Chapter 49

• Brain death criteria can be applied only in the absence of hypothermia, hypotension, metabolic or endocrine abnormalities, neuromuscular blocking agents, or drugs known to depress brain function.
• Neonates’ risk of retinopathy of prematurity (ROP) increases with low birth weight and complexity of comorbidities (eg, sepsis). In contrast to pulmonary toxicity, ROP correlates better with arterial than with alveolar O2 tension.
• Pressure control ventilation (PCV) is similar to pressure support ventilation in that peak airway pressure is controlled but is different in that a mandatory rate and inspiratory time are selected. As with pressure support, gas flow ceases when the pressure level is reached; however, the ventilator does not cycle to expiration until the preset inspiration time has elapsed.
• The disadvantage of PCV is that tidal volume is not guaranteed.
• When compared with oral intubation for extended periods of time in the intensive care unit, nasal intubation may be more comfortable for the patient, more secure (fewer instances of accidental extubation), and less likely to cause laryngeal damage. Nasal intubation, however, has significant adverse events associated with its use.
• When left in place for more than 2–3 weeks, both oral and nasal translaryngeal tracheal tubes (TTs) predispose patients to subglottic stenosis. If longer periods of mechanical ventilation are necessary, the TT should generally be replaced by a cuffed tracheostomy tube.
• The major effect of positive end-expiratory pressure (PEEP) on the lungs is to increase functional residual capacity.
• A higher incidence of pulmonary barotrauma is observed when excessive PEEP or continuous positive airway pressure is added, particularly at levels greater than 20 cm H2O.
• Maneuvers that produce sustained maximum lung inflation such as the use of an incentive spirometer can be helpful in inducing cough as well as preventing atelectasis and preserving normal lung volume.
• In patients with acute respiratory distress syndrome, a Vt of > 10 mL/kg is associated with increased mortality.
• Early elective tracheal intubation is advisable when there are obvious signs of heat injury to the airway.
• Because of concern that intermittent hemodialysis associated with hypotension may perpetuate renal injury, continuous renal replacement therapy is increasingly used in critically ill patients with acute renal failure who do not tolerate the hemodynamic effects of intermittent hemodialysis.
• Advanced age (> 70 years), corticosteroid therapy, chemotherapy, prolonged use of invasive devices, respiratory failure, renal failure, head trauma, and burns are established risk factors for nosocomial infections.
• Systemic venodilation and transudation of fluid into tissues result in a relative hypovolemia in patients with sepsis.
• In contrast to nonstressed patients, who require about 0.5 g/kg/d of protein, critically ill patients generally require 1.0–1.5 g/kg/d.
• The gastrointestinal tract is the route of choice for nutritional support when its functional integrity is intact.
• Abrupt withdrawal of total parenteral nutrition (TPN) can precipitate hypoglycemia due to high circulating insulin levels, but this is not a common problem if the patient is not overfed; in this case, 10% glucose can be temporarily substituted for the TPN and gradually decreased.

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