The two previous editions of "Applied Physiology in Intensive Care Medicine" proved extremely successful, and the book has now been revised and split into two volumes to enhance ease of use. In this second volume some of the most renowned experts in the field offer detailed reviews on measurement techniques and physiological processes of crucial importance in intensive care medicine. Throughout, a key aim is to help overcome the fundamental unevenness in clinicians understanding of applied physiology, which can lead to suboptimal treatment decisions. "Applied Physiology in Intensive Care" has been written by some of the most renowned experts in the field and provides an up-to-date compendium of practical bedside knowledge essential to the effective delivery of acute care medicine. It will serve the clinician as an invaluable reference source on key issues regularly confronted in everyday practice.

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. However, the rationale and efficacy of hemodynamic monitoring to affect outcome has come into question. We now have increasing evidence that outcome from critical illness can be improved by focused resuscitation based on existing hemodynamic monitoring, whereas non-specific aggressive resuscitation impairs survival. Thus, this book frames hemodynamic monitoring into a functional perspective wherein hemodynamic variables and physiology interact to derive performance and physiological reserve estimates that themselves drive treatment. This philosophy, as well as the limitations and applications of common and evolving hemodynamic measures and their focused use in the care of critically ill patients are discussed, relevant to one underlying truth: No monitoring device, no matter how simple or sophisticated, will improve patient-centered outcomes useless coupled to a treatment which, itself, improves outcome.

This monograph focuses on splanchnic function in health and disease. It represents a distillate of the communication that took place at the First International Symposium of Applied Physiol ogy of the Peripheral Circulation, "Splanchnic Circulation: No Longer a Silent Partner." The individual chapters roughly follow the individual presentations and display in durable form the con cepts and importance that this symposium achieved. The concept for this annual symposium was the child of An tonio Artigas, who not only recruited sponsorship but also Jean Francois Dhainaut and me to help with the organization and work. We chose the splanchnic circulation as the peripheral cir culatory system to be presented first for many important reasons. Much new information has become available which demon strates, as the title of the symposium implies, that splanchnic function has major influence on the overall expression of health and disease in humans. All aspects of splanchnic physiology, it seems, have been rediscovered to be dynamic, important, and complex in their interactions within individual tissues and among remote tissues and organs. It is hoped that after having reviewed this monograph the reader will agree that the splanchnic circula tion and its organ systems are emerging as important aspects of critical illness and host-defense homeostasis."

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."

The two previous editions of Applied Physiology in Intensive Care Medicine proved extremely successful, and the book has now been revised and split into two volumes to enhance ease of use. In this second volume some of the most renowned experts in the field offer detailed reviews on measurement techniques and physiological processes of crucial importance in intensive care medicine. Throughout, a key aim is to help overcome the fundamental unevenness in clinicians' understanding of applied physiology, which can lead to suboptimal treatment decisions. Applied Physiology in Intensive Care has been written by some of the most renowned experts in the field and provides an up-to-date compendium of practical bedside knowledge essential to the effective delivery of acute care medicine. It will serve the clinician as an invaluable reference source on key issues regularly confronted in everyday practice.

The two previous editions of Applied Physiology in Intensive Care Medicine proved extremely successful, and the book has now been revised and split into two volumes to enhance ease of use. This first volume comprises three elements -- "physiological notes," "technical notes," and seminal studies. The physiological notes concisely and clearly capture the essence of the physiological perspectives underpinning our understanding of disease and response to therapy. The technical notes then succinctly explain some of the basics of "how to" in this technology-centered field of critical care medicine. Finally, a number of seminal studies are provided on diverse topics in intensive care. Applied Physiology in Intensive Care, written by some of the most renowned experts in the field, is an up-to-date compendium of practical bedside knowledge that will serve the clinician as an invaluable reference source on key issues regularly confronted in everyday practice.

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. However, the rationale and efficacy of hemodynamic monitoring to affect outcome has come into question. We now have increasing evidence that outcome from critical illness can be improved by focused resuscitation based on existing hemodynamic monitoring, whereas non-specific aggressive resuscitation impairs survival. Thus, this book frames hemodynamic monitoring into a functional perspective wherein hemodynamic variables and physiology interact to derive performance and physiological reserve estimates that themselves drive treatment. This philosophy, as well as the limitations and applications of common and evolving hemodynamic measures and their focused use in the care of critically ill patients are discussed, relevant to one underlying truth: No monitoring device, no matter how simple or sophisticated, will improve patient-centered outcomes useless coupled to a treatment which, itself, improves outcome.

Dr. Michael Pinsky has assembled an expert team of authors on the topic of Hemodynamic Monitoring. Articles topics include: The interface between monitoring and physiology at the bedside; Defining goals of resuscitation in the critically ill; Minimally invasive hemodynamic monitoring; Bedside ultrasound for the intensivist; Invasive hemodynamic monitoring; Functional hemodynamic monitoring; Using what you get: dynamic physiological signatures of critical illness; and Effect of organizational issues on resuscitation effectiveness.