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Denver Health Medical Center
HANDBOOK OF SURGICAL
CRITICAL CARE
The Practice and the Evidence
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Denver Health Medical Center
HANDBOOK OF SURGICAL
CRITICAL CARE
The Practice and the Evidence
Fredric M. Pieracci, MD, FACS
Ernest E. Moore, MD, FACS
NEW JERSEY
Denver Health Medical Center, USA
University of Colorado Health Sciences Center, USA
World Scientic
•
LONDON • SINGAPORE • BEIJING • SHANGHAI • HONG KONG • TAIPEI • CHENNAI
Published by
World Scientic Publishing Co. Pte. Ltd.
5 Toh Tuck Link, Singapore 596224
USA ofce: 27 Warren Street, Suite 401-402, Hackensack, NJ 07601
UK ofce: 57 Shelton Street, Covent Garden, London WC2H 9HE
Library of Congress Cataloging-in-Publication Data
Denver Health Medical Center handbook of surgical critical care : the practice and the evidence /
[edited by] Fredric M. Pieracci, Ernest E. Moore.
p. ; cm.
Handbook of surgical critical care
Includes bibliographical references and index.
ISBN 978-9814602181 (hardcover : alk. paper)
I. Pieracci, Fredric M., editor. II. Moore, Ernest Eugene, editor. III. Denver Health, issuing body.
IV. Title: Handbook of surgical critical care.
[DNLM: 1. Surgical Procedures, Operative--Handbooks. 2. Critical Care--Handbooks.
3. General Surgery--Handbooks. WO 39]
RD51.5
617.028--dc 3
2014045929
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library.
Copyright © 2015 by World Scientic Publishing Co. Pte. Ltd.
All rights reserved. This book, or parts thereof, may not be reproduced in any form or by any means,
electronic or mechanical, including photocopying, recording or any information storage and retrieval
system now known or to be invented, without written permission from the publisher.
For photocopying of material in this volume, please pay a copying fee through the Copyright Clearance
Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, USA. In this case permission to photocopy
is not required from the publisher.
In-house Editor: Darilyn Yap
Typeset by Stallion Press
Email: enquiries@stallionpress.com
Printed in Singapore
Dedication
Fredric M. Pieracci
To my wife, Antonia, and my children, Emma, Luca, and Gia, for their unwavering
support.
Ernest E. Moore
To my physician wife, Sarah, and physician boys, Hunter and Peter, for their
enduring belief in my endeavors.
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Table of Contents
Dedication v
Foreword xi
Contributing Authors xv
I: Background 1
1. Critical Care Responsibility in Healthcare Reform 3
2. Initial Approach to the Trauma Patient 11
3. Systems-based Approach to the Critically Ill Surgical Patient 33
II: System-Based Management 39
4. Central Nervous System 41
i. Cerebral Blow Flow 43
ii. Intracranial Hypertension 47
iii. Spine Trauma: Diagnosis, Clearance, and Mobility 57
iv. Surgical Critical Care and Behavioral Health 73
5. Cardiovascular 95
i. Fundamentals of Oxygen Transport and Cellular Metabolism 97
ii. Recognition and Characterization of Shock 109
iii. Resuscitation Strategies 115
iv. Measurements of Preload Responsiveness 121
v. Vasoactive Medications 131
vii
viii Table of Contents
vi. Dysrhythmias 139
vii. Acute Coronary Syndromes 157
viii. Vascular Emergencies 179
6. Respiratory 193
i. Airway Management 195
ii. Acid-Base Physiology 205
iii. Mechanical Ventilation 213
iv. Liberation from Mechanical Ventilation 225
v. Acute Respiratory Distress Syndrome 237
vi. Pleural Space and Mediastinum 245
7. Renal 251
i. Acute Renal Insufficiency and Failure 253
ii. Approach to the Anuric/Oliguric Critically Ill Surgical Patient 259
iii. Renal Replacement Therapy 265
iv. Electrolytes 275
v. Rhabdomyolysis 287
8. Gastrointestinal 293
i. Nutrition in the Critically Ill 295
ii. Tube Feed Intolerance 305
iii. Gastrointestinal Ischemia 311
iv. Hepatopancreaticobiliary 325
v. Colorectal 337
vi. Abdominal Compartment Syndrome 345
9. Hematology 353
i. Intensive Care Unit Anemia and Packed Red Blood
Cell Transfusion 355
ii. Diagnosis and Management of Coagulopathy 365
iii. Prevention and Management of Venous Thromboembolism 403
10. Infectious Disease 443
i. Evaluation of Fever 445
ii. Antimicrobial Stewardship 451
iii. Sepsis 465
iv. Ventilator-associated Pneumonia 481
v. Urinary Tract Infection 489
vi. Intra-abdominal Infections 495
vii. Blood Stream/Central Venous Catheter-associated Infections 505
viii. Necrotizing Soft Tissue Infection 511
Table of Contents ix
11. Endocrine 519
i. Endocrine Emergencies 521
ii. Adrenal Insufficiency 539
iii. Glycemic Control 549
III: ICU Procedures 557
12. Principles of Ultrasound 559
13. Echocardiography 567
14. Central Venous Cannulation 575
15. Arterial Cannulation 591
16. Tube Thoracostomy 603
17. Lumbar Puncture 611
18. Inferior Vena Cava Filter 619
19. Percutaneous Tracheostomy 629
20. Percutaneous Endoscopic Gastrostomy 637
21. Difficult Urinary Catheterization 647
22. Bedside Laparotomy 655
IV: Special Populations 661
23. Pediatric 663
24. Geriatric 673
25. Bariatric 683
26. Cardiothoracic 691
27. Obstetrics 697
V: Special Issues 703
28. Burn 705
29. Hypothermia 713
30. Orthopaedics 721
31. Pharmacology 731
32. Free Flap Monitoring 747
33. Ethics of Surgical Critical Care 765
Index 783