Update Intensive Care Medicine

Abdominal compartment syndrome (ACS) is a condition associated with significant morbidity and mortality. This article includes a case summary of a patient who developed ACS, after which the pathophysiology, diagnosis and management of this important condition are discussed.
Abdominal Compartment Syndrome – December 1, 2012

The aim of this article is to provide the reader with a basic understanding of the physiology and biochemistry of acid base balance and its disturbances. This subject is often made unnecessarily complex and most disturbances of acid base control can be understood with the application of a few key principles.Acid Base Balance (Update 13) – June 1, 2001

This overview is written to give a basic understanding of the blood gas and a step-wise approach to its interpretation. The section on physics is to give a more complete understanding but you can gloss over it and go straight to the clinical significance.
Acid Base Balance and Interpretation of Blood Gas Results (Update 16) – June 1, 2003

Disorders in acid-base balance are commonly found in critically ill patients. Clinicians responsible for these patients need a clear understanding of acid-base pathophysiology in order to provide effective treatment for these disorders. Acid-base Disorders in Critical Care (Update 28, 2012) – December 21, 2012

This review is for anaesthetists who specialise in intensive care, focusing on the first few days following injury to the cervical spine and the spinal cord. Acute cervical spine injuries in adults (Update 28, 2012) – December 21, 2012

The anaesthetist’s involvement will range from participating in the resuscitation of patients with polytrauma to the provision of safe anaesthesia to allow surgical treatment for cervical spine or other injuries. The importance of early immobilization is emphasised and strategies used to ‘clear’ the cervical spine are described.Acute Cervical Spine Injury – June 1, 2008

This article describes the causes, diagnosis and management of acute kidney injury (AKI). Many centres in the developing world do not have access to renal replacement therapy and the emphasis is on prompt recognition, treatment and prevention of worsening AKI.
Acute kidney injury (Update 28, 2012) – December 21, 2012

Successful management of this rare but potentially devastating disorder relies on early recognition. The hallmark of acute liver failure (ALF) is encephalopathy (ranging from a subtle alterations in consciousness level to coma) in the context of an acute, severe liver injury.Acute Liver Failure in ICU – June 1, 2007

ARDS is a process of hypoxaemic respiratory failure associated with non-cardiogenic pulmonary oedema. It is the result of diffuse inflammatory damage to the alveoli and pulmonary capillaries from a range of local or systemic insults. ARDS is often associated with multiple organ dysfunction and carries a high mortality and financial cost.
Acute Respiratory Distress Syndrome – June 1, 2007

Identify and treat the underlying cause
Ventilate at low tidal volume
Apply generous PEEP
Maintain a low hydrostatic pressure in the lungs (avoid fluid overload)
Consider the prone position in severe cases
Consider steroids in persistent ARDS
Acute respiratory distress syndrome (Update 28, 2012) – December 21, 2012

The serious complications of blood transfusion are described. Although immunologically mediated reactions to transfusion products are potentially serious, anaesthetists are most likely to encounter those relating to massive blood transfusion and transfusion related acute lung injury (TRALI). Blood Transfusion – Complications – June 1, 2007

The practice of diagnosing death varies between countries. It is particularly important when futility of treatment is discussed or when patients are considered for organ donation. The clinical features and diagnosis of brainstem death are described.
Brainstem death (Update 28, 2012) – December 21, 2012

This article desribes the stepwise assessment, resuscitation and management of patients with burns.Burns (Update 16) – June 1, 2003

Estimation of cardiac output has an important role in patient management during anaesthesia and critical care. Cardiac output can be measured in a number of ways, from simple clinical assessment to invasive haemodynamic monitoring.Cardiac output monitoring (Update 28, 2012) – December 21, 2012

Cardiac output can be measured in a number of ways, from simple clinical observation to invasive haemodynamic monitoring. Estimation of cardiac output has an important role in patient management during anaesthesia and critical care. This ranges from monitoring the predictable changes of anaesthetic induction to assessing cardiac output during anaesthesia for major surgery or resuscitation of trauma victims and critically ill patients. Advanced monitoring techniques are often used when clinical signs are difficult to interpret.Cardiac Output Monitors – June 1, 2007

Central venous access is the placement of a venous catheter in a vein that leads directly to the heart. This article decribes the technique for CVDC insertion and their use in theatre and ICU.Central Venous Access and Monitoirng – December 1, 2000

Central venous catheters are extensively used in ICUs in high-income countries, but they remain beyond the facilities available in many developing world ICUs. In developing countries, their main use is as access for delivery of irritant drugs such as catecholamine infusions and for intravenous access in patients requiring prolonged organ support due to illnesses such as tetanus. The different sites of insertion are described and the common techniques for insertion are outlinedCentral venous cannulation (Update 28, 2012) – December 21, 2012

Many of the life saving therapies delivered in an ICU can be delivered in the most resource-poor settings. This article describes how infrastructure, personnel and clinical care may be designed to deliver effective care for all critically ill patients.Critical care where there is no ICU (Update 28, 2012) – December 21, 2012

This article provides and overview of the factors we should consider when managing patients with a critical illness, particularly concerning endof- life care.Cultural issues in end-of-life care – December 21, 2012

Delerium is a common problem in ICU patients and results in longer hospital stays, and increased morbidity and mortality. Standardised assessment tools are available and have highlighted a higher incidence than previously believed.Delirium in critical care (Update 28, 2012) – December 21, 2012

Diabetic ketoacidosis remains a frequent and lifethreatening complication of type 1 diabetes. Recent national (UK) guidelines have seen some changes in the management of the condition, and this article reflects the current best practice.Diabetic ketoacidosis (Update 28, 2012) – December 21, 2012

The Early Warning Score is a simple physiological scoring system that can be calculated at the patient.s bedside, using parameters which are measured in the majority of unwell patients. It does not require complex, expensive equipment to measure any of the parameters. It is reproducible patients and can be used to quickly identify patients who are clinically deteriorating and who need urgent intervention.Early Warning Scores – June 1, 2003

This article presents modified basic and advanced life support algorithms for use in pregnant women suffering cardiac or respiratory arrest. The indications and timing for perimortem caesarian section are discussed.Emergency management of maternal collapse and arrest – December 1, 2009

This article covers the basic aspects of management of patients who have ingested a poisonous agent. Specific common agents are described in more detail. In particular, the recommendations on the management of paracetamol in the UK have recently been altered in order to make treatment algorithm easier to use and administration of acetylcysteine safer.Emergency management of poisoning (Update 28, 2012) – December 21, 2012

Evidence-based medicine (EBM) has an established role in management of critically ill patients. However ICU patients form a highly heterogeneous group and present challenges to the conduct of high quality randomised controlled trials. Evidence-based medicine in critical care (Update 28, 2012) – December 21, 2012

Anaesthetists frequently care for patients in haemorrhagic shock, and must be capable of judging its severity. This article will discuss the assessment and clinical signs associated with hypovolaemia and the management of the shock state.Haemorrhagic Shock – June 1, 1992

This is a report of a patient who has suffered a head injury. The purpose is to illustrate the practical application of the basic physiological and pharmacological principles involved in effective management of patients with head injuries. The problem is presented with suggested management and a range of anaesthetic techniques.Head Injury Management – June 1, 2000

Hospital-acquired (nosocomial) pneumonia (HAP) is the second most common hospital-acquired infection, with an incidence of 5-15 per 1000 hospital admissions. Hospital-acquired pneumonia (Update 28, 2012) – December 21, 2012

This article describes the principles of triage of newly admitted patients and those who deteriorate on the ward. The existing systems are explained and the authors suggest those that are best suited to practice in a lowresource setting.
Identifying critically ill patients (Update 28, 2012) – December 21, 2012

This article describes the way in which vasoactive drugs are used in critically ill patients. Typical clinical scenarios are used to demonstrate why we choose certain drugs in certain conditions. The safety aspects of running infusions of highly potent drugs are.Inotropes and vasopressors in critical care (Update 28, 2012) – December 21, 2012