RT Book, Section
A1 Filippatos, Gerasimos S.
A1 Baltopoulos, George
A1 Karambatsos, Elias
A1 Nieminen, Markku S.
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2284740
T1 Chapter 23. Diagnostic and Management Strategies for Acute Heart Failure in the Intensive Care Unit
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2284740
RD 2021/03/07
AB Patients  are  admitted  to  the  intensive  care  unit  (ICU)  with  manifestations  of  acute  heart  failure  (AHF)  that  arise  in  three  general  contexts:  decompensation  of  chronic  heart  failure,  as  a  complication  of  a  cardiac  process  such  as  ischemia  or  valve  incompetence,  and  when  cardiomyopathy  complicates  other  critical  illness.Determining  which  of  the  contexts  of  AHF  is  present  is  invaluable  to  guide  therapy.Predominant  signs  and  symptoms  arise  from  venous  congestion  after  elevation  of  ventricular  end-diastolic  pressure  and  hypoperfusion;  in  a  given  patient,  different  contributions  of  these  processes  may  be  present.Measurement  of  brain  natriuretic  peptide  has  been  a  useful  addition  to  the  diagnostic  armamentarium  to  determine  whether  heart  failure  is  a  cause  of  acute  dyspnea;  this  measurement  is  most  useful  when  obtained  acutely  and  before  initiation  of  therapies  and,  hence,  has  a  limited  role  for  assessing  patients  after  admission  to  the  ICU.Echocardiography  is  an  extremely  useful  tool  to  assess  ventricular  function  and  define  cardiac  anatomy;  on  occasion,  information  from  invasive  measurement  of  intravascular  pressure  or  venous  oxygen  saturation  is  also  required  to  guide  therapy.Many  patients  will  exhibit  respiratory  distress  and  different  degrees  of  impaired  oxygenation;  whereas  many,  if  not  most,  patients  can  be  managed  with  oxygen  for  this  component  of  AHF,  ventilatory  support  in  the  form  of  continuous  positive  airway  pressure  or  bilevel  airway  support  (BiPAP)  should  be  considered  for  patients  not  responding  adequately  to  oxygen  therapy  alone  or  whose  respiratory  symptoms  and  findings  are  severe  from  the  onset.Diuretics  are  useful  for  treating  venous  congestion  and  inotropes  for  inadequate  perfusion,  but  each  carry  risk  of  excessive  dosing;  the  mainstay  of  therapy  for  most  patients  should  be  afterload  reduction  and  search  for  the  underlying  causes  of  ventricular  dysfunction  and  decompensation.Vasoconstrictive  agents  should  be  used  only  when  and  as  long  as  truly  life-threatening  hypotension  is  present