Practical Trends in Anesthesia and Intensive Care 2019

Description

Contents 1: The Role of the Heart in Weaning Failure 1.1 Weaning as an Intense Exercise 1.2 The Diagnosis of Weaning Failure of Cardiovascular Origin 1.3 Transthoracic Echocardiography 1.4 Conclusions References 2: MDR Infections in the ICU 2.1 Infections and Resistance: The Problem Dimension 2.2 Infections and Resistance: Definitions 2.3 MDR Gram Positive 2.3.1 MRSA 2.3.2 Potential Role for the New Antibiotics 2.3.3 VRE 2.4 MDR Gram Negative 2.4.1 ESBL-Producing Enterobacteriaceae 2.4.2 AmpC-Producing Enterobacteriaceae 2.4.2.1 Carbapenem-Resistant Gram Negative 2.4.3 XDR P. aeruginosa 2.4.4 XDR A. baumannii 2.4.5 KPC-Producing K. pneumoniae and Other Carbapenemase-Producing Enterobacteriaceae (CRE) 2.5 Empiric Therapy 2.6 Duration of Therapy 2.7 Role of Additional Therapies in Gram-Negative MDR/XDR Bacteria Septic Shock 2.8 Prevention and Control of MDR Infections in the ICU 2.9 Antimicrobial Stewardship References 3: The Diaphragmatic Dysfunction 3.1 Introduction 3.2 The Diaphragm 3.3 Anatomy and Respiratory Function 3.4 Diaphragmatic Dysfunction and Fatigue 3.4.1 Diaphragmatic Dysfunction 3.5 Invasive Evaluation of Diaphragmatic Function 3.6 Noninvasive Evaluation of Diaphragmatic Function: The Ultrasound 3.7 Diaphragmatic Displacement 3.7.1 Limits of the Technique 3.8 Thickness and Thickening Fraction 3.9 Conclusion References 4: Neuromuscular Blocking Agents: Review on Agents (NMBA and Antagonists) and Monitoring 4.1 Introduction 4.2 Neuromuscular Blocking Agents (NMBAs): The Classification [5, 7, 8, 10, 16, 18] 4.2.1 Neuromuscular Junction and Basic Physiology of Neurotransmission [5, 15, 18, 19] (Fig. 4.1) 4.3 Depolarizing Neuromuscular Blocking Agents: Succinylcholine (SCh) [7, 8, 10, 18, 19] (Fig. 4.2) 4.3.1 Side Effects [7, 8, 18, 19] 4.4 Nondepolarizing Neuromuscular Blocking Agents (NDNMBAs) 4.4.1 Aminosteroidal NDNMBAs 4.4.2 Benzylisoquinoline Derivatives 4.5 Monitoring Neuromuscular Function in Anesthesia [5, 15, 16, 17, 20–22] 4.5.1 Train of Four (TOF) [5, 15, 16, 22] 4.5.2 Post-Tetanic Twitch Count (PTC) [5, 15, 22] 4.5.3 Double-Burst Stimulation (DBS) [5, 15] 4.6 Neuromuscular Blockade Antagonization 4.6.1 Acetylcholinesterase Inhibitors (ACEIs) [5, 7, 8, 17, 18] 4.6.2 Sugammadex (SUG) [5, 7, 8, 17, 18, 31, 32] 4.7 Future Perspectives [7, 8, 34–36] References 5: Extracorporeal Circulation in Acute Respiratory Failure: High Flow Versus Low Flow 5.1 Introduction 5.2 General Principles of Treatment 5.3 History 5.4 Techniques 5.4.1 Extracorporeal Membrane Oxygenation (ECMO) 5.4.2 Extracorporeal CO2 Removal (ECCO2R) 5.5 Indications and Contraindications 5.6 Complications 5.7 Managing Considerations 5.7.1 Ventilation During Extracorporeal Circulation 5.7.2 Anticoagulation 5.7.3 Pharmacokinetic Implications 5.7.4 Weaning from Extracorporeal Circulation 5.7.5 Economic Impact 5.7.6 Ethical Considerations 5.7.7 Selected Centers 5.8 Conclusions References 6: Acute Asthma Exacerbations in Children: From Emergency Room to Intensive Care Unit Management 6.1 Introduction 6.2 Pathophysiology 6.2.1 Asthma Evaluation 6.2.2 Exacerbations Treatment 6.3 Emergency Department Management 6.4 Intensive Care Unit Management 6.4.1 Primary Preintubation Therapies in PICU 6.4.2 Noninvasive Positive Pressure Ventilation 6.4.3 The Decision to Intubate 6.4.4 Supportive Measures During Invasive Ventilation 6.4.5 Invasive Mechanical Ventilation 6.4.6 Adjunctive Therapies 6.5 Weaning from Mechanical Ventilation 6.5.1 Criteria for Discharge from the PICU References 7: An Update on the Nonoperating Room Anesthesia 7.1 Introduction and Historical/Cultural Contest 7.2 Definition of Analgesia and Procedural Sedation 7.3 Risks of NORA/PSA 7.4 Patients Who Strictly Require an Anesthetic Assessment and Management 7.5 Minimum Monitoring Requirements 7.6 Setting Requirements 7.7 General Minimum Requirements 7.8 Postprocedural Assistance and Discharge 7.9 Conclusions References 8: Pediatric Airway Management 8.1 Peculiar Anatomic and Physiologic Characteristics in Children 8.2 Approach to Intubation in Children 8.3 Pediatric Airway Evaluation 8.4 Equipment and Materials 8.5 Anesthesiologic Procedures 8.5.1 Planned Difficult Intubation 8.6 Elective Fiberoptic-Guided Intubation and the Use of Supraglottic Airway Devices (SGA) 8.7 Unpredicted Difficult Intubation 8.8 Conclusions References 9: Goal-Directed Fluid Therapy 9.1 Introduction 9.2 Rationale 9.3 Global Post-operative Complications 9.4 Renal Complications 9.5 Infectious Complications 9.6 Gastrointestinal Complication 9.7 Cardiovascular Complication 9.8 Application 9.9 GDFT 9.10 Protocols References 10: Management of Acute Ischemic Stroke 10.1 Introduction 10.2 Ischemic Cerebral Stroke 10.2.1 Clinical Features 10.2.2 Initial Management, Clinical Assessment, and Monitoring of the Acute Stroke Patient 10.2.3 Assessment of Vital Functions 10.2.4 Basic Diagnostic Tests 10.2.5 Airway Control 10.2.6 Management of Changes in Body Temperature 10.2.7 Cardiovascular Monitoring and Blood Pressure Management 10.2.8 Neuroimaging in the Acute Phase of Stroke 10.2.9 Treatment Strategies in Acute Ischemic Stroke 10.3 Intravenous Thrombolysis 10.4 Endovascular Treatment 10.5 Choice of the Therapeutic Strategy 10.6 Complications and Potential Critical Events in the Setting of Reperfusion Therapies 10.7 Potential Critical Events During Intravenous Thrombolysis 10.7.1 Brain Hemorrhage 10.7.2 Systemic Hemorrhage 10.7.3 Angioedema 10.8 Potential Critical Events During Endovascular Treatment 10.8.1 Interhospital Transfers, “Drip and Ship” 10.8.2 Blood Pressure Management 10.8.3 Choice of Sedation 10.8.4 Extubation 10.8.5 Complications of Endovascular Treatment 10.9 Intensive-Care Management of Acute Stroke Patients 10.9.1 Cerebral Edema 10.9.2 Decompressive Craniectomy 10.9.3 Glycemic State Management 10.9.4 Start of Antiplatelet Therapy 10.9.5 Deep Vein Thrombosis Prophylaxis 10.9.6 Initiation of Anticoagulation Therapy 10.9.7 Tracheostomy 10.9.8 Dysphagia Screening 10.9.9 Neurorehabilitation References 11: Delirium: From the Operating Room to the ICU 11.1 Introduction 11.2 Definition 11.3 Incidence 11.4 Pathophysiology 11.5 Risk Factors 11.6 Identification of Delirium 11.7 Postoperative Delirium Risk Prediction 11.8 Delirium Prevention 11.9 Pharmacologic Prophylaxis 11.10 Nonpharmacological Measures 11.10.1 Mobilization 11.10.2 Sleep 11.10.3 Perioperative 11.10.4 Sedation Bundles 11.11 Delirium Treatment 11.12 Conclusions References 12: Preoperative Evaluation of the Patient Candidate for Major Abdominal Surgery 12.1 Cardiovascular Risk 12.1.1 Presence of Active Cardiac Pathologies 12.1.2 Cardiovascular Risk Depending on the Type of Surgery 12.1.3 Factors In Patient-Related Cardiac Risk 12.1.4 Functional Capacity 12.2 Respiratory Risk 12.3 Renal Risk 12.4 Hemorragic Risk 12.4.1 PONV References 13: Monitoring the Depth of Anesthesia 13.1 Awareness 13.2 EEG and Anesthesia 13.3 EEG Recording and Processing 13.4 Commercially Available Devices 13.5 Auditory Evoked Potential Monitoring 13.6 Indications to Monitoring the Anesthesia Depth 13.7 Use in Critically Ill Patients 13.8 Evaluation of Antinociception 13.9 Conclusions References 14: How Do I Prepare Myself and My Staff for a Difficult Airway? 14.1 Introduction 14.2 What Makes an Airway Difficult? 14.3 Direct or Indirect Laryngoscopy? 14.4 Face Mask Ventilation and Supraglottic Airway Devices 14.5 Spontaneous Breathing Techniques 14.6 Extubation 14.7 Cricothyrotomy and (Emergency) Front of Neck Access (eFONA) 14.8 The New Challenge: Non-technical Skills 14.9 Airway Management as a Continuum of Care References