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Advances and Challenges in Critical Care, An Issue of Clinics in Chest Medicine, E-Book

Advances and Challenges in Critical Care, An Issue of Clinics in Chest Medicine, E-Book

Shyoko Honiden

(2015)

Additional Information

Abstract

Drs. Honiden and Siner have put together a comprehensive issue on Critical Care as it relates to Chest Medicine. Articles include:Recent advances in management of Acute respiratory distress syndrome, Simulation training for critical care, Telemedicine (E-ICU issues), Adverse event reporting/quality improvement in the ICU, ICU Mobility, Hospital-acquired infections/resistant organisms/emerging pathogens, Circadian rhythm disturbance and sleep in the ICU environment, Advances in Sepsis Research, Controversies in ICU nutrition, and more!

Table of Contents

Section Title Page Action Price
Front Cover Cover
Advances and Challenges\rin Critical Care i
Copyright ii
Contributors iii
EDITORS iii
AUTHORS iii
Contents vii
Preface: Advances and Challenges in Critical Care Medicine vii
New Technologies and Interventions vii
Novel Uses of Extracorporeal Membrane Oxygenation in Adults vii
Novel Uses of Targeted Temperature Management vii
ICU Telemedicine Solutions vii
Supportive Care vii
Controversies and Misconceptions in Intensive Care Unit Nutrition vii
Sleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit viii
Barriers and Challenges to the Successful Implementation of an Intensive Care Unit Mobility Program: Understanding Systems ... viii
Integration of Palliative Care Services in the Intensive Care Unit: A Roadmap for Overcoming Barriers viii
Education and Quality Improvement ix
Clinical Reasoning and Risk in the Intensive Care Unit ix
Adverse Event Reporting and Quality Improvement in the Intensive Care Unit ix
Five Questions Critical Care Educators Should Ask About Simulation-Based Medical Education ix
Disease Specific Management ix
Recent Advances in the Management of the Acute Respiratory Distress Syndrome ix
Critically Ill Patients with Interstitial Lung Disease x
Management of Right Heart Failure in the Intensive Care Unit x
Advances in Sepsis Research x
Management of Infections with Drug-Resistant Organisms in Critical Care: An Ongoing Battle x
PROGRAM OBJECTIVE xi
TARGET AUDIENCE xi
LEARNING OBJECTIVES xi
ACCREDITATION xi
DISCLOSURE OF CONFLICTS OF INTEREST xi
UNAPPROVED/OFF-LABEL USE DISCLOSURE xi
TO ENROLL xii
METHOD OF PARTICIPATION xii
CME INQUIRIES/SPECIAL NEEDS xii
CLINICS IN CHEST MEDICINE xiii
FORTHCOMING ISSUES xiii
December 2015 xiii
March 2016 xiii
June 2016 xiii
RECENT ISSUES xiii
June 2015 xiii
March 2015 xiii
December 2014 xiii
Preface: Advances and Challenges in Critical Care Medicine xv
Novel Uses of Extracorporeal Membrane Oxygenation in Adults 373
Key points 373
INTRODUCTION 373
CONFIGURATIONS OF EXTRACORPOREAL MEMBRANE OXYGENATION 373
EMERGING INDICATIONS FOR EXTRACORPOREAL MEMBRANE OXYGENATION IN RESPIRATORY FAILURE 375
EMERGING INDICATIONS FOR EXTRACORPOREAL MEMBRANE OXYGENATION IN CARDIAC FAILURE 379
INTERHOSPITAL TRANSPORT ON EXTRACORPOREAL MEMBRANE OXYGENATION 380
EARLY MOBILIZATION ON EXTRACORPOREAL MEMBRANE OXYGENATION 380
EXTRACORPOREAL MEMBRANE OXYGENATION AS DESTINATION THERAPY 380
COMPLICATIONS 381
ECONOMIC IMPACT OF EXTRACORPOREAL MEMBRANE OXYGENATION 381
ETHICAL IMPLICATIONS OF EXTRACORPOREAL MEMBRANE OXYGENATION 381
SUMMARY 381
REFERENCES 381
Novel Uses of Targeted Temperature Management 385
Key points 385
INTRODUCTION 385
Historical Context and Current Practice 385
Purpose of the Review 386
Targeted Temperature Management Mechanisms of Cellular Protection 386
QUESTION 1: WHICH INTENSIVE CARE UNIT PATIENTS WITH NEUROLOGIC INJURY SHOULD I COOL? 387
Nonshockable and In-Hospital Cardiac Arrest 387
Hepatic Encephalopathy 387
Acute Ischemic Stroke 387
Intracerebral Hemorrhage 389
Traumatic Brain Injury 389
QUESTION 2: WHICH INTENSIVE CARE UNIT PATIENTS WITH NONNEUROLOGIC INJURY SHOULD I COOL? 389
Acute Myocardial Infarction 389
Sepsis 389
Acute Respiratory Distress Syndrome 390
Meningitis 390
Contrast-Induced Nephropathy 390
Traumatic Cardiac Arrest 390
QUESTION 3: HOW SHOULD I COOL CRITICALLY ILL PATIENTS? 390
Surface Versus Endovascular 390
Intranasal Induction 390
Use of Adjunctive Agents: Inhaled Xenon 395
QUESTION 4: WHAT ARE THE PRACTICAL CONSIDERATIONS FOR TARGETED TEMPERATURE MANAGEMENT USE? 395
Timing of Targeted Temperature Management 395
Time to Goal Temperature 395
Depth of Cooling 395
Duration and Rewarming 395
QUESTION 5: IS TARGETED TEMPERATURE MANAGEMENT SAFE? HOW SHOULD I MONITOR TARGETED TEMPERATURE MANAGEMENT PATIENTS? 397
Infection 397
Bleeding 397
Electroencephalogram Monitoring 397
Electrolyte Monitoring 397
Prognostication 397
SUMMARY 398
REFERENCES 398
ICU Telemedicine Solutions 401
Key points 401
INTENSIVE CARE UNIT TELEMEDICINE SOLUTIONS 401
PATIENT SAFETY 402
INCREASED ACCESS TO EXPERTISE: A LEVERAGED WORKFORCE SOLUTION 403
IMPROVING EFFECTIVENESS: POPULATION MANAGEMENT, STANDARDIZATION, AND REPORTING 404
INTENSIVE CARE UNIT TELEMEDICINE STAFFING 404
INTERMITTENT INTENSIVE CARE UNIT TELEMEDICINE 404
FINANCIAL CONSIDERATIONS 405
SUMMARY 405
REFERENCES 406
Controversies and Misconceptions in Intensive Care Unit Nutrition 409
Key points 409
INTRODUCTION 409
ANSWERS TO COMMON MISCONCEPTIONS IN INTENSIVE CARE UNIT NUTRITION 409
Starvation During Hospitalization Negatively Impacts Clinical Outcomes 409
Enteral Nutrition Is Almost Never Contraindicated in Critically Ill Patients 410
Parenteral Nutrition Is Not Superior or Equivalent to Enteral Nutrition 410
Mandatory Use of Gastric Residual Volumes to Assess Tolerance of Enteral Nutrition Is Unnecessary 411
OTHER CONTROVERSIES IN INTENSIVE CARE UNIT NUTRITION 412
The Optimal Dose: Trophic Versus Full Feeds 412
Continuous Versus Intermittent/Bolus 412
Use of Omega-3 Fatty Acids 415
SUMMARY 415
REFERENCES 415
Sleep Loss and Circadian Rhythm Disruption in the Intensive Care Unit 419
Key points 419
INTRODUCTION 419
CONSEQUENCES OF INTENSIVE CARE UNIT SLEEP DISRUPTION 421
SOURCES OF INTENSIVE CARE UNIT SLEEP DISRUPTION 421
Chronic Sleep Disorder 421
Acute Illness–Related Factors 421
Environment Factors 423
Medical Interventions 423
MANAGEMENT GOALS 424
PHARMACOLOGIC STRATEGIES 424
NONPHARMACOLOGIC STRATEGIES 425
SELF-MANAGEMENT STRATEGIES 425
SUMMARY/DISCUSSION 425
REFERENCES 425
Barriers and Challenges to the Successful Implementation of an Intensive Care Unit Mobility Program 431
Key points 431
INTRODUCTION 431
THE CHALLENGE OF EARLY INTENSIVE CARE UNIT MOBILIZATION AS A CHANGE INITIATIVE 432
START BY LETTING GO OF THE IDEA OF CHANGING CULTURE 433
Planning for Change at a Systems/Organizational Level: Tackling the Environment by Recognizing Muda (Waste), Muri (Overburd ... 433
Applying the Toyota Model to an Intensive Care Unit Mobility Project: First Take Inventory of the Current State 433
Understanding How Institutions Change: Organizational Sociology 435
PLANNING FOR CHANGE AT A LEADERSHIP LEVEL 436
UNDERSTANDING THE PSYCHOLOGY OF CHANGE AND MOTIVATION AT AN INDIVIDUAL LEVEL 437
BRINGING IT ALL TOGETHER: A STEP-BY-STEP PRESCRIPTION FOR ENACTING CHANGE IN THE HEALTH CARE ENVIRONMENT 439
SUMMARY 439
REFERENCES 440
Integration of Palliative Care Services in the Intensive Care Unit 441
Key points 441
THE IMPORTANCE OF PALLIATIVE CARE 441
BENEFITS OF PALLIATIVE CARE IN THE INTENSIVE CARE UNIT 442
BARRIERS TO IMPLEMENTATION OF PALLIATIVE CARE 442
SCREENING TOOLS AND BUNDLING 443
SPECIFIC STEPS FOR IMPLEMENTATION AND INTEGRATION OF A PALLIATIVE CARE PROGRAM INTO THE INTENSIVE CARE UNIT 444
Goal 1: Garnering Local Support from Thought Leaders 444
Goal 2: Recruitment of a Palliative Care Team and Definition of Roles 445
Goals 3 and 4: Initiation of Palliative Care into the Intensive Care Unit and Full Integration into Daily Workflow 446
SUMMARY 446
REFERENCES 446
Clinical Reasoning and Risk in the Intensive Care Unit 449
Key points 449
INTRODUCTION 449
ANALYSIS, INTUITION, AND METHOD 450
EXPERTS AND NOVICES: NOT ALL REASONING IS DONE THE SAME WAY 450
A METHOD OF CLINICAL REASONING: THE MODIFIED BAYESIAN APPROACH FOR THE INTENSIVE CARE UNIT 451
INTERVENTION IN THE CRITICALLY ILL: RISK VERSUS BENEFIT 455
PERCEPTION VERSUS REALITY OR PERCEPTION AS REALITY? 456
SUMMARY 458
REFERENCES 458
Adverse Event Reporting and Quality Improvement in the Intensive Care Unit 461
Key points 461
INTRODUCTION 461
DEFINITIONS OF ADVERSE EVENT AND ERRORS 461
RISK FACTORS 462
HISTORICAL BACKGROUND 462
EVENT DETECTION 462
APPROACHES TO QUALITY EVALUATION 463
ADVERSE EVENT AND ERROR REPORTING 464
SAFETY CULTURE 465
REFERENCES 465
Five Questions Critical Care Educators Should Ask About Simulation-Based Medical Education 469
Key points 469
INTRODUCTION 469
WHAT IS SIMULATION-BASED MEDICAL EDUCATION? 470
WHY SHOULD SIMULATION-BASED MEDICAL EDUCATION BE USED? 470
WHAT CAN BE TAUGHT AND ASSESSED WITH SIMULATION-BASED MEDICAL EDUCATION? 471
HOW SHOULD SIMULATION-BASED MEDICAL EDUCATION BE USED? 473
WHAT ARE THE CHALLENGES RELATED TO SIMULATION-BASED MEDICAL EDUCATION? 474
SUMMARY 475
REFERENCES 475
Recent Advances in the Management of the Acute Respiratory Distress Syndrome 481
Key points 481
INTRODUCTION 481
DEFINITIONS AND EPIDEMIOLOGY 481
Incidence and Outcomes 482
VENTILATOR STRATEGIES 483
Tidal Volume Reduction 483
Positive End-Expiratory Pressure 484
ALTERNATE MODES OF VENTILATION 486
High-Frequency Oscillatory Ventilation 486
Airway Pressure Release Ventilation 487
NONVENTILATOR THERAPIES OF BENEFIT 488
Paralytics 488
Prone Positioning 488
Fluid Balance 489
NONVENTILATOR THERAPIES OF UNCERTAIN BENEFIT 489
Steroids 489
Inhaled Nitric Oxide 490
Statins 490
Extracorporeal Life Support 490
FUTURE DIRECTIONS 490
Prevention 491
Early Identification 491
SUMMARY 491
REFERENCES 491
Critically Ill Patients with Interstitial Lung Disease 497
Key points 497
INTRODUCTION 497
EPIDEMIOLOGY 497
UNDERLYING PHYSIOLOGY 498
RESPIRATORY FAILURE 498
Outcomes 498
VENTILATORY STRATEGIES 498
Noninvasive Ventilation 498
High-Flow Nasal Cannula 500
Invasive Mechanical Ventilation 501
WORSENING OF ESTABLISHED DIAGNOSIS 502
Acute Exacerbation of Idiopathic Pulmonary Fibrosis 502
Acute Exacerbation of Non–Idiopathic Pulmonary Fibrosis Interstitial Lung Disease 504
PERIOPERATIVE 504
Nonpulmonary Procedures 504
Pulmonary Surgery 505
Lung cancer 505
Open lung biopsy for diagnosis of interstitial lung disease 505
NEW DIAGNOSIS OF INTERSTITIAL LUNG DISEASE IN THE INTENSIVE CARE UNIT 505
PULMONARY HYPERTENSION 506
EXTRACORPOREAL LIFE SUPPORT 507
LUNG TRANSPLANT 507
SUMMARY 507
REFERENCES 507
Management of Right Heart Failure in the Intensive Care Unit 511
Key points 511
INTRODUCTION 511
DIAGNOSTIC CLUES 511
ASSESSMENT OF RIGHT HEART FAILURE 512
MANAGEMENT 513
Intravascular Volume Management 513
Vasoactive Support 513
The sympathomimetic vasopressors 514
Vasopressin 514
Dopamine 514
Epinephrine 514
Inotropic therapy 514
Pulmonary Vasodilators 515
Inhaled nitric oxide 515
Prostanoid analogue therapy 515
Phosphodiesterase-5 inhibitors 515
SUMMARY OF VASOACTIVE SUPPORT 516
Adjunctive Support 516
Maintenance of Sinus Rhythm 516
Ventilator Strategies 516
Rescue Interventions 516
Atrial septostomy 516
Potts shunt 517
SUMMARY 517
REFERENCES 517
Advances in Sepsis Research 521
Key points 521
INTRODUCTION 521
PATHOGENS AND PATHOGEN TOXINS 521
Pathogen Toxins Induce an Inflammatory Response 522
Sequestration as the Initial Step in Limiting the Adverse Effects of Pathogen Toxins 522
Subsequent Clearance of Pathogen Toxins from the Circulating Lipoprotein Compartment 522
How This Knowledge May Lead to Innovative Therapeutic Strategies 522
INNATE IMMUNE SIGNALING INDUCED BY PATHOGEN TOXINS 523
Innate Immune Receptors 523
Toll-like receptors 523
NOD-like receptors 523
Retinoic acid-inducible gene-like receptors 523
Nuclear factor-κB and alternative signaling pathways 525
An Example of Septic Organ Dysfunction: Proinflammatory and Antiinflammatory Responses in the Heart 525
How This Knowledge May Lead to Innovative Therapeutic Strategies 525
VASCULAR LEAK 525
Fluid Homeostasis in Sepsis 525
Vascular Leak and the Vasopressin Axis in Sepsis 526
Sphingosine-1-Phosphate and Endothelial Permeability 527
How This Knowledge May Lead to Innovative Therapeutic Strategies 527
Why Have Most Sepsis Trials Failed? 527
SUMMARY 528
REFERENCES 528
Management of Infections with Drug-Resistant Organisms in Critical Care 531
Key points 531
INTRODUCTION 531
TREATMENT 531
Gram-negative Infections 532
Gram-positive Infections 535
Fungal Infections 536
DIAGNOSTICS 538
SUMMARY 538
REFERENCES 538
Index 543