Search

This book, part of the European Society of Intensive Care Medicine textbook series, teaches readers how to use hemodynamic monitoring, an essential skill for today's intensivists. It offers a valuable guide for beginners, as well as for experienced intensivists who want to hone their skills, helping both groups detect an inadequacy of perfusion and make the right choices to achieve the main goal of hemodynamic monitoring in the critically ill, i.e., to correctly assess the cardiovascular system and its response to tissue oxygen demands.The book is divided into distinguished sections: from physiology to pathophysiology; clinical assessment and measurements; and clinical practice achievements including techniques, the basic goals in clinical practice as well as the more appropriate hemodynamic therapy to be applied in different conditions. All chapters use a learning-oriented style, with practical examples, key points and take home messages, helping readers quickly absorbthe content and, at the same time, apply what they have learned in the clinical setting. The European Society of Intensive Care Medicine has developed the Lessons from the ICU series with the vision of providing focused and state-of-the-art overviews of central topics in Intensive Care and optimal resources for clinicians working in Intensive Care.

This book describes the pathophysiological significance of the hemodynamic monitoring parameters available to the clinician and their role in providing reliable and reproducible information on the cardiocirculatory status of a patient in shock. It is explained how measurements of these parameters enable the intensivist to understand the patient's condition and to make more informed treatment decisions in order to optimize the hemodynamic status and improve the prognosis. Full guidance is provided on measurement of intravascular blood pressures, cardiac output, and derived variables. Methods of cardiac output determination based on the classical pulmonary thermodilution, transpulmonary thermodilution, echocardiography, and Doppler techniques are reviewed. Techniques based on calibrated and non-calibrated pulse contour analysis are discussed, with attention to their limitations. Furthermore, the dynamic indices of fluid responsiveness, their clinical applications, and issues related to their use are addressed. Care is also taken to explain the physiological concepts underlying various devices used by anesthesiologists and intensivists.

This book represents the collective efforts of several excellent,clini­ cian-scientists who have devoted many years of their lives and many hours in each day to the application of physiological principles to the bedside care of critically ill patients. The universal challenge of car­ diovascular instability confronts all health care providers who treat patients in an acute care setting. Whether that be in the field or Emergency Department, general ward, operating suite or intensive care unit, all patients carry a common theme of potential life-taking processes which must to identified and treated in a timely fashion or severe morbidity and death rapidly follow. Since the cardiovascular system subserves the body in maintain­ ing metabolic stability through global and regional blood flow at an adequate pressure to insure appropriate autoregulation of blood flow distribution, it would be difficult to describe the mechanisms of cardiovascular instability their diagnosis and treatment without placing them within the context of overall metabolism and tissue vi­ ability. Accordingly, this book has been grouped into four arbitrary subsets. First, we address issues of basic cardiovascular physiology. Classic developments of ventricular pump function and arterial re­ sistance are balanced with newer applications of ventriculo-arterial coupling, right ventricular function, and tissue oxygen delivery.

In this book are discussed topics of particular importance to critical care cardiovascular diagnosis and management in the perioperative period. Chapter topics are the causes for heart failure; the pathophysiology of heart failure; coronary heart disease and ischemic preconditioning; hypertensive urgencies and emergencies; diagnosis of heart failure; preoperative cardiac risk assessment; hemodynamic monitoring in patients with heart failure; electrocardiography of heart failure - features and arrhythmias; pharmacologic management for patients with heart failure; devices for management of heart failure; pacemaker and internal cardioverter-defibrillator therapies; management of cardiopulmonary arrest; circulatory shock - anaphylactic, cardiogenic, haemorrhagic, septic; prevention and management of cardiac dysfunction during and after cardiac surgery; vasodilator therapy - systemic and pulmonary; and, thromboembolism and anticoagulation. This work represents an important update for anaesthesiologists, cardiologists, cardiac surgeons, emergency care physicians and intensivists caring for patients with acute, life-threatening cardiovascular afflictions.