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KEY CONCEPTS
Pulmonary edema usually results from either an increase in the net hydrostatic pressure across the capillaries (hemodynamic or cardiogenic pulmonary edema) or an increase in the permeability of the alveolar–capillary membrane (increased permeability edema or noncardiogenic pulmonary edema).
Reduced tidal volumes are associated with the greatest improvement in outcome after ARDS of any intervention subjected to a randomized clinical trial to date.
Early elective tracheal intubation is advisable when there are obvious signs of heat injury to the airway. Patients with hoarseness and stridor require immediate tracheal intubation or a surgical airway.
The criteria developed by the Acute Kidney Injury Network are now most often used to stage acute kidney injury (AKI). AKI is diagnosed by documenting an increase in serum creatinine of more than 50%, or an absolute increase of 0.3 mg/dL, and a reduction in urine output to less than 0.5 mL/kg/h for 6 h or longer, with all findings developing over 48 h or less.
Septic shock is defined as acute circulatory failure in a patient with sepsis or, more specifically, systolic blood pressure less than 90 mm Hg that is not responsive to volume resuscitation and requiring vasopressors for life support.
Critically ill patients frequently have abnormal host defenses from advanced age, malnutrition, drug therapy, loss of integrity of mucosal and skin barriers, and underlying diseases. Thus, age greater than 70 years, corticosteroid therapy, chemotherapy of malignancy, prolonged use of invasive devices, respiratory failure, kidney failure, head trauma, and burns are established risk factors for nosocomial infections.
Systemic pooling of blood and transudation of fluid into tissues result in relative hypovolemia in patients with sepsis.
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The range of conditions that specialists in critical care medicine must address is extraordinarily broad. Many frequent concerns of the intensivist are covered in other chapters and will not be discussed here, to avoid duplication. Therefore, for an overview of critical care medicine, the reader will need to refer to chapters where airway management (Chapter 19), inhalation therapy and ventilator management (Chapter 58), adrenergic agonists (Chapter 14), vasodilators (Chapter 15), fluids and electrolytes (Chapters 49,50,51), burn injury (Chapter 39), arrhythmias (Chapter 21), acute hypertension (Chapter 21), asthma and chronic obstructive pulmonary disease (Chapter 24), liver failure (Chapter 34), kidney disease (Chapter 31), resuscitation (Chapter 55), traumatic brain injury (Chapter 39), spinal cord injury (Chapter 39), diabetes (Chapter 35), nutrition (Chapter 53), and delirium (Chapters 28 and 54) are discussed.
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Poisoning and drug overdosage commonly result in patient admissions to the critical care unit and, indeed, this chapter contains such a case description. Initial treatment of such patients is most often initiated in the emergency department. The possible drugs (and ...