPHY TRAINING FOR INTENSIVISTS | 382 | ||
| Chapter 10. Noninvasive Monitoring Cardiac Output Using Partial CO2 Rebreathing | 383 | ||
| THEORY OF OPERATION | 384 | ||
| COMMERCIAL SYSTEMS FOR HEMODYNAMIC MONITORING USING PARTIAL CO2 REBREATHING | 385 | ||
| NICO VALIDATION AND LIMITATIONS | 386 | ||
| AFFECT OF PULMONARY DISEASE | 387 | ||
| CARDIOTHORACIC SURGERY PATIENTS | 387 | ||
| PARTIAL CO2 REBREATHING MEASUREMENTS IN SEVERE LUNG INJURY | 388 | ||
| NICO IN PEDIATRIC AND GERIATRIC AGE GROUPS | 389 | ||
| HIP SURGERY PATIENTS | 389 | ||
| OTHER APPLICATIONS | 389 | ||
| SUMMARY | 389 | ||
| REFERENCES | 390 | ||
| Chapter 11. Mechanisms, Detection, and Potential Management of Microcirculatory Disturbances in Sepsis | 393 | ||
| AN OVERVIEW OF THE MICROCIRCULATION | 394 | ||
| MECHANISMS OF MICROCIRCULATORY DYSFUNCTION IN SEPSIS | 394 | ||
| MEASUREMENT OF MICROCIRCULATORY FUNCTION | 395 | ||
| TECHNICAL LIMITATIONS OF VARIOUS TECHNIQUES | 398 | ||
| PROGNOSTIC VALUE OF MEASURING MICROVASCULAR FLOW | 398 | ||
| RESUSCITATING THE MICROCIRCULATION IN SEPSIS | 400 | ||
| SUMMARY | 403 | ||
| REFERENCES | 403 | ||
| Chapter 12. Detection of Hypoxia at the Cellular Level | 409 | ||
| EFFECTIVE TISSUE OXYGENATION | 410 | ||
| INEFFECTIVE TISSUE OXYGENATION | 411 | ||
| THE ROLE OF LACTATE IN SEPSIS | 414 | ||
| TISSUE-SPECIFIC CONSIDERATIONS | 415 | ||
| SUMMARY | 418 | ||
| REFERENCES | 418 | ||
| Index | 423 |