Applied Physiology in Intensive Care Medicine PDF
Preview Applied Physiology in Intensive Care Medicine
M. R.Pinsky·L.Brochard·J.Mancebo Applied Physiology in Intensive Care Medicine M. R. Pinsky · L. Brochard · J. Mancebo Applied Physiology in Intensive Care Medicine With116Figuresand21Tables 123 MICHAEL R. PINSKY, Prof., MD, Dr hc, FCCP, FCCM UniversityofPittsburgMedical Center Dep.of Critical CareMedicine 3550Terrace Street Pittsburgh,PA15261 USA LAURENT BROCHARD, MD JORDI MANCEBO, MD, PhD Hôpital HenriMondor Hospitalde SantPau RéanimationMédicale ServeiMedicina Intensiva 51av.MaréchaldeLattredeTassigny Avda. S. AntonioM. Claret167 94010 Créteil Cedex 08025Barcelona France Spain Thearticlesinthisbookappearedinthejournal„Intensive CareMedicine“ between2002and2006. ISBN-103-540-37361-6 Springer-VerlagBerlin Heidelberg NewYork ISBN-13978-3-540-37361-2 Springer-VerlagBerlin Heidelberg NewYork Libraryof Congress Control Number:2006930741 Thisworkissubjecttocopyright. Allrightsarereserved,whetherthewholeorpartofthe materialisconcerned,speci.callytherightsoftranslation,reprinting,reuseofillustrations, recitation,broadcasting,reproductiononmicro.lmsorinanyotherway,andstorageindata banks.Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisions oftheGerman CopyrightLawof September9,1965,initscurrentversion,andpermissionfor usemustalwaysbeobtainedfrom Springer-Verlag.Violationsareliableforprosecutionunder theGerman CopyrightLaw. Springerisapartof Springer Science+BusinessMedia springer.com © Springer-VerlagBerlin Heidelberg2006 Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublication doesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfrom therelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. Productliability:thepublisherscannotguaranteetheaccuracyofanyinformationaboutdos- ageandapplicationcontainedinthisbook. Ineveryindividualcasetheusermustchecksuch informationbyconsultingtherelevantliterature. Editor:Dr.Ute Heilmann Desk Editor:Meike Stoeck Production:LE-TeXJelonek, Schmidt&VöcklerGbR,Leipzig CoverDesign:Frido Steinen-Broo,eStudio Calamar, Spain Printedonacid-freepaper21/3100/YL543210 Introduction The practice of intensive care medicine is at the very forefront of titration of treatment and monitoring response. The substrate of this care is the critically ill patient who, by definition,isatthelimitsofhisorherphysiologicreserve. Suchpatientsneedimmediate, aggressivebutbalancedlife-alteringinterventionstominimizethedetrimentalaspectsof acuteillnessandhastenrecovery. Treatmentdecisionsandresponsetotherapyareusually assessed by measures of physiologic function, such as assessed by cardio-respiratory monitoring. However, how one uses such information is often unclear and rarely supportedby prospectiveclinicaltrials. Inreality,the bedsideclinicianisforcedtorely primarily on physiologic principles in determining the best treatments and response to therapy. However,thephysiologicfoundationpresentinpracticingphysiciansisuneven andoccasionallysupportedmorebyhabitorpriortrainingthanscience. A series of short papers published in Intensive Care Medicine since 2002 under the headingPhysiologic Notesattemptstocapturetheessenceofthephysiologicperspectives thatunderpinbothourunderstandingofdiseaseandresponsetotherapy. Thispresent volumecombinesthecompletelistofthesePhysiologic NotesupuntilJuly2006withthe associated review articles over the same interval that also addressed these central issues. This volume was created to address this fundamental unevenness in our understanding ofappliedphysiologyandunderscorewhatisknownandhowmeasuresandmonitoring interactwithorgansystemfunctionandresponsetotherapy. Thiscollectionofphysiologic perspectives and reviews, written by some of the most respected experts in the field, represent an up-to-date and invaluable compendium of practical bedside knowledge essentialtotheeffectivedeliveryofacutecaremedicine. Althoughthistextcanberead fromcovertocover,thereaderisencouragedtousethistextasareferencesourcereading individualPhysiologic NotesandReviewarticlesastheypertaintospecificclinicalissues. Inthatwaytherelevantinformationwillhaveimmediatepracticalmeaningandhopefully becomeincorporatedintoroutinepractice. Wehopethatthereaderfindsthesepapersandreviewsusefulintheirpracticeandenjoy readingthemasmuchasweenjoyededitingtheoriginalarticlesthatitcomprises. Michael R. Pinsky, Prof., MD, Dr hc Laurent Brochard, MD, PhD Jordi Mancebo, MD, PhD Contents 1.2. Cardiovascular: 1. Physiological Notes Pulmonary vascular resistance: A meaningless variable? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 1.1 Pulmonary RobertNaeije 1.1.1 Respiratory Mechanics Pulmonary artery occlusion pressure . . . . . . . . . . . 49 Intrinsic (or auto-) positive end-expiratory pressure MichaelR.Pinsky during controlled mechanical ventilation . . . . . . . . . 3 LaurentBrochard Clinical significance of pulmonary artery occlusion pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Intrinsic (or auto-) positive end-expiratory pressure MichaelR.Pinsky during spontaneous or assisted ventilation . . . . . . . . 7 LaurentBrochard Pulmonary capillary pressure . . . . . . . . . . . . . . . . 57 JukkaTakala Work of breathing . . . . . . . . . . . . . . . . . . . . . . . . 11 BelenCabello,JordiMancebo Ventricular interdependence: how does it impact on hemodynamic evaluation in clinical practice? . . . 61 Interpretation of airway pressure waveforms . . . . . . 15 FrançoisJardin EvansR.Fernandez-Perez,RolfD.Hubmayr Cyclic changes in arterial pressure during 1.1.2 Gas exchange mechanical ventilation . . . . . . . . . . . . . . . . . . . . . 65 FrançoisJardin Dead space . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 UmbertoLucangelo,luisBlanch 1.3. Metabolism and Renal Function Alveolar ventilation and pulmonary blood flow: Lactic acidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 The V/Q concept . . . . . . . . . . . . . . . . . . . . . . . . . 21 DanielDeBacker A T EnricoCalzia,PeterRadermacher Defining renal failure: Physiological principles . . . . . 73 Mechanisms of hypoxemia . . . . . . . . . . . . . . . . . . 25 RinaldoBellomo,JohnA.Kellum, RobertRodríguez-Roisin,JosepRoca ClaudioRonco Pulse oximetry . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Hypotension during intermittent hemodialysis: AmalJubran new insights into an old problem . . . . . . . . . . . . . . 79 FrédériqueSchortgen Effects of body temperature on blood gases . . . . . . 33 AndreasBacher 1.4. Cerebral Function Venous oximetry . . . . . . . . . . . . . . . . . . . . . . . . . 37 Intracranial pressure: Part one: Historical overview FrankBloos,KonradReinhart and basic concepts . . . . . . . . . . . . . . . . . . . . . . . . 85 PeterJ.D.Andrews,GiuseppeCiterio Influence of FO on the PO/FO ratio . . . . . . . . . . 41 I 2 a 2 I 2 JeromeAboab,BrunoLouis, Intracranial pressure: Part two: Clinical applications BjörnJonson,LaurentBrochard and technology . . . . . . . . . . . . . . . . . . . . . . . . . . 89 PeterJ.D.Andrews,GiuseppeCiterio VIII Contents 2. Physiological Reviews Acute right ventricular failure – from pathophysiology to new treatments . . . . . . . . . . . . 217 AlexandreMebazaa,PeterKarpati, 2.1. Measurement techniques EstelleRenaud,LarsAlgotsson Fluid responsiveness in mechanically ventilated patients: a review of indices used in intensive care . . 95 Red blood cell rheology in sepsis . . . . . . . . . . . . . 229 KarimBendjelid,Jacques-AndréRomand MichaelPiagnerelli, KarimZouaoui-Boudjeltia, Different techniques to measure intra-abdominal MichelVanhaeverbeek,Jean-LouisVincent pressure (IAP): time for a critical re-appraisal . . . . . 105 ManuL.N.G.Malbrain Stress-hyperglycemia, insulin and immunomodulation in sepsis . . . . . . . . . . . . . . . 239 Tissue capnometry: does the answer lie PaulE.Marik,MuruganRagavanh under the tongue? . . . . . . . . . . . . . . . . . . . . . . . . 121 AlexandreToledoMaciel, Hypothalamic-pituitary dysfunction in critically JacquesCreteur,Jean-LouisVincent ill patients with traumatic and nontraumatic brain injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Noninvasive monitoring of peripheral perfusion . . . 131 IoannaDimopoulou,StylianosTsagarakis AlexandreLima,JanBakker Matching total body oxygen consumption and Ultrasonographic examination of the venae cavae . . 143 delivery: a crucial objective? . . . . . . . . . . . . . . . . 259 AntoineVieillard-Baron,FrançoisJardin PierreSquara Normalizing physiological variables in acute illness: 2.2. Physiological processes five reasons for caution . . . . . . . . . . . . . . . . . . . . 269 Sleep in the intensive care unit . . . . . . . . . . . . . . . 147 BrianP.Kavanagh,L.JoanneMeyer SAiramParthasarathy,MartinJ.Tobin Magnesium in critical illness: metabolism, 3. Seminal Studies in Intensive Care assessment, and treatment . . . . . . . . . . . . . . . . . . 157 LuisJ.Noronha,GeorgeM.Matuschak Manipulating afterload for the treatment of acute heart failure: a historical summary . . . . . . . . . . . . 279 Pulmonary endothelium in acute lung injury: ClaudePerret,Jean-FrançoisEnrico from basic science to the critically ill . . . . . . . . . . . . 171 stylianosEOrfanos,IreneMavrommati, Nosocomial pneumonia . . . . . . . . . . . . . . . . . . . 283 IonnaKorovesi,CharisRoussos WaldemarGJohanson,LisaL.Dever Pulmonary and cardiac sequelae of subarachnoid The introduction of positive end-expiratory haemorrhage: time for active management? . . . . . 185 pressure into mechanical ventilation: CarolS. A.Macmillan, a retrospective . . . . . . . . . . . . . . . . . . . . . . . . . . 291 IanS.Grant,PeterAndrews KonradJ.Falke Permissive hypercapnia-role in protective lung Elastic pressure-volume curves in acute lung injury ventilatory strategies . . . . . . . . . . . . . . . . . . . . . . 197 and acute respiratory distress syndrome . . . . . . . . 295 JohnG.Laffey,DonalO’Croinin, BjörnJonson PaulMcLoughlin,BrianP.Kavanagh The concept of “baby lung” . . . . . . . . . . . . . . . . . 303 Right ventricular function and positive pressure LucianoGattinoni,AntonioPesenti ventilation in clinical practice: from hemodynamic subsets to respirator settings . . . . . . . . . . . . . . . . . 207 The effects of anesthesia and muscle paralysis on AntoineVieillard-Baron,FrançoisJardin the respiratory system . . . . . . . . . . . . . . . . . . . . 313 GöranHedenstierna,LennartEdmark Contents IX Diaphragmatic fatigue during sepsis Organ dysfunction during sepsis . . . . . . . . . . . . . 345 and septic shock . . . . . . . . . . . . . . . . . . . . . . . . 323 SuveerSingh,TimothyW.Evans SophieLanone,CamilleTaillé, JorgeBoczkowski,MichelAubier Ventilator-induced lung injury: from the bench to the bedside . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 The use of severity scores in the intensive care . . . . . 331 LorraineN.Tremblay,ArthurS.Slutsky Jean-RogerLeGall Remembrance of Weaning Past: Oxygen transport-the oxygen delivery the Seminal Studies . . . . . . . . . . . . . . . . . . . . . . . 367 controversy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337 MartinJ.Tobin jean-LouisVincent,DanielDeBacker Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . 377 Contributors Jérôme Aboab Karim Bendjelid RéanimationMédicale Surgical Intensive CareDivision, Hôpital HenriMondor GenevaUniversity Hospitals Créteil,France 1211Geneva14, Switzerland Lars Algotsson Lluis Blanch Departmentof Anaesthesiology– Critical Care Center Heart-LungDivision Hospitalde Sabadell University HospitalofLund, ParcTaulis/n,08208 Sabadell, Spain 22185Lund, Sweden Frank Bloos Peter J.D. Andrews Klinikfür Anästhesiologieund Intensivtherapie Departmentof Anaesthetics, Intensive KlinikumderFriedrich-Schiller-Universität CareandPainMedicine Erlanger Allee101,07747Jena,Germany Universityof Edinburgh,WesternGeneral Hospital CreweRoad, EH42XU Edinburgh, Scotland,UK Jorge Boczkowski INSERMU700and IFR02,Facult XavierBichat Michel Aubier 16rue Henri Huchard,75018Paris,France INSERMU700and IFR02,FacultXavierBichat 16rue Henri Huchard,75018Paris,France Laurent Brochard RéanimationMédicale Andreas Bacher Hôpital HenriMondor, Departmentof Anesthesiology UniversitéParis12, INSERM andGeneral Intensive Care U651,94010 Créteil,France MedicalUniversityofVienna, AKH WähringerGürtel18–20,1090Vienna, Austria Belen Cabello Hospital Santa Creui SantPau, Daniel De Backer ServiciodeMedicina Intensiva Departmentof Intensive Care, Av/ Sant AntoniMaria Claret167, ErasmeUniversity Hospital CP08025Barcelona, Spain FreeUniversityofBrussels RoutedeLennik808,1070Brussels,Belgium Enrico Calzia Sektion AnästhesiologischePathophysiologie Jan Bakker undVerfahrensentwicklungUniversitätsklinik Departmentof Intensive Care, ErasmusMC für Anästhesiologie,UniversitätUlm UniversityMedical CenterRotterdam Parkstrasse11,89070Ulm,Germany P.O.Box2040,3000 CA Rotterdam,The Netherlands Giuseppe Citerio Neurorianimazione,Dipartimento Rinaldo Bellomo di AnestesiaeRianimazione Departmentof Intensive Care Nuovo Ospedale SanGerardo andDivisionof Surgery ViaDonizetti106,20052Monza, Italy Austin&RepatriationMedical Centre 3084 Heidelberg,Melbourne,Victoria, Australia Jacques Creteur Departmentof Intensive Care, ErasmeUniversity Hospital,Free UniversityofBrussels RoutedeLennik808,1070Brussels,Belgium XII Contributors Lisa L. Dever Göran Hedenstierna UMDNJ-NewJerseyMedical School, ClinicalPhysiology,Departmentof VA NewJersey Health Care System Medical Sciences,University Hospital 385Tremont, East Orange, NJ07018,USA 75185Uppsala, Sweden Ioanna Dimopoulou Rolf D. Hubmayr SecondDepartmentof Critical CareMedicine, Mayo Clinic CollegeofMedicine Attikon Hospital,Medical School National Rochester55905,MN,USA and KapodistrianUniversityof Athens 2Pesmazoglou Street,14561 François Jardin Kifissia, Athens,Greece Hôpital AmbroiseParé, ServicedeRéanimationMédicale, Lennart Edmark 9avenue CharlesdeGaulle, Departmentof Anesthesiaand Intensive Care 92104Boulogne,France Central Hospital 72335Vasteras, Sweden Waldemar G. Johanson† UMDNJ-NewJerseyMedical School Jean-François Enrico 185 South Orange, Newark, NJ07018,USA Former Chiefof Intensive CareUnit Hôpitaldes Cadolles, Björn Jonson Neuchâtel, Switzerland Departmentof ClinicalPhysiology University HospitalofLund Timothy W. Evans 22185Lund, Sweden Imperial College SchoolofMedicine Departmentof Intensive CareMedicine Amal Jubran RoyalBrompton Hospital,London,UK DivisionofPulmonaryand Critical CareMedicine Edward HinesJr.Veterans Affairs Hospital Konrad J. Falke Route111 N, Hines, IL,60141,USA Klinikfür Anaesthesiologyund operative IntensivmedizinBerlin Peter Karpati CampusVirchow Klinikum,Charite, Departmentof Anaesthesiology Berlin,Germany and Critical CareMedicine HopitalLariboisie`re,2Rue AmbroisePare Evans R. Fernández Pérez 75475Paris Cedex10,France Mayo Clinic CollegeofMedicine Rochester55905,MN,USA Brian P. Kavanagh Departmentof Critical CareMedicine, Jean-Roger Le Gall Hospitalfor Sick Children Departmentof Intensive CareMedicine 555University Avenue,Toronto, Saint-LouisUniversity Hospital,Paris,France ONT,M5G1X8, Canada Luciano Gattinoni John A. Kellum Istitutodi AnestesiaeRianimazione Divisionof Critical CareMedicine, Scaife Hall Fondazione IRCCS OspedaleMaggiorePoliclinico UniversityofPittsburghMedial Centre, Mangiagalli,Regina Elenadi Terrace Street,Pittsburgh,PA 15260,USA Milano,Universitàdegli Studi ViaFrancesco Sforza35,20122Milan, Italy Ioanna Korovesi Departmentof Critical Care&Pulmonary Ian S. Grant Medicineand“M. Simou”Laboratory Departmentof Anaesthesia, Medical School,Universityof Universityof Edinburgh, Athens, Evangelismos Hospital WesternGeneral Hospital, Edinburgh, 45–47 Ipsilandou St.,10675 Athens,Greece Scotland,UK
The list of books you might like
