Controversies in critical care medicine
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| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1996
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| Schriftenreihe: | Critical care clinics
12,3 |
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| Online-Zugang: | Inhaltsverzeichnis |
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| 245 | 1 | 0 | |a Controversies in critical care medicine |c Andrew B. Leibowitz, guest ed. |
| 264 | 1 | |a Philadelphia [u.a.] |b Saunders |c 1996 | |
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Datensatz im Suchindex
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| adam_text | ! CONTROVERSIES IN CRITICAL CARE MEDICINE
CONTENTS
Preface xiii
Andrew B. Leibowitz
ICU Scoring Systems Allow Prediction of Patient Outcomes
and Comparison of ICU Performance 503
Richard B. Becker and Jack E. Zimmerman
Data support the use of prognostic systems for evaluating ICU
performance. ICU effectiveness can be assessed by comparing
actual and predicted group death rates, and efficiency can be
assessed by comparing ICU length of stay and resource use.
Prognostic estimates that consider daily changes in physiology
provide an objective measure of an individual patient s response
to therapy. These prognostic estimates can be used to support
clinical decisions, but must be used as a supplement rather than
as a substitute for good clinical judgment.
ICU Scoring Systems Do Not Allow Prediction of
Patient Outcomes or Comparison of ICU Performance 515
John P. Sherck and Clayton H. Shatney
Recent revisions of the major ICU scoring systems have broad¬
ened their database markedly and increased their statistical accu¬
racy. For a specific patient, however, the systems cannot be accu¬
rate enough to direct management decisions. Significant questions
remain about the reliability of these systems for comparing differ¬
ent ICUs and different patient populations, especially in surgical
and trauma patients. Current scoring systems, therefore, cannot
be used reliably in either the management of the individual
patient or in the making of quality comparisons between ICUs.
CRITICAL CARE CLINICS VOLUME 12 • NUMBER 3 • JULY 1996 vii
Does a Full Time, 24 Hour Intensivist Improve Care
and Efficiency? 525
Richard W. Carlson, Dennis E. Weiland, and
Komandoor Srivathsan
This article reviews the hypothesis that staffing with full time
intensive care physicians leads to improvements in the manage¬
ment of ICUs and in the outcome for ICU patients. Variations in
the professional organization of critical care units in the United
States are discussed. The advantages and disadvantages of open,
closed, and transitional (comanagement) ICU organizational
structures are presented.
Does Pulmonary Artery Catheter Use Change Outcome? Yes 553
Louis R. M. Del Guercio
This article discusses the advantages of pulmonary artery cathe¬
ters, with emphasis on the Swan Ganz catheter. Various studies
and published reports confirming the efficacy of pulmonary ar¬
tery catheter use are reviewed. In the author s opinion, it is
evident that the Swan Ganz catheter has withstood the test of
time and scrutiny.
Do Pulmonary Artery Catheters Improve Patient
Outcome? No 559
Andrew B. Leibowitz
Although pulmonary artery catheters provide physiologic infor¬
mation previously unobtainable by other means, their effect on
patient outcome remains questionable. Risks associated with their
use, the inherent inaccuracy of the data collected, problems with
general interpretation of data, and the potential for ineffective,
inappropriate, and injurious interventions based on data pro¬
vided by pulmonary artery catheterization make it an unproven
therapy when applied to large patient groups. The notion that
pulmonary artery catheterization does not improve patient out¬
come has recently been supported by literature reviews, clinical
investigations, and surveys of patient outcome.
Does Gastric Tonometry Work? Yes 569
Steven D. Brown and Guillermo Gutierrez
Gastric tonometry is gaining acceptance rapidly as a noninvasive
method of monitoring tissue dysoxia in a key organ system that
previously could not he assessed easily. In addition to being
noninvasive, gastric tonometry also identifies dysoxia in shock
sooner than currently available monitors. This allows for more
timely intervention with a subsequent improvement in prognosis
in defined groups of patients. Tonometry data that suggest con¬
tinued dysoxia despite intervention should signal clinicians to
seek alternative diagnoses or to question the efficacy of current
therapies, including antibiotics.
viii CONTENTS
Does Gastric Tonometry Work? No 587
Ernest Benjamin and John M. Oropello
Gastrointestinal tonometry is supposed to diagnose gut mucosal
hypoxia using gastric luminal Pco2 and arterial bicarbonatemia,
which are substituted in a modified Henderson Hasselbach equa¬
tion. This article reviews some of the problems inherent to the
multiple assumptions underlying this technique. Tonometry is
influenced by several local factors and by systemic acid base
imbalances that are unrelated to oxygenation. Tonometry is a
rather crude and cumbersome method of gut capnometry, a tech¬
nology that may provide valuable information regarding visceral
perfusion, but not necessarily oxygenation.
High Inflation Pressure and Positive End expiratory Pressure:
Injurious to the Lung? No 603
Loren D. Nelson
Recent published reports have arrived at conflicting conclusions
regarding the potential adverse effects of high inflation pressure
on ventilator induced lung injury. The contribution of positive
end expiratory pressure to high airway pressure induced lung
injury is even more controversial. Oxygen toxicity, macrobaro
trauma, and volutrauma interact to produce ventilator induced
lung injury. This article explores the many manifestations of
ventilator induced lung injury and the means proposed to pre¬
vent or limit its physiologic effects.
High Inflation Pressure and Positive End expiratory Pressure:
Injurious to the Lung? Yes 627
Peter J. Papadakos and Michael J. Apostolakos
The traditional practice of using high inflation pressure and high
levels of positive end expiratory pressure has fallen out of favor.
New modes of mechanical ventilation have been developed that
emphasize lung protection and are based on physiologic parame¬
ters. Pressure control and pressure regulated volume control are
two such modes that may be used in a lung protective strategy.
The early use of this technique may limit barotrauma and allow
for rapid weaning.
Does Increasing Oxygen Delivery Improve Outcome? Yes 635
Kathleen M. Kelly
Clinical outcomes continue to support the necessity of main¬
taining an optimal level of oxygen delivery in critically ill pa¬
tients, yet the question remains as to what optimal oxygen deliv¬
ery is. This article discusses several concepts related to the issue
of oxygen delivery, including flow dependency and mathematical
coupling, oxygen debt and its correlation with mortality, and
lactate levels as they relate to the prediction of survival.
CONTENTS ix
Does Increasing Oxygen Delivery Improve Outcome in the
Critically 111? No 645
Juan J. Ronco, John C. Fenwick, and Martin G. Tweeddale
The strategy of treating critically ill patients by increasing oxygen
delivery and consumption to values previously observed among
survivors of critical illness (supranormal values) is based on the
belief that (1) tissue hypoxia may persist in critically ill patients
despite aggressive early resuscitation to traditional endpoints of
adequate tissue perfusion and (2) that increasing oxygen delivery
can reverse tissue hypoxia. This article addresses the question of
whether increasing oxygen delivery improves outcomes in criti¬
cally ill patients by reviewing the relationship between whole
body oxygen delivery and consumption and by critically examin¬
ing the randomized controlled trials that have increased oxygen
delivery to supranormal values.
Early Nutritional Support in Critical Illness Is Important 661
Harry C. Sax
The hypermetabolic state in critically ill patients is characterized
by wasting of lean body mass and immunosuppression. The gut
is among the most metabolically active organs. Failure to main¬
tain gut function by way of early enteral nutrition can lead to
increased infectious complications. Early enteral nutrition im¬
proves outcome and may maintain muscle mass by blunting the
cytokine mediated hypermetabolic response.
Nutrition Support Is Not Beneficial and Can Be Harmful in
Critically 111 Patients 667
Paul L. Marino and Matthew J. Finnegan
Malnutrition in critical illness is the result of abnormal metabo¬
lism in the host, and it is unlike the malnutrition of starvation, in
which the cause is inadequate nutrient intake. To correct the
nutrient defects in critically ill patients, resolution of metabolic
abnormalities, not the intake of nutrient substrates, is needed.
This article demonstrates that there is little evidence to indicate
that nutrition support is beneficial as therapy for seriously ill pa¬
tients.
Is Renal Dose Dopamine Protective or Therapeutic? Yes 677
Olivia V. Carcoana and Roberta L. P Tines
The ability of renal dose dopamine to augment renal function in
a variety of clinical settings has been documented. The direct
action of dopamine or dopamine receptors contributes to the
natriuretic effect of dopamine. Various clinical studies demon¬
strate the beneficial effects of renal dose dopamine in improving
renal function. Although the precise mechanism responsible for
this effect remains a matter of controversy, evidence supports the
positive effects of renal dose dopamine.
X CONTENTS
Is Renal Dose Dopamine Protective or Therapeutic? No 687
David B. F. Cottee and W. Peter Saul
This article argues that dopamine infused in low doses has not
been shown to avert the onset of or ameliorate the course of acute
renal failure in critically ill patients. The inotropic and diuretic
effects of dopamine are discussed, and its adverse effects are
described. An attempt is made to offer an evidence based role for
low dose dopamine, namely as a diuretic in ventilated, euvolemic
patients resistant to conventional diuretic therapy.
Hypertensive, Hypervolemic, Hemodilutional Therapy for
Aneurysmal Subarachnoid Hemorrhage: Is It Efficacious? Yes 697
Jamie S. Ullman and Joshua B. Bederson
Vasospasm is an important contributor to death and disability
after aneurysmal subarachnoid hemorrhage (SAH), with delayed
ischemic deficits (DID) occurring in as much as 30% of patients
with angiographic spasm. There is strong evidence that hyperten¬
sive, hypervolemic, hemodilutional (HHH) therapy reverses the
signs of DID and that its prophylactic use reduces the incidence
of DID and subsequent infarction. Improvement of outcome in
even the poorest grade patients has been demonstrated. Litera¬
ture supporting the use of HHH therapy in aneurysmal SAH is
reviewed.
Hypertensive, Hypervolemic, Hemodilutional Therapy for
Aneurysmal Subarachnoid Hemorrhage: Is It Efficacious? No 709
John M. Oropello, Larry Weiner, and Ernest Benjamin
Many neurosurgeons routinely use hypertensive, hypervolemic,
hemodilutional, or hyperdynamic therapy (HT) in some form to
prevent or to treat vasospasm. Despite the widespread use of
this therapy during the past 20 years, however, there are no
randomized, prospective, controlled clinical studies demonstra¬
ting that HT improves the short or long term neurologic outcome
or survival after subarachnoid hemorrhage. Guidelines need to
be developed to standardize the clinical application of HT, and
well controlled, prospective, randomized clinical trials must be
conducted before HT can become an accepted treatment for vaso¬
spasm.
Special Article
The Aorta: Aortic Aneurysm, Trauma,
and Dissection 733
Raimund Erbel and Jose Zamorano
Because of the close relationship between the esophagus and the
aorta, multiplane transesophageal echocardiography provides an
excellent way to view the thoracic aorta. In this article, clinical
CONTENTS Xi
features of aortic aneurysm, trauma, and aortic dissection are
described, as is the potential use of transesophageal echocardiog
raphy in the assessment of these entities.
Index 767
Subscription Information Inside back cover
xii CONTENTS
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| series | Critical care clinics |
| series2 | Critical care clinics |
| spelling | Controversies in critical care medicine Andrew B. Leibowitz, guest ed. Philadelphia [u.a.] Saunders 1996 XII S., S. 503 - 700 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Critical care clinics 12,3 Therapieerfolg (DE-588)4126073-9 gnd rswk-swf Intensivtherapie (DE-588)4027258-8 gnd rswk-swf Intensivmedizin (DE-588)4027263-1 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Intensivmedizin (DE-588)4027263-1 s DE-604 Intensivtherapie (DE-588)4027258-8 s Therapieerfolg (DE-588)4126073-9 s Leibowitz, Andrew B. Sonstige oth Critical care clinics 12,3 (DE-604)BV000019838 12,3 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=007306824&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Controversies in critical care medicine Critical care clinics Therapieerfolg (DE-588)4126073-9 gnd Intensivtherapie (DE-588)4027258-8 gnd Intensivmedizin (DE-588)4027263-1 gnd |
| subject_GND | (DE-588)4126073-9 (DE-588)4027258-8 (DE-588)4027263-1 (DE-588)4143413-4 |
| title | Controversies in critical care medicine |
| title_auth | Controversies in critical care medicine |
| title_exact_search | Controversies in critical care medicine |
| title_full | Controversies in critical care medicine Andrew B. Leibowitz, guest ed. |
| title_fullStr | Controversies in critical care medicine Andrew B. Leibowitz, guest ed. |
| title_full_unstemmed | Controversies in critical care medicine Andrew B. Leibowitz, guest ed. |
| title_short | Controversies in critical care medicine |
| title_sort | controversies in critical care medicine |
| topic | Therapieerfolg (DE-588)4126073-9 gnd Intensivtherapie (DE-588)4027258-8 gnd Intensivmedizin (DE-588)4027263-1 gnd |
| topic_facet | Therapieerfolg Intensivtherapie Intensivmedizin Aufsatzsammlung |
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| work_keys_str_mv | AT leibowitzandrewb controversiesincriticalcaremedicine |