Update in Intensive Care Medicine – serie

Respiratory failure is a complex disease process whereby the underlying disease and therapeutic measures interact. This book contains an extensive bibliographic review, focusing on preventive and therapeutic studies, that was methodologically standardized, with authors assessing and classifying studies according to statutes of evidence-based medicine. It considers the epidemiology and outcome of mechanical ventilation; addresses ventilator modes and utility of pulmonary mechanics monitoring for treatment; analyzes physiologic effect and patient-outcomes of pulmonary recruitment and lung protective ventilation procedures; describes complications that can be present in these patients such as ventilator-associated pneumonia and useful methods to prevent respiratory infections; covers the impact of bronchodilators, corticosteroids, and antibiotics in acute exacerbation of chronic obstructive pulmonary disease; discusses how, when, and in whom to do tracheostomy; and evaluates the use of sedation and neuromuscular blockade as well as current clinical trials in acute lung injury.

Hemodynamic monitoring is one of the major diagnostic tools available in the acute care setting to diagnose cardiovascular insufficiency and monitor changes over time in response to interventions.

There have been tremendous advances in understanding the cellular mechanisms involved in sepsis and contributing to the development of multiple organ dysfunction and mortality in this setting. The chapters in this book provide up-to-date insights into important pathways that are initiated by sepsis.

This volume presents the latest updates in the basic science and clinical issues associated with coronary circulation and myocardial ischemia. New and clinically relevant aspects of coronary blood flow are reviewed in a four-part structure: (1) The basic physiology of coronary blood flow, its control and dysregulation with atherosclerotic disease. (2) The applied physiological aspects of blood flow and myocardial performance. Important concepts such as pre-conditioning, inflammation and thrombosis and fibrinolysis are addressed within the context of ventricular pump function. (3) The functional assessment of the coronary circulation, going beyond coronary angiography and nuclear scanning to address cutting edge technologies including echocardiographic analysis of tissue blood flow, PET analysis of myocardial viability, rapid nuclear magnetic imaging, and intracoronary ultrasound imaging. (4) Non-thrombotic, anti-thrombotic and thrombolytic therapies for coronary ischemia.

This book brings together basic scientists or clinicians from a variety of different backgrounds - immunology, infectious diseases or critical care - who share a common interest in understanding the changes that occur in immune responses in sepsis.

Researchers from many disciplines, with both basic and clinical perspectives, came together in this volume to review and debate issues pertaining to the investigation and control of tissue oxygenation in acute medicine, as well as treatments to improve tissue oxygenation when abnormal. In this latter context, special emphasis is placed on understanding the effect of blood substitutes on the circulation and on the potential roles of this family of compounds in clinical medicine.

Critically ill and critically injured patients require specialized nutrition support to avoid the complications of progressive malnutrition. There is a paucity of information providing practical solutions to these difficult clinical problems. From Nutrition Support to Pharmacologic Nutrition in the ICU focuses on the theoretical and practical aspects of the management of this high-risk patient population. Each chapter presents a state-of-the-art discussion of nutritional and metabolic issues relevant to this resource-intensive patient population and contains current references, liberal tables and figures, and the personal insights of recognized international leaders in this field.

This book describes how the integrated approach offered by health services research can improve the quality of care provided to critically ill patients. By focusing on the needs of the patient, health services research links conventional scientific disciplines, systems research, education, and management, with the aim of translating developments in knowledge into sustained change in culture and practice. Intensive care has much to offer in this respect, as it can both benefit from and contribute to the collaborative methodology of health services research. Although the contributions are directed at critical care, the content is relevant to all health care disciplines, including health services administration.

This volume covers the most important aspects of cerebral blood flow (CBF) from bench to bedside. It first defines the basic physiology of CBF, those qualities that make it unique or are shared with other organs and their clinical implications. There follows a section on CBF pathophysiology that explores many of the known and proposed mechanisms of cerebral ischemia in stroke and trauma states. The third section describes the numerous and powerful means available to measure blood flow, tissue function and overall perfusion. These are essential measures if one is to assess the effectiveness of therapies aimed at preventing or reversing cerebral ischemia. The final section describes the interesting and often successful recent clinical trials aimed at preventing or reversing cerebral ischemia. This collection of multicenter trial data and their implications in one volume is unique in this field. This book addresses all the major aspects of CBF from basic issues to clinical practice.

Whereas a great deal has been learned during the past quarter century about the inflammatory processes associated with sepsis (and other related conditions, such as ischemia/reperfusion injury), our understanding is far less developed with respect to the pathophysiological events that lead to organ dysfunction under these conditions.

For many years, intensive care has focused on avoiding immediate death from acute, life-threatening conditions. However, there are increasing reports of a number of lingering consequences for those who do indeed survive intensive care. Examples include on-going high risk of death, neurocognitive defects, significant caregiver burden, and continued high healthcare costs.Surviving Intensive Care, written by the world's experts in this area, is dedicated to better understanding the consequences of surviving intensive care and is intended to provide a synopsis of the current knowledge and a stimulus for future research and improved care of the critically ill.