More than 20 years ago it was recognized by Stoutenbeek and colleagues that patients in the intensive care unit suffered from infections developed whilst being treated. Moreover, the majority of these infections appeared to originate from bacteria that were acquired in the intensive care leading to pathologic colonisation and overgrowth in the gut, subsequently leading to organ site infections. Selective decontamination of the digestive tract (SDD) is an antibiotic strategy which aims to prevent secondary infections in critically ill patients. This book provides both the scientific rationale and the practical approach to nurses, physicians, pharmacists and microbiologists to design a SDD treatment strategy tailored to each individual patient and the local hospital situation.

Improving standards of care is a real challenge in Intensive Care Medicine. Bettering clinical performance, patient safety, risk management and audit represents the cornerstone for raising the quality of care in ICU patients. Communication is the platform from where to start to reach a consensus in an extremely crowded area, a unique multidisciplinary and multiprofessional environment in which quality of care and, ultimately, patient survival need to be ameliorated.

This practical and evidence-based workbook offers a series of assessment, implementation and evaluation activities for professionals working in critical care contexts. Designed to improve the quality of care delivery, it looks both at collaboration between professionals and between patients and/or family members. Collaborative Practice in Critical Care Settings: identifies the issues relating to the "current state" of collaboration in critical care through a series of assessment activities; provides a series of interventional activities which can address shortfalls of collaboration previously identified; and offers advice on generating evidence for the effects of any interventions implemented. The activities presented in this book are based on extensive empirical research, ensuring this book takes into account the everyday work environment of professionals in critical care units. It is suitable for practitioners and educators, as well as patient safety leads and managers.

In modern medicine the most functional methodologies are taking an increasing importance in spreading informations, rendering it credible while at the same time using reliable data to focus interaction between basic science and clinical medicine. Critical care medicine embraces these needs and more than any other discipline thrives and develops thanks to interdisciplinary contact.

APICE 2004 has been organised to provide precise answers to these issues. In particular, considerable emphasis has been given to the reviews regarding the most important aspects - or the most significant clinical developments - in the sectors involving variety of functions: neurological, respiratory and cardiovascular, gastrointestinal, metabolism and perfusion; trauma infections, sepsis and organ failure; perioperative medicine and life support techniques; information technology dedicated to clinical medicine, but also as a means of information and education. The contributing authors are all part of leading research groups at the international level in the various sectors presented in the volume.

The Annual Update compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

Leading neurocritical care and intensive care specialists from the Neurosciences Critical Care Unit of the Johns Hopkins Hospital have joined forces to spell out concisely for first line health care providers the diverse standards and therapeutic regimens required for the care of critically ill neurological and neurosurgical patients. Their authoritative reference guide takes an algorithmic approach to immediate patient care, incorporating both ancillary investigation to confirm clinical diagnosis and appropriate management guidelines. The book offers comprehensive summaries of the best diagnostic and management practices for a wide range of neurocritical problems, including encephalopathy, intercerebral and subarachnoid hemorrhage, traumatic brain injury postoperative care, ischemic stroke, brain tumors, spinal cord injury, and more. A compact disk accompanies the book for downloading an ebook version to the reader's PC or PDA.
Authoritative and highly practical, the Handbook of Neurocritical Care offers first-line hospital physicians and EMS personnel a comprehensive quick-reference guide to the rapid diagnosis and management of critically ill neurological and neurosurgical patients.

Preface

Introduction

Heino von Prondzynski, Member of the Executive Committee of
F. Hoffmann-La Roche AG and Head of the Diagnostics Division

Winner of the 2002 IFCC-Roche Diagnostics Award

"Apoptosis In Sepsis And Multiple Organ Dysfunction Snydrome"

S. Zeerleder, B. Zwart, W. A. Wuillemin, L. A. Aarden, A. B. J. Groeneveld,
C. Caliez, A. E. M. van Nieuwenhuijze; G. J. van Mierlo, A. J. M. Eerenberg,
B. L??mmle, and C. E Hack

Inflammation ??? Infection ??? Sepsis

Finalists

"Plasma Procalcitonin And C-Reactive Protein In Acute Septic Shock:
Clinical And Biological Correlates"

R. Claeys, S. Vinken, H. Spapen, K. ver Elst, L. Huyghens, F. K. Gorus

National Winners

"4G/5G Promoter Polymorphism In The Plasminogen Activator Inhibitor-1
Gene In Children With Systemic Meningococcaemia"

G. Geishofer, W. Zenz, B. Resch, S. Panzer, G. Endler, D. H??ring,
C. Mannhalter

Hypoxia ??? Ischaemia

Finalist

"Phospholipases A2 Levels And Distribution In Bronchoalveolar Lavage
Fluid Of Patients With Acute Respiratory Distress Syndrome (ARDS):
Application Of A Fluorimetric Method"

E. I. Kitsiouli, G. Nakos, M. E. Lekka

Blood Gases ??? Electrolytes ??? Trace Elements

National Winner

"Magnesium In The ICU"

A. Abraham, A. Bachwani

Cardiology ??? Haemodynamics ??? Stroke

Finalist

"Single-Point Troponin T Measurement On The Day Of Coronary Care
Unit Discharge After Myocardial Infarction Strongly Correlates With
Ejection Fraction And Infarct Size By Nuclear Imaging And With CK-MB
Release"

G. Bonetti, F. Pagani, R. Giubbini, C. Cuccia, M. Panteghini

National Winner

"Soluble Adhesion MoleculesIn Acute Stroke"

A. M. Simundic, V. Basic, E. Topic, V. Demarin, N. Vrkic, B. Kunovic,
M. Stefanovic, A. Begonja

Nephrology

National Winner

"Monitoring Of The Renal Functions During Continuous Renal
Replacement Therapy ??? The Application Of The Analysis Of Cystatin C
And Natriuretic Peptides"

M. Balik, A. Jabor, A. Hendl, M. Kol????, M. Pavlisov??, D. Brestan

Haematology ??? Haemostatis

National Winners

"Serum Levels Of Soluble Transferrin Receptors (sTfR) Correlate Better
With Severity Of Disease Than With Iron Stores In Patients With Malignant
Lymphomas"

J. Bjerner, L. M. Amlie, L. S. Rusten, E. Jakobsen

New Technology ??? Methods

Finalists

"A Rapid And Sensitive Immunoassay For Determination Of S-100 Protein
In A Point-Of-Care Setting"

S. Eriksson, L. Dean, K. Pettersson

National Winner

"A New Approach Of Endotoxin Testing By Using A Monoclonal Antibody
Against Endotoxin (WN1-222/5) And Flow Cytometry"

J. Nolde, F. E. Di Padova, H. Brade H., K. H. Staubach

Organizational Aspects

National Winner

"Improvement Of Critical Care Management In A Healthcare Area By
Implementing Point-Of-Care Testing In Primary Care. A Preliminary
Approach"

M. L. Hortas, I. P??rez-Montaut, M. Redondo, N. Montiel, R. Molina,
C. Gonz??lez

Miscellaneous

National Winners

"Studies On The Potential Effect Of Nitrite"

Y. Tian, C. Wang, S. Song

Index

About Roche and the Roche Diagnostics Division

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.

The coronary circulation is central to sustaining myocardial viability. Unlike the cir culations of most other organs, if the coronary circulation becomes insufficient to sustain myocardial contractile function, overall quality of life rapidly declines and life can abruptly end. In partnership with the cerebral circulation, the coronary circula tion plays a central role in sustaining life. However, unlike the cerebral circulation, whose function is self-sufficient to define life, the coronary circulation determines global blood flow and thus the initial state for the remainder of the body. This unique condition, together with the reality that coronary artery disease primarily affects peo ple in their productive years of life, has allowed physicians and scientists who study the heart to enjoy a privileged position in the field of medical research and clinical practice. Thus, it comes as little surprise that many new and exciting research developments involving the coronary circulation have recently come to the forefront of medical thinking. This reality, coupled with the large number of clinical trials of agents specif ically designed to sustain or improve coronary flow in many disease states, makes the timing of this monograph relevant. The book features papers presented at a recent international symposium, the fourth in a series of meetings on Applied Physiology of the Peripheral Circulation. The papers selected by the editors review the most impor tant advances in the fields of cardiology and the coronary circulation."

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.

Even if in the last years more information on sepsis and new treatments has become available, mortality rate is however high. In fact, the complexity of the several biohumoral factors involved in this process is difficult to understand. Another major problem is the consequent organ failure, which grows in a sequential way and in relation with the lesion gravity and the functional reserves of the patient. The volume presents the most recent results of research in this field.

This book will provide 300 practice MCQs divided into three practice papers. Correct answers will follow, accompanied by short referenced notes drawing from recent important journal articles, major critical care textbooks and selected internet resources. Since there is no other dedicated intensive care MCQ book on the market, this book would be relevant to the following groups: junior intensive care trainees, senior intensive care nursing staff wishing to enhance their medical knowledge, intensive care consultants as a teaching aid and trainees preparing for professional examinations. This MCQ book will also be ideal in preparation for the European Diploma in Intensive Care Medicine (EDIC) Part 1 examination, as the questions will be matched as closely as possible in style and difficulty to those in the EDIC Part 1. The EDIC is an internationally recognised qualification for medical trainees in intensive care, set by the European Society for Intensive Care Medicine (ESICM). It is a two-part examination consisting of a 100-question multiple choice paper (Part 1) and a clinical and viva voce examination (Part 2). To ensure relevance, the questions will be designed with reference to the training syllabus provided by the ESICM.

Critical care medicine is a relatively new specialty. Over the past few decades, we have seen an enormous growth in the number of inten sive care units (ICUs) worldwide. Medical students, residents, fellows, attending physicians, critical care nurses, pharmacists, respiratory ther apists, and other health-care providers (irrespective of their ultimate field of practice) will spend several months or years of their profes sional lives taking care of critically ill or severely injured patients. These clinicians must have special training, experience, and compe tence in managing complex problems in their patients. In addition, they must interpret the data obtained by many kinds of monitoring devices, and they must integrate this information with their knowl edge of the pathophysiology of disease. This handbook was written for every practitioner engaged in criti cal care medicine. We have attempted to present basic and generally accepted clinical information and some important formulas as well as laboratory values and tables that we feel will be useful to the practi tioner of critical care medicine. Chapter 1 provides an introduction to the ICU. Chapters 2 through 18 follow an outline format and are divided by organ system (i. e. , neurologic disorders, cardiovascular dis orders), as well as special topics (i. e. , environmental disorders, trauma, toxicology). In addition, many of these chapters review some useful facts and formulas systematically. Finally, Chapters 19 and 20 supply lists of pharmacologic agents and dosages commonly used in the ICU and laboratory values relevant to the ICU.

Over two decades an abundance of knowledge has been accumulated focus ing on the understanding of the molecular and cellular pathomechanisms of stressful conditions like systemic inflammation and sepsis. We have learned that there is a clear correlation between the magnitude of the inciting traumatic event and the degree of inflammatory dysbalance. The immunoinflammatory disintegration comprises a simultaneous col lapse of the otherwise very smoothly balanced pro- and antiinflammatory vectors of cytokine regulation. Most recently, we understood that it is predominantly the dysregulation of antiinflammatory mediators that plays a pivotal role for the phenomenon of trauma-induced depression or paralysis of cell-mediated immune responses. The substantial intellectual and logistic investments of numerous investi gators towards understanding the biology of sepsis inevitably lead us towards a rewarding status in terms of reaching spheres of clinical relevance. From the evolutionary collection of a multitude of ex-vivo and in-vivo immuno mechanistic parameters, some were found to represent most significant bio logical markers to support the clinician to characterize better the severity of inflammatory illness and to predict outcome. Chapter one of this book, authored by G. Grass and E.A.M. Neugebauer, analyses elegantly our current knowledge on the assessment of the immuno logical status in terms of risk and prognosis of sepsis.

Infections contracted by patients constitute an important factor in the manage- ment of any hospital unit. For patients with weakened resistance due to trauma, after surgery and in intensive care, infection-related complications have a nega- tive impact on care quality indicators, specifically in terms of protracted hospi- talisation time, increased costs from complications and extended hospitalisation, and increased mortality rate. Effective strategies to prevent and treat infections are a priority in optimising the cost-effectiveness of care. Infection control, diag- nostics and targeted antibiotic therapy require an integrated epidemiological, microbiological and clinical approach. This is indispensable for critically ill patients, especially when the processes of infection and sepsis are supported by micro-organisms which are multidrug-resistant and difficult to root out. The importance of this subject has been demonstrated by a European obser- vational study on the prevalence of hospital infections in patients under intensive care. In this study, the prevalence of infections contracted in a "high-risk" envi- ronment was 21 %, while other studies have observed that the incidence of pneu- monia in patients undergoing artificial ventilation varied between 8% and 54%, with a median of 24%. These figures alone are enough to show the clinical impor- tance of the infective process and the need for continuous interdisciplinary updating and exchanges of experience.

The interest of researchers, clinicians, practitioners and surgeons in critical care medicine is growing. Clinical pharmacology and new technologies now allow more appropriate therapies, and the commitment of all those involved in this field is of fundamental importance for reaching high interventional standards, in both the prevention and treatment of critical conditions, but also for satisfying the concept of cost-effectiveness in critical care. In this volume advances in critical care medicine are described, including the application of new technologies in the clinical setting, the full integration of computers and informatics, and the continual training of physicians and technicians.

This major reference work is the most comprehensive resource on oncologic critical care. The text reviews all significant aspects of oncologic ICU practices, with a particular focus on challenges encountered in the diagnosis and management of the critically ill cancer patient population. Comprised of over 140 chapters, the text explores such topics as the organization and management of an oncologic ICU, diseases and complications encountered in the oncologic ICU, multidisciplinary care, surgical care, transfusion medicine, special patient populations, critical care procedures, ethics, pain management, and palliative care. Written by worldwide experts in the field, Oncologic Critical Care is a valuable resource for intensivists, advance practice providers, nurses, and other healthcare providers, that will help close significant knowledge and educational gaps within the realm of medical care for critically ill cancer patients.

Extracorporeal membrane oxygenation (ECMO) has been in clinical use for some 40 years, but it is only in the past decade that its application in the treatment of life-threatening circulatory and respiratory failure has truly flourished. This book presents a comprehensive overview of both pathophysiological and practical aspects of circulatory and respiratory extracorporeal support. The basics of ECMO, including its history, the "ECMO team," cannulation, materials, and blood- surface interactions, are first discussed. The various indications for and particular characteristics of circulatory and respiratory extracorporeal life support are then described in detail in the main part of the book. Patient care during ECMO and monitoring of the ECMO patient are also carefully covered, with explanation of the management of technical and clinical complications and transport-related problems. Further topics include long-term therapy options beyond ECMO, such as ventricular assist devices and transplants, outcome, the new frontiers of ECMO for organ procurement and future challenges. The authors are well-known experts in the field whose authoritative contributions and attention to practical aspects will be invaluable for novices and experienced practitioners alike.

An experienced physician knows how to recognize a patient suffering from sepsis, but cannot accurately determine whether the patient will survive. Cardinal elements of the treatment for sepsis include specific antibiotic and vasoactive drugs, enteral and parenteral nutrition, artificial respiration, and optimization of the oxygen transport to tissues. Nonetheless, with a certain frequency, these techniques are insufficient to ensure the recovery of a critically ill patient, especially when it is necessary to overcome functional alterations subsequent to organ and vital-system overload. The key elements in the progression of the sepsis-MODS syndrome are tied to numerous factors. These include: the severity and location of the lesion; the patient's age; the remaining functional reserve; the presence of mediatory which may be stimulatory, inhibitory or both.

This book is a complete guide to the use of ultrasound in critical care. Beginning with an overview of ultrasound and its applications, the next chapters discuss basic physics of ultrasound, modes of ultrasonography, and Doppler imaging. The following sections cover the use of ultrasound in different critical care situations including for vascular access, in acute respiratory distress syndrome, for cardiac evaluation, in neurocritical care, in the ICU, and more. The book concludes with clinical case scenarios and guidance on infection control and legal issues in ICU sonography. The comprehensive text is further enhanced by more than 300 ultrasound images, figures and tables to assist learning. Key points Comprehensive guide to the use of ultrasound in critical care Includes discussion on basic physics and modes of ultrasound Provides clinical case scenarios and guidance on infection control Features more than 300 ultrasound images, figures and tables

Approach any critical care challenge using a practical, consistent strategy based on best practices with Evidence-Based Practice of Critical Care, 3rd Edition. Unique, question-based chapters cover the wide variety of clinical options in critical care, examine the relevant research, and provide recommendations based on a thorough analysis of available evidence. Drs. Clifford S. Deutschman and Patrick J. Nelligan, along with nearly 200 critical-care experts, provide a comprehensive framework for translating evidence into practice, helping both residents and practitioners obtain the best possible outcomes for critically ill patients. Covers a full range of critical care challenges, from routine care to complicated and special situations. Helps you think through each question in a logical, efficient manner, using a practical, consistent approach to available management options and guidelines. Features revised and updated information based on current research, and includes all-new cases on key topics and controversies such as the use/overuse of antibiotics, drug resistance in the ICU, non-invasive mechanical ventilation, frequency of transfusions, and duration of renal replacement therapies. Provides numerous quick-reference tables that summarize the available literature and recommended clinical approaches. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

The management of the critically ill patients has been in the past few years a discipline at the forefront of development which continues to make progress with the support of basic and clinical research. This work is a collection of material that deals with the management of critically ill patients, published on the occasion of the 13th APICE congress in November 1998, which celebrated 40 years of Critical Care Medicine.

Sepsis represents a life threatening condition to ICU patients. The evolution of sepsis to severe sepsis or septic shock may occur in an unpredictable way. In the coming millennium the prevention and management of sepsis and organ dysfunction will present a real challenge for researchers and clinicians.

The Yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in their field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediattrics, intensive care and emergency medicine. (With approximately 90 contributions.)