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Critical Care Handbook of the Massachusetts General Hospital
Sample Weaning Strategies for Opioids, Dexmedetomidine, and Midazolam - Flowchart
Table of Contents
Free Topics
About
Acute Coronary Syndromes
Adverse Drug Reactions
Calculator - Cardiac Output (Fick)
Calculator - Sodium Deficit
Coagulopathies and Hemostatic Abnormalities in the Critically Ill
Complications of Blood Transfusion Therapy
Considerations Surrounding Resuscitative Strategies
Diagnostic Testing and Treatment for Adrenal Insufficiency
Drug Overdose
Electrolyte Abnormalities: Calcium, Phosphorus, and Magnesium
Etiology and Pathophysiology
Figure - A: Hemodialysis Achieves Solute Clearance by Diffusion Across a Semipermeable Membrane from a Higher Concentration (in the Patient’s Blood) to a Lower Concentration
Figure - Acute Acalculous Cholecystitis (AAC)
Flowchart - Pathophysiology of Trauma-Induced Coagulopathy (TIC) and Corresponding Triggers of Thromboelastometry and Whole-Blood Impedance Aggregometry
Flowchart - Point-of-Care Algorithm for Bleeding Management in Cardiovascular Surgery Guided by Thromboelastometry and Whole-Blood Impedance Aggregometry
Heart Failure
Hemorrhage
Hf Management and Treatment
Neuromuscular Junction Disorders
Normal Adrenal Physiology and Pathophysiology of Adrenal Insufficiency
Preeclampsia
Respiratory Support
Specific Gastrointestinal Problems by Organ
Specific Injuries
Substances of Abuse and Addiction
Table - Abridged Massive Transfusion Protocol of the Massachusetts General Hospital
Table - Adjusted Fluid Calculations
I. General Principles
1. Hemodynamic Monitoring
1. Hemodynamic Monitoring
Alternatives to Blood Pressure Monitoring
Arterial Blood Pressure Monitoring
Central Venous Pressure Monitoring
F - 1-1 The Assumptions When Extrapolating Mean Arterial Pressure (MAP) to a Morbidity and Mortality Benefit
F - 1-2 Arterial Waveforms as One Travels Distally along the Arterial Tree
F - 1-3 The Central Venous Pressure (CVP) Waveform
F - 1-4 Characteristic Pressure Waves Seen During Insertion of a Pulmonary Artery Catheter
Pulmonary Artery Catheters
Selected Readings
T - 1-1 Risks and Benefits of Different Central Line Access Approaches
10. Critical Care of the Neurologic Patient
10. Critical Care of the Neurologic Patient
Blood Pressure Management
Brain Death Determination
F - 10-1 Intracranial Compliance Curve
F - 10-2 Intracranial Pressure Wave
F - 10-3 Checklist for Brain Death Determination Criteria
Glucose Management
Management of Elevated ICP
Management of Status Epilepticus
Mechanical Ventilation in the Neuro ICU
Monitoring
Neuroimaging
Selected Readings
Sodium and Water Homeostasis
T - 10-1 Common Findings in Brainstem Lesions
Temperature Regulation
11. Nutrition in Critical Illness
11. Nutrition in Critical Illness
Assessment of Nutritional Status
Complications of Parenteral Nutrition
Components of Nutrition
Delivery Route of Enteral Nutrition
Dose of Enteral Nutrition
Enteral Formulas
Enteral Nutrition
Gastric Residual Volume (GRV) and Risk of Aspiration
Indications and Timing of Nutritional Support
Monitoring of Nutrition
Nutritional Modifications in Disease
Parenteral Nutrition
Pathophysiology of Nutrition in Critical Illness
Selected Readings
Supplemental Nutrition Therapy
T - 11-1 Modified NUTRIC Score
T - 11-2 NRS-2002 Score
T - 11-3 Two Examples of Predictive Equations for the Estimation of Resting Energy Expenditure
T - 11-4 Enteral Formulas Used at the Massachusetts General Hospital
T - 11-5 Calculation of TPN Contents
T - 11-6 Recommended Daily Doses of Electrolytes, Vitamins, and Trace Elements
12. Infectious Disease
12. Infectious Disease
Advances and Challenges in Sepsis
Antibiotic Resistance and Infection Prevention
Empiric and Emergency Treatment
F - 12-1 Antimicrobial De-Escalation Management Strategies
F - 12-2 Summary of the Management Strategies for a Patient with Suspected Hospital-Acquired Pneumonia (HAP) or Ventilator-Associated Pneumonia (VAP)
Fungal Infections
Hospital-Acquired Infections
Infective Endocarditis
Intra-Abdominal Infections
Intravascular Catheter-Related Infections
Selected Readings
Skin and Soft Tissue Infections
T - 12-1 Potential Sites of Infection in Patients in the Intensive Care Unit
T - 12-10 Definition of Infective Endocarditis According to the Proposed Modified Duke Criteria
T - 12-11 Definition of Terms Used in the Proposed Modified Duke Criteria for the Diagnosis of Infective Endocarditis (IE)
T - 12-12 Treatment Recommendations for Native Valve and Prosthetic Valve Infective Endocarditis (IE)
T - 12-2 Classification of Common Pathogenic Bacterial Genera and Species
T - 12-3 Susceptibility of ICU and Non-ICU Ward Subsets of Lower Respiratory Tract Infection Isolates of Pseudomonas aeruginosa and Enterobacterales to C/T and Comparator AgentsâSMART 2018-2019, United States
T - 12-4 Common Pathogens and Sites of Infection in Patients Who Are Critically Ill
T - 12-5 Review of Selected -Lactam Antibiotics
T - 12-6 Review of Selected Cephalosporin Antibiotics
T - 12-7 Common Causes of Persistent Fever
T - 12-8 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)
T - 12-9 Criteria for Defining Severe Community-Acquired Pneumonia
Thoracic Infections
Urinary Tract Infections
Viral Infections
13. Critical Care Management of Covid-19
13. Critical Care Management of Covid-19
Intensive Care Unit Management
Long-Term Sequelae of Severe Covid-19
Multiorgan Involvement
Preventing Infection in the Intensive Care Unit
Selected Readings
14. Transporting the Patient Who is Critically Ill
14. Transporting the Patient Who is Critically Ill
ICU Patient Hospital Transport Checklist
ICU Patient Hospital Transport Status Checklist
Minimizing Risks of Transport
Modes of Transport
Risks Associated with Transport
Selected Readings
Special Patient Populations
T - 14-1 Verbal Hand-off Between Sending and Receiving Providers
T - 14-2 Systems-Based Complications
T - 14-3 Patient-Based Complications
T - 14-4 Complications Associated with Transport
T - 14-5 Essential Components of Safe Patient Transport
T - 14-6 Indications for Elective Intubation Prior to Transport
T - 14-7 Transport Medicine Society Recommendations for COVID-19
T - 14-8 Medical Conditions Potentially Worsened by Altitude and Air Transport
Use of Checklists
15. Coronary Artery Disease
15. Coronary Artery Disease
Acute Coronary Syndromes
Angina
Complications of Myocardial Infarction
Perioperative Myocardial Ischemia and Infarction
Selected Readings
T - 15-1 Location of Acute Ischemia or Infarct by Electrocardiograph
T - 15-2 Contraindications to -Blockers in Acute Coronary Syndrome
T - 15-3 Comparison of Thrombolytic Drugs
16. Valvular Heart Disease
16. Valvular Heart Disease
Antibiotic Prophylaxis for Endocarditis/Rheumatic Heart Disease
Aortic Regurgitation
Infective Endocarditis
Mitral Regurgitation
Mitral Stenosis
Prosthetic Valves
Pulmonic Valve Disease
Selected Readings
T - 16-1 Qualitative Summary of Acute Hemodynamic Goals of Left-Sided Valvular Lesions
Tricuspid Regurgitation
Tricuspid Stenosis
2. Respiratory Monitoring
2. Respiratory Monitoring
F - 2-1 Red and Infrared Wavelengths Used in Pulse Oximetry and Corresponding Types of Hemoglobin
F - 2-10 Approaches to Determining Transpulmonary Pressure
F - 2-11 Gastric Pressure Measurement in a Patient with Diaphragm Paralysis
F - 2-12 Electric Impedance Tomography (EIT)
F - 2-13 Campbell Diagram
F - 2-2 Oxyhemoglobin Dissociation Curve
F - 2-3 Pulse Oximeter Waveform from a Patient Who Responded to Volume Expansion and from Another Who Did not Respond to Volume Expansion
F - 2-4 Normal Capnogram
F - 2-5 An Increased Phase III Occurs in the Capnogram in Patients with Obstructive Lung Disease
F - 2-6 The Volume-Based Capnogram
F - 2-7 Use of the Partial Carbon Dioxide Rebreathing Method to Measure Cardiac Output Using Capnometry
F - 2-8 Peak Alveolar Pressure (Pplat) is Determined by Applying an End-Inspiratory Breath-Hold
F - 2-9 Use of the Tidal Volume Waveform to Measure Time Constant () and Calculate Expiratory Airway Resistance
Indicators of Oxygen Delivery, Consumption, and Gas Exchange
Lung Mechanics
Measurement of Lung Mechanics
Measurements Taken from a Spontaneously Breathing Patient on a Ventilator
Mechanical Ventilation Basics
Methods of Monitoring Gas Exchange
Static Pressure-Volume Curves
Work of Breathing
3. Use of Ultrasound in Critical Illness
3. Use of Ultrasound in Critical Illness
Acknowledgments
Basic Versus Advanced Critical Care Echocardiography
F - 3-1 Transthoracic Echocardiograms Showing the Basic Views Needed for a Goal-Directed Echocardiographic Examination in the Intensive Care Unit (ICU)
F - 3-2 Ultrasound Examination of the Lung
F - 3-3 Selected Images from a Focused Assessment with Sonography for Trauma (FAST) Exam
Lung Ultrasound
Other Applications of Point-of-Care Ultrasound in the Intensive Care Unit
Selected Readings
T - 3-1 Suggested Uses for Point-of-Care Ultrasound in the Critical Care Setting
Ultrasound Utility in Critical Care Medicine
4. Airway Management
4. Airway Management
Assessment of the Need for an Advanced Airway
Endotracheal and Tracheostomy Tube Maintenance
Endotracheal and Tracheostomy Tubes
Extubation
F - 4-1 Optimal Patient Positioning
F - 4-2 Laryngoscopes (Clockwise from Bottom Left
F - 4-3 Endotracheal Tubes (Top to Bottom
F - 4-4 Supraglottic Airways (Left to Right
F - 4-5 Difficult Airway Algorithm
Indications for Advanced Airway
Intubation Pharmacology
Intubation Techniques
Preparation for Placement of an Advanced Airway
Selected Readings
Special Intubating Circumstances
T - 4-1 Endotracheal Tube Sizes
T - 4-2 Contents of Emergency Airway Kit
Tracheostomy
5. Mechanical Ventilation
5. Mechanical Ventilation
Breath Types During Mechanical Ventilation
Classification of Mechanical Ventilation
Complications of Mechanical Ventilation
F - 5-1 Simplified Block Diagram of a Mechanical Ventilator System
F - 5-10 Examples of Pressure Support Ventilation with Termination Flows of 10%
F - 5-11 Synchronized Intermittent Mandatory Ventilation
F - 5-12 Synchronized Intermittent Mandatory Ventilation with Pressure Support
F - 5-13 Airway Pressure Release Ventilation (APRV)
F - 5-2 Factors Affecting Aerosol Delivery During Mechanical Ventilation
F - 5-3 An Algorithm for Application of Noninvasive Ventilation
F - 5-4 Constant-Flow Volume Ventilation
F - 5-5 Descending-Ramp Volume Ventilation
F - 5-6 Pressure-Controlled Ventilation
F - 5-7 Examples of Fast
F - 5-8 Continuous Mandatory Ventilation (Assist-Control Ventilation)
F - 5-9 Pressure Support Ventilation
High-Frequency Ventilation
Modes of Ventilation
Phase and Control Variables
Selected Readings
Specific Ventilator Settings
T - 5-1 Comparison of Several Breath Types During Mechanical Ventilation
The Equation of Motion
The Ventilator System
6. Hemodynamic Management
6. Hemodynamic Management
F - 6-1 Modified Scai Shock Checklist
Hypertension
Pharmacologic Therapies of Hypotension and Shock
Selected Readings
Shock
T - 6-1 Hemodynamic Parameters in Shock
T - 6-2 Commonly Used Vasopressor and Inotropic Agents: Receptor Selectivity
T - 6-3 Commonly Used Vasopressor and Inotropic Agents: Hemodynamic Effects and Major Clinical Side Effects
7. Sedation and Analgesia
7. Sedation and Analgesia
F - 7-1 General Stepwise Approach to Analgosedation
F - 7-2 Sample Weaning Strategies for Opioids, Dexmedetomidine, and Midazolam
Monitoring and Titration of Sedatives
Neuromuscular Blockade
Pain Management
Sedative Medications
Selected Readings
T - 7-1 The Richmond Agitation Sedation Scale (RASS)
8. Fluids, Electrolytes, and Acid-Base Management
8. Fluids, Electrolytes, and Acid-Base Management
Acid-Base Physiology
Acknowledgments
Electrolyte Abnormalities: Calcium, Phosphorus, and Magnesium
Electrolytes and Electrolyte Abnormalities: Sodium
Fluid Deficits and Replacement Therapy
Potassium
Selected Readings
T - 8-1 Total Body Water as a Percentage of Body Weight (%)
T - 8-2 Fluid Electrolyte Composition of Body Compartments
T - 8-3 Composition of Crystalloid Solutions
T - 8-4 Physiologic and Chemical Characteristics of Colloid Solutions
T - 8-5 Simple Acid-Base Disorders and Compensatory Changes
T - 8-6 Classification of Metabolic Acidoses
9. Trauma
9. Trauma
Diagnostic Studies and the Secondary Survey
Initial Evaluation and Primary Survey (The Abcdes)
Other Considerations
Specific Injuries
Summary
Trauma Resuscitation
II. Specific Considerations
17. Cardiac Dysrhythmias
17. Cardiac Dysrhythmias
Anesthesia-Related Topics
Bradyarrhythmia
Classification and Management
Conclusion
Epilepsy
Etiology
Selected Readings
T - 17-1 Cardiovascular Reflexes
T - 17-2 Current Antiarrhythmic Drug Therapy for Atrial Fibrillation
T - 17-3 Rate Control Medications for Atrial Fibrillation
T - 17-4 Drug-Induced Arrhythmias
Tachyarrhythmias
18. Heart Failure
18. Heart Failure
Cardiomyopathies
Hf Management and Treatment
Orthotopic Heart Transplant (Oht)
Selected Readings
T - 18-1 Triggers of Acute HF
T - 18-2 Signs and Symptoms of HF
T - 18-3 Stevenson Matrix
T - 18-4 New York Heart Association (NYHA) Class and AHA/ACC Staging
T - 18-5 Treatment Goals in HF
19. ECMO and Ventricular Assist Devices
19. ECMO and Ventricular Assist Devices
Extracorporeal Membrane Oxygenation (ECMO)
F - 19-1 IABP Tracing
F - 19-2 VA ECMO and VV ECMO
F - 19-3 Impella
Selected Readings
T - 19-1 LVAD Troubleshooting
Ventricular Assist Devices
20. Acute Respiratory Distress Syndrome
20. Acute Respiratory Distress Syndrome
Additional Strategies
Bedside Imaging and Monitoring
Development and Progression of Acute Respiratory Distress Syndrome
Epidemiology
Etiology
F - 20-1 Electrical Impedance Tomography (EIT)
Mechanical Ventilation in Patients with Acute Respiratory Distress Syndrome
Pathophysiology
Selected Readings
Treatment
21. Asthma and Chronic Obstructive Pulmonary Disease
21. Asthma and Chronic Obstructive Pulmonary Disease
Assessment
Definitions
Epidemiology
F - 21-1 Tracings of Volume (Obtained by Integration of the Flow Signal)
F - 21-2 Expiratory Flow Volume Curve During Passive Exhalation at Zero End-Expiratory Pressure in a Patient with Chronic Obstructive Pulmonary Disease
Pharmacologic Therapy
Physiology
Respiratory Support
Selected Readings
T - 21-1 Medications Used in Asthma or Chronic Obstructive Pulmonary Disease
22. Deep Venous Thrombosis and Pulmonary Embolism in the Intensive Care Unit
22. Deep Venous Thrombosis and Pulmonary Embolism in the Intensive Care Unit
Diagnosis
F - 22-1 A Patient with a Saddle Pulmonary Embolism (PE) As Seen on a PE Computed Tomography (CT)
F - 22-2 A Schematic of How Pulmonary Embolism (PE) Can Lead to Death
Follow-Up
Initial Evaluation of the Patient with Confirmed or Suspected Pulmonary Embolism
Selected Readings
T - 22-1 This Table Shows the Clinical Features that Are Used to Calculate the sPESI Score in Assessing PE Servility
Treatment
23. Pulmonary Hypertension
23. Pulmonary Hypertension
Critical Care Management of Pulmonary Hypertension and Right Ventricular Failure
Evaluation
F - 23-1 Diastolic Interventricular Septal Flattening (âD Signâ)
F - 23-2 PH Diagnostic Algorithm
F - 23-3 The âDeath Spiralâ of RV Failure
Management
Selected Readings
T - 23-1 PH Hemodynamic Definitions
24. Discontinuation of Mechanical Ventilation
24. Discontinuation of Mechanical Ventilation
Assessing for Ventilator Discontinuation Potential
Clinical Practice Guidelines
Decannulation
Definitions
Delirium in the Intensive Care Unit
Extubation
Extubation to Noninvasive Ventilation or High-Flow Nasal Cannula
Factors Contributing to a Failed Spontaneous Breathing Trial
Prolonged Mechanical Ventilation
Sedation Management
Selected Readings
Standardized Care of the Patient Who is Intubated
Summary
Technical Approaches to the Spontaneous Breathing Trial
Ventilator Dependence
Ventilator Modes and Weaning
25. Acute Kidney Injury
25. Acute Kidney Injury
Epidemiology
Etiology and Pathophysiology
Evaluation
F - 25-1 Stage-Based Management of AKI
F - 25-2 A: Hemodialysis Achieves Solute Clearance by Diffusion Across a Semipermeable Membrane from a Higher Concentration (in the Patientâs Blood) to a Lower Concentration
Management of Acute Kidney Injury (Figure 25.1)
Managing Complications of Acute Kidney Injury
Renal Replacement Therapy
Risk Factors
Selected Readings
T - 25-1 Classification of Acute Kidney Injury
T - 25-2 Etiologies of Acute Kidney Injury in the Intensive Care Unit
T - 25-3 Diagnostic Studies and Indices of Urine
26. Critical Care of Patients with Liver Disease
26. Critical Care of Patients with Liver Disease
Evaluation
Evaluation and Management of Acute Liver Failure
Management of Acute Decompensation
Postoperative Management of the Patient Undergoing Orthotopic Liver Transplantation
Selected Readings
27. Coagulopathy and Hypercoagulability
27. Coagulopathy and Hypercoagulability
Coagulopathies and Hemostatic Abnormalities in the Critically Ill
F - 27-1 Rotational Thromboelastometry/Thromboelastography (ROTEM/TEG) Parameters
F - 27-2 Characteristic Thromboelastometry Traces
F - 27-3 Pathophysiology of Trauma-Induced Coagulopathy (TIC) and Corresponding Triggers of Thromboelastometry and Whole-Blood Impedance Aggregometry
F - 27-4 Point-of-Care Algorithm for Bleeding Management in Cardiovascular Surgery Guided by Thromboelastometry and Whole-Blood Impedance Aggregometry
F - 27-5 Iceberg Model of HIT
Selected Readings
T - 27-1 Causes of Disseminated Intravascular Coagulation
T - 27-2 The HIT 4T Score
Treatment
28. Acute Gastrointestinal Diseases
28. Acute Gastrointestinal Diseases
Evaluation of Suspected Gastrointestinal Pathology
F - 28-1 A Plain Chest Radiograph Demonstrating Pneumoperitoneum (Left) and an Abdominal Film Demonstrating Small Bowel Obstruction and Nasogastric Tube Placement (Right)
F - 28-2 Acute Pancreatitis
F - 28-3 Acute Acalculous Cholecystitis (AAC)
F - 28-4 Small Bowel Obstruction
F - 28-5 Cecal Volvulus
Gastrointestinal Bleeding
Selected Readings
Specific Gastrointestinal Problems by Organ
T - 28-1 Diagnostic Modalities for Acute Gastrointestinal Diseases in the Intensive Care Unit
T - 28-2 Causes of Gastrointestinal (GI) Bleeding
T - 28-3 Ranson Criteria for Prognosis of Acute Pancreatitis
T - 28-4 Causes of Ileus
29. Endocrine Disorders and Glucose Management
29. Endocrine Disorders and Glucose Management
Adrenal Insufficiency in Septic Shock
Carcinoid Syndrome
Cushing Syndrome
Diabetic Ketoacidosis
Diagnosis and Treatment of Hypercalcemia
Diagnostic Testing and Treatment for Adrenal Insufficiency
F - 29-1 Diagnosis and Management of Hyperglycemic Emergencies
F - 29-2 Regulation of Adrenal Hormone Secretion
F - 29-3 Regulation of Thyroid Hormone Secretion and Activity
Hyperglycemia of Critical Illness
Hyperosmolar Hyperglycemic State
Normal Adrenal Physiology and Pathophysiology of Adrenal Insufficiency
Pheochromocytoma and Paraganglioma
Regulation of Calcium Homeostasis
Selected Readings
Special Considerations in Thyroid Disorders
T - 29-1 Insulin Infusion Initial Dosing
T - 29-2 Insulin Infusion Adjustment
T - 29-3 Causes of Diabetic Ketoacidosis
T - 29-4 Differential Diagnosis of Anion Gap Acidosis
T - 29-5 Differential Diagnosis of Adrenal Insufficiency
T - 29-6 Glucocorticoid and Mineralocorticoid Activity
Thyroid Function and Disease
Thyroid Function in Critical Illness
30. Acute Weakness
30. Acute Weakness
Myopathic Causes
Neuromuscular Junction Disorders
Other Causes
Pns Causes
Selected Readings
T - 30-1 Manual Muscle Testing Screen for ICU-Acquired Weakness in Cooperative Patients
T - 30-2 Medications that Can Exacerbate Symptoms of Myasthenia Gravis (MG)
31. Drug Overdose, Poisoning, and Adverse Drug Reactions
31. Drug Overdose, Poisoning, and Adverse Drug Reactions
Adverse Drug Reactions
Drug Overdose
F - 31-1 The Rumack-Matthew Nomogram is Designed to Help Determine the Risk of Hepatotoxicity Based on Hours Since Ingestion (x-Axis) Versus the Serum Acetaminophen Level in G/Ml (Y-Axis)
Nerve Agent Toxicity
Poisonings
Selected Readings
Substances of Abuse and Addiction
T - 31-1 Kingâs College Criteria for Need for Liver Transplantation
T - 31-2 Dosing Regimen for N-acetylcysteine
T - 31-3 Hunter Serotonin Toxicity Criteria
T - 31-4 NIAID Criteria for Anaphylaxis
T - 31-5 Dosing Regimen for Ethanol and Fomepizole
32. Adult Resuscitation
32. Adult Resuscitation
Algorithm
Basic Life Support (BLS)
Causes of Cardiac Arrest
Dysrhythmias
F - 32-1 Adult Cardiac Arrest Algorithm
Medications
Postresuscitation Care
Recognition
Selected Readings
Special Scenarios
Teamwork and Leadership
Termination of Resuscitation (Tor)
Vascular Access
33. Burn Critical Care
33. Burn Critical Care
Burn Wound Management
Burn-Specific Secondary Survey
Chemical Burns
Cold Injury
Components of Primary Survey in Patients with Burns
Considerations Surrounding Resuscitative Strategies
Electrical Injury
Electrolyte Abnormalities and Acute Renal Failure
F - 33-1 Zones of Burn Injury
F - 33-2 Schematic of ârule of 9âsâ to Estimate Burn Surface Area in Adults
F - 33-3 Schematic of Burn Escharotomy Incisions
F - 33-4 Schematic of Burn Escharotomy Incisions for Hand Burns
Inhalation Injury and Carbon Monoxide Poisoning
Mechanical Ventilation
Metabolic Response and Nutrition
Selected Readings
Significant Morbidity and Mortality Associated with Thermal Burns with Inhalational Injuries
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis
T - 33-1 Adjusted Fluid Calculations
Tools to Help in Hemodynamic Monitoring
34. Transfusion Medicine
34. Transfusion Medicine
Blood Component Therapy
Blood Conservation and Salvage Techniques
Complications of Blood Transfusion Therapy
Massive Transfusions
Pharmacologic Therapy
Pretransfusion Testing
Selected Readings
Synthetic Blood Substitutes
T - 34-1 Transfusion Compatibility
T - 34-2 Treatment of Suspected Acute Hemolytic Transfusion Reaction
T - 34-3 Abridged Massive Transfusion Protocol of the Massachusetts General Hospital
35. Obstetric Critical Care
35. Obstetric Critical Care
Acute Fatty Liver of Pregnancy
Acute Respiratory Distress Syndrome
Amniotic Fluid Embolism
Cardiopulmonary Resuscitation
Cardiovascular Disorders
Endocrine Disorders
F - 35-1 Causes of Maternal ICU Admission in Developed Nations from 2006 to 2019
General Considerations Relevant to the Obstetric, Critically Ill Population
Hemorrhage
Local Anesthetic Systemic Toxicity
Neurologic Disease
Preeclampsia
Selected Readings
Sepsis
T - 35-1 Physiologic Changes of Pregnancy
T - 35-2 Blood Gas Measurements During Pregnancy
T - 35-3 Diagnostic Criteria for Preeclampsia and Preeclampsia with Severe Features
Trauma
Venous Thromboembolism
III. Health Care Services
36. Intensive Care Unit Handoffs and Transitions
36. Intensive Care Unit Handoffs and Transitions
Commonly Used Handoff Tools
Communication and Teamwork Strategies in Other Industries
Communication Strategies Adapted for Health Care: Teamstepps
Elements of Successful Handoffs
Essential Role of Communication in Adverse Events
F - 36-1 Teamstepps 2.0 Framework and Competencies
F - 36-2 I-Pass Framework
F - 36-3 Example of Institution-Specific Implementation of I-Pass Framework for Transitions of Care Between the ICU and the OR
F - 36-4 Considerations for Handoff Redesign
Implementing Handoff Tools in the Intensive Care Unit
Selected Readings
Sustaining Improvements
Types of Handoffs in the Intensive Care Unit
Written and Verbal Handoffs
37. Recovery After Critical Illness
37. Recovery After Critical Illness
Acute Respiratory Distress Syndrome
Selected Readings
Sepsis
Trauma
Traumatic Brain Injury
38. The Economics of Critical Care: Measuring and Improving Value in the Intensive Care Unit
38. The Economics of Critical Care: Measuring and Improving Value in the Intensive Care Unit
Influence of Policy Environment
Selected Readings
T - 38-1 Outcomes Hierarchy for Critical Care
T - 38-2 Five Things Physicians and Patients Should Question: The Choosing Wisely Campaign
The Value of Critical Care Expenditures
39. Telemedicine and Remote Electronic Monitoring Systems in the Intensive Care Unit
39. Telemedicine and Remote Electronic Monitoring Systems in the Intensive Care Unit
Barriers and Challenges to Tele-ICU
F - 39-1 Centralized Tele-ICU Model
F - 39-2 Decentralized Model of Tele-ICU
F - 39-3 Tele-ICU Workflow
History of Intensive Care Unit Telemedicine/Tele-ICU
Organization of Tele-ICU Service
Selected Readings
Summary
Tele-ICU Models and Organization of Service
Tele-ICU Outcomes and Quality Metrics
40. Quality Improvement and Standardization of Practice
40. Quality Improvement and Standardization of Practice
F - 40-1 The Plan-Do-Study Act (PDSA) Cycle
F - 40-2 The Massachusetts General Hospital Central Line Infection Prevention Checklist
F - 40-3 The ABCDE Bundle
Infection Control and the Intensive Care Unit
Quality Metrics, Morbidity, and Safety in the Intensive Care Unit
Selected Readings
Standardization
41. Ethical, Legal, and End-of-Life Issues in Intensive Care Unit Practice
41. Ethical, Legal, and End-of-Life Issues in Intensive Care Unit Practice
F - 41-1 Get to Know Me Posters
Goals of Care
Guidelines for Withdrawing Life-Sustaining Therapies
Limited Resource Allocation
Medical Errors in the Intensive Care Unit
Organ Donation
Palliative Care in the Intensive Care Unit: It is not Just for the End of Life
Pharmacologic Choices
Proactive Approach
Selected Readings
Special Populations
Supporting Providers
T - 41-1 Proactive Measures to Minimize Moral Distress and ICU Conflict
T - 41-2 Framework and Example Scripting for ICU Family Meetings
The Family Meeting
Treatment Decisions
42. Intensive Care Unit Care After Organ Transplant
42. Intensive Care Unit Care After Organ Transplant
Liver Transplantation
Lung Transplantation
Renal Transplantation
Selected Readings
T - 42-1 Immunosuppressive Medications
T - 42-2 Extended Donor Criteria for Liver Transplantation
43. Disaster Management
43. Disaster Management
Component Categories
Disaster Planning and Preparedness
Evaluation by Functional Domains
F - 43-1 The Incident Command System Structure Offers a Simple Mechanism to Facilitate Command and Control During a Disaster
F - 43-2 The Challenge of Uncertainty Regarding Potential Disaster Limits âcompleteâ Efforts Regarding Anticipatory Planning
F - 43-3 A Planning Team for an ICU Can Provide Direction to Specific Efforts for Planning and Preparation
Intensive Care Unit Disaster Team
Key Roles and Stakeholders
Management
Overview of Disaster Management
Recovery
Selected Readings
T - 43-1 Global Planning Shortfalls
T - 43-2 Elements of Disaster Preparation
T - 43-3 Preparation for Disaster Management
T - 43-4 Component Categories
Unit Analysis
Front Matter
Contributors
Preface
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