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Oxford Textbook of 

Critical Care


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Oxford Textbook of

Critical Care
SECOND EDITION
Edited by

Professor Andrew Webb, MD, FRCP, MFMLM
Clinical Professor, Division of Critical Care, Faculty of Medicine,
The University of British Columbia, Canada

Professor Derek C. Angus, MD, MPH, FRCP
Distinguished Professor and Mitchell P. Fink Endowed Chair
Department of Critical Care Medicine
University of Pittsburgh and UPMC Health System

Professor Simon Finfer, MBBS, FAHMS, FRCP,
FRCA, FCICM, DrMed
Professor of Critical Care, The George Institute for Global Health, University of Sydney
Senior Staff Specialist in Intensive Care, Royal North Shore Hospital, Sydney

Professor Luciano Gattinoni, MD FRCP
Chief of the Department of Anaesthesia, Resuscitation and Emergency Medicine,
Fondazione IRCCS Ca’ Granda—Ospedale Maggiore Policlinico
Full Professor in Anesthesiology and Intensive Care Medicine, Department
of Pathophysiology and Transplantation, University of Milan

Professor Mervyn Singer, MD FRCP, FRCP, FFICM
Professor of Intensive Care Medicine, University College London

1


1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
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© Oxford University Press 2016
The moral rights of the authors‌have been asserted
First Edition Published in 1999
Second Edition Published in 2016
Impression: 1
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Foreword

One may ask in today’s internet-based world whether there is still
a need for textbooks when there is so much opinion and advice
already available online. Although possibly not able to capture
and include the very latest research results, textbooks provide a
solid basis and background of the subject in question giving an
essential framework of understanding on which to build. This
Oxford Textbook of Critical Care is a true example of quality. All
the authors are well-known experts in their field, the chapters
have all been carefully reviewed and the contents are, therefore,

relevant and reliable. What is more, as with many recent publications, this textbook is also available as an online version for easy
reference.
This completely revised and comprehensive version of the 1999
edition covers all possible aspects of intensive care medicine making it an impressive tome. The chapters are short, concise and to
the point, and thus easy to read and understand. The book is wellillustrated and the layout is fresh and attractive. The key points,

highlighted at the start of each chapter, provide a useful summary
of each topic and the book in general is clinically-orientated, making it of value for the practicing clinician, as well as physicians in
training. The book benefits from an impressive list of true experts
from around the globe, giving it international appeal and insight—
it is a real credit to the editors that so many leading authorities have
contributed!
I believe textbooks still have an important role in providing a
trustworthy source of knowledge. As different textbooks will have
a slightly different focus, include different authors, and use various
presentation formats they can complement each other. This book
will occupy an important place in this field and is a highly recommended reference for all involved in the care of critically-ill patients.
Jean-Louis Vincent, MD PhD
Professor of Intensive Care Medicine, Université Libre de
Bruxelles


Preface

Since the first edition of the Oxford Textbook of Critical Care was
published there have been many advances in our understanding and
management of critical illness. We prefaced the first edition with a
note on the exacting nature of critical care; the holistic complexity of the patient with multisystem dysfunction, the out-of-hours
commitment, the often stressful and highly charged situations
requiring considerable agility of brain and hand, and the continuing evolution (and occasional revolution) in perceived ‘best practice’. However, these challenging demands are precisely what attract

the critical care practitioner to the specialty. The importance of
strong support mechanisms—from colleagues, from national and
international societies, and from robust educational and research
outputs—is paramount to not only sustain but also enhance the
quality of care given.
Recognizing the increasing use of electronic media for reference,
we have continued the format used in the first edition. The traditional chapter layout of a textbook gave way to system-orientated
sections. Each section has been subdivided into short topics grouped
within the section according to clinical problems. We believe the
reader will often come to this book, in paper or electronic format,
wishing to update on a specific clinical problem that matches an
issue experienced at the bedside. Furthermore, this layout facilitates manageable and relevant searches in electronic media.
The Oxford Textbook of Critical Care is a single-volume major reference book aiming to cover the breadth of clinical and organizational aspects of adult critical care medicine in readable chunks. We

clearly acknowledge that every single topic cannot possibly be covered in detail, but hope its comprehensive nature will be found useful by all health care providers who look after critically-ill patients.
We recognize there are often local, national, and international
differences in philosophy and management strategy. Some of these
differences are seemingly contradictory and it is often difficult for
physicians in one country to assimilate information produced for
another. We intended from the outset to offer the Oxford Textbook
of Critical Care as an international text. We have attempted to give
a balanced view where international differences exist and, in many
cases, have sat squarely on the fence. We make no apology for this
since we believe the book should inform rather than dictate.
Producing this edition has been a mammoth task, co-ordinating
the efforts of over 600 authors from all corners of the world. We
thank all those who have contributed to this project and to members of the staff of Oxford University Press for persuading us to
take on this second edition, and whose skill and support have been
essential to the editorial and production process. Finally, the editors
are saddened to hear of the passing of Dr Mitchell Fink, Prof Albert

Jaeger and Dr Jan Kornder since the submission of their contributions to the book.
Andrew Webb
Derek C. Angus
Simon Finfer
Luciano Gattinoni
Mervyn Singer


Contents

Abbreviations   xxvii

PART 1.2

Contributors   xxxix

Communication  

SECTION 1

ICU organization and management
PART 1.1

The intensive care unit  
1
Design of the ICU   3
Neil A. Halpern

2
Staffing models in the ICU   7

Tim Buchman and Michael Sterling

3
Rapid response teams for the
critically ill   11
Ken Hillman and Jack Chen

4
In-hospital transfer of the
critically ill   14
Lorna Eyre and Simon Whiteley

5
Pre- and inter-hospital transport of
the critically ill and injured   19
Kelly R. Klein and Paul E. Pepe

6
Regional critical care delivery systems   24
Theodore J. Iwashyna and Colin R. Cooke

7
Integration of information
technology in the ICU   28
Daniel Martich and Jody Cervenak

8
Multiple casualties and disaster
response in critical care   32
Yoram Weiss and Micha Shamir

9
Management of pandemic critical illness   37
Robert Fowler and Abhijit Duggal

10
Effective teamwork in the ICU   43
Peter G. Brindley

11
Communication with patients
and families in the ICU   46
Leslie P. Scheunemann and Robert M. Arnold

12
Telemedicine in critical care   51
Bela Patel and Eric J. Thomas
PART 1.3

Training  
13
Clinical skills in critical care   56
Graham Nimmo and Ben Shippey

14
Simulation training for critical care   60
Ben Shippey and Graham Nimmo

15
Leadership skills in the ICU   64

Carole Foot and Liz Hickson
PART 1.4

Safety and quality  
16
Patient safety in the ICU   71
Bradford D. Winters and Peter J. Pronovost

17
Policies, bundles, and protocols
in critical care   75
Jeffrey Mazer and Mitchell M. Levy

18
Managing biohazards and
environmental safety   78
Ferenc Kovari and Gilbert Park


x

contents

19
Managing ICU staff welfare,
morale, and burnout   81
Gavin G. Lavery and Linda-Jayne Mottram
PART 1.5

Governance  

20
ICU admission and discharge criteria   86
Julian Bion and Anna Dennis

21
Resource management and
budgeting in critical care   90
Jukka Takala

22
Costs and cost-effectiveness
in critical care   94

SECTION 2

Pharmacotherapeutics
PART 2.1

Respiratory drugs  
32
Oxygen in critical illness   139
James N. Fullerton and Mervyn Singer

33
Bronchodilators in critical illness   144
Rajiv Dhand and Michael McCormack
PART 2.2

Cardiovascular drugs  

David J. Wallace and Derek C. Angus

34
Vasopressors in critical illness   149

PART 1.6

35
Vasodilators in critical illness   153

Research  
23
Evidence-based practice in critical care   100
Marius Terblanche and Damon C. Scales

24
Research ethics in the ICU   104
Neal W. Dickert and Scott D. Halpern

Daniel De Backer and Patrick Biston
A. B. J. Groeneveld and Alexandre Lima

36
Inotropic agents in critical illness   158
Abdallah Fayssoil and Djillali Annane

37
Anti-anginal agents in critical illness   161
Ajay Suri and Jean R. McEwan

38
Anti-arrhythmics in critical illness   165
PART 1.7

Medico-legal and
ethical issues  
25
Informed consent in the ICU   108
Henry J. Silverman

26
Patient rights in the ICU   113
Thaddeus M. Pope and Douglas B. White

27
Medico-legal liability in critical care   117
Michael A. Rie
PART 1.8

Critical illness risk prediction  
28
The role and limitations
of scoring systems   121
Hannah Wunsch and Andrew A. Kramer

29
Severity of illness scoring systems   125
Graeme K. Hart and David Pilcher

30

Organ failure scoring   130
Rui Moreno

31
Genetic and molecular expression
patterns in critical illness   133
Anthony F. Suffredini and J. Perren Cobb

John LeMaitre and Jan Kornder

39
Pulmonary vasodilators
in critical illness   170
Benjamin Chousterman and Didier Payen
PART 2.3

Gastrointestinal drugs  
40
Gastrointestinal motility drugs
in critical illness   175
Sonja Fruhwald and Peter Holzer

41
Stress ulcer prophylaxis and treatment
drugs in critical illness   180
Waleed Alhazzani and Deborah J. Cook
PART 2.4

Nervous system drugs  
42

Sedatives and anti-anxiety agents
in critical illness   185
Curtis N. Sessler and Katie M. Muzevich

43
Analgesics in critical illness   189
Mayur B. Patel and Pratik P. Pandharipande

44
Antidepressants in critical illness   193
Scott R. Beach and Theodore A. Stern


contents

45
Antiseizure agents in critical illness   198
Sebastian Pollandt and Lori Shutter

46
Inhalational anaesthetic agents
in critical illness   202
Laurent Beydon and Flavie Duc

47
Muscle relaxants in critical illness   206
Brian J. Pollard

48
Neuroprotective agents in critical illness   210

Jerrold L. Perrott and Steven C. Reynolds
PART 2.5

Hormonal drugs  
49
Hormone therapies in critical illness   215
Mark S. Cooper

50
Insulin and oral anti-hyperglycaemic
agents in critical illness   218
Roosmarijn T. M. van Hooijdonk and Marcus J. Schultz
PART 2.6

Haematological drugs  
51
Anticoagulants and antithrombotics
in critical illness   223
Vickie McDonald and Marie Scully

52
Haemostatic agents in critical illness   229
Beverley J. Hunt
PART 2.7

Antimicrobial and
immunological drugs  
53
Antimicrobial drugs in critical illness   234
A. P. R. Wilson and Preet Panesar

54
Steroids in critical illness   241
Didier Keh

55
Immunotherapy in critical illness   244
Hans-Dieter Volk and Levent Akyüz
PART 2.8

Fluids and diuretics  
56
Colloids in critical illness   248
Andrew Webb

57
Crystalloids in critical illness   252
Karthik Raghunathan and Andrew Shaw

58
Diuretics in critical illness   256
Marlies Ostermann and Ruth Y. Y. Wan

SECTION 3

Resuscitation
PART 3.1

Respiratory management  
59

Airway management in cardiopulmonary
resuscitation   263
Jerry P. Nolan and Jasmeet Soar

60
Artificial ventilation in cardiopulmonary
resuscitation   268
Jasmeet Soar and Jerry P. Nolan
PART 3.2

Circulatory management  
61
Pathophysiology and causes
of cardiac arrest   273
Peter Thomas Morley

62
Cardiac massage and blood flow
management during cardiac arrest   277
Gavin D. Perkins

63
Defibrillation and pacing during
cardiac arrest   280
Charles D. Deakin

64
Therapeutic strategies in managing
cardiac arrest   284
John Field

65
Post-cardiac arrest arrhythmias   289
Marwan F. Jumean and Mark S. Link

66
Management after resuscitation
from cardiac arrest   294
Jerry P. Nolan and Michael J. A. Parr

67
Ethical and end-of-life issues
after cardiac arrest   299
Carolyn Benson and G. Bryan Young
PART 3.3

Fluid management  
68
Physiology of body fluids   304
Anthony Delaney

69
Choice of resuscitation fluid   308
John Myburgh and Naomi E. Hammond

70
Therapeutic goals of fluid resuscitation   313
Bashar S. Staitieh and Greg S. Martin

xi

xii

contents

SECTION 4

PART 4.5

Acute respiratory failure  

The respiratory system

83
Dyspnoea in the critically ill   381

PART 4.1

Paolo Tarsia

Physiology  
71
Normal physiology of the respiratory system  

321

Göran Hedenstierna and João Batista Borges
PART 4.2

Respiratory monitoring  
72
Blood gas analysis in the critically ill   326
Gavin M. Joynt and Gordon Y. S. Choi

73
Pulse oximetry and capnography in the ICU   331
Richard Lee

74
Respiratory system compliance and
resistance in the critically ill   335
Ricardo Luiz Cordioli and Laurent Brochard

75
Gas exchange principles in the
critically ill   340
Peter D. Wagner

76
Gas exchange assessment in the
critically ill   345
Peter D. Wagner

77
Respiratory muscle function
in the critically ill   350
Theodoros Vassilakopoulos and Charis Roussos

78

Imaging the respiratory system
in the critically ill   355
Lawrence R. Goodman
PART 4.3

Upper airway obstruction  
79
Upper airway obstruction in the critically ill   363
Edmond Cohen
PART 4.4

Airway access  
80
Standard intubation in the ICU   369
Sebastian G. Russo and Michael Quintel

81
The difficult intubation in the ICU   373
Michael Frass

82
The surgical airway in the ICU   376
Danja S. Groves and Charles G. Durbin Jr

84
Pulmonary mechanical dysfunction
in the critically ill   385
Umberto Lucangelo and Massimo Ferluga

85

Hypoxaemia in the critically ill   389
Susannah Leaver and Timothy Evans

86
Hypercapnia in the critically ill   394
John G. Laffey and Brian P. Kavanagh

87
Cardiovascular interactions in
respiratory failure   399
Jae Myeong Lee and Michael R. Pinsky
PART 4.6

Ventilatory support  
88
Physiology of positive-pressure
ventilation   404
Göran Hedenstierna and Hans Ulrich Rothen

89
Respiratory support with continuous
positive airways pressure   407
Francesco Mojoli and Antonio Braschi

90
Non-invasive positive-pressure ventilation   411
Giulia Spoletini and Nicholas S. Hill

91
Indications for mechanical ventilation   415

Neil R. MacIntyre

92
Design and function of
mechanical ventilators   419
Robert L. Chatburn and Eduardo Mireles-Cabodevila

93
Setting rate, volume, and time in
ventilatory support   430
Charles M. Oliver and S. Ramani Moonesinghe

94
Respiratory support with positive
end-expiratory pressure   433
Ignacio Martin-Loeches and Antonio Artigas

95
Volume-controlled mechanical
ventilation   437
Kristy A. Bauman and Robert C. Hyzy

96
Pressure-controlled mechanical
ventilation   440
Thomas Muders and Christian Putensen

97
Pressure support ventilation   447
Hérnan Aguirre-Bermeo and Jordi Mancebo

contents

98
High-frequency ventilation and
oscillation   450
Mireia Cuartero and Niall D. Ferguson

99
Prone positioning in the ICU   455
Paolo Taccone and Davide Chiumello

100Failure to ventilate in critical illness   460
Vito Fanelli and V. Marco Ranieri

101Ventilator trauma in the critically ill   465
Marcelo Amato and Andreas Wolfgang Reske
PART 4.7

Weaning ventilatory support  
102Assessment and technique of weaning   470
Martin J. Tobin

103Weaning failure in critical illness   474
Annalisa Carlucci and Paolo Navalesi
PART 4.8

Extracorporeal support  
104Extracorporeal respiratory and cardiac

support techniques in the ICU   478
Claire Westrope and Giles Peek

105Treating respiratory failure with
extracorporeal support in the ICU   483
Giacomo Bellani and Antonio Pesenti
PART 4.9

Aspiration and inhalation  
106Aspiration of gastric contents
in the critically ill   487
Sara Froio and Franco Valenza

107Inhalation injury in the ICU   492
Silvia Coppola and Franco Valenza
PART 4.10

Acute respiratory
distress syndrome  
108Pathophysiology of acute respiratory
distress syndrome   497
Lorraine B. Ware

109Therapeutic strategy in acute
respiratory distress syndrome   501
Charlotte Summers and Geoffrey Bellingan

PART 4.11

Airflow limitation  

110Pathophysiology and causes
of airflow limitation   506
David V. Tuxen

111Therapeutic approach to
bronchospasm and asthma   511
Brett G. Sampson and Andrew D. Bersten

112Therapeutic strategy in acute or
chronic airflow limitation   516
Francesco Macagno and Massimo Antonelli
PART 4.12

Respiratory acidosis and alkalosis  
113Pathophysiology and therapeutic
strategy of respiratory acidosis   522
Luciano Gattinoni and Alfredo Lissoni

114Pathophysiology and therapeutic
strategy of respiratory alkalosis   527
Thomas Langer and Pietro Caironi
PART 4.13

Pneumonia  
115Pathophysiology of pneumonia   531
Jordi Rello and Bárbara Borgatta

116Diagnosis and management of
community-acquired pneumonia   534
Antoni Torres and Adamantia Liapikou

117Diagnosis and management of
nosocomial pneumonia   539
Jean Chastre

118Diagnosis and management of
atypical pneumonia   543
Martin Langer and Edoardo Carretto
PART 4.14

Atelectasis and sputum retention  
119Pathophysiology and prevention
of sputum retention   548
John J. Marini and Paolo Formenti

120Lung recruitment techniques in the ICU   553
Thomas Kiss and Paolo Pelosi

121Chest physiotherapy and tracheobronchial
suction in the ICU   560
Gianluigi Li Bassi and J. D. Marti

xiii


xiv

contents

122Toilet bronchoscopy in the ICU   565

Gianluigi Li Bassi and Carles Agusti

134Mixed and central venous oxygen
saturation monitoring in the ICU   623
Frank Bloos and Konrad Reinhart

PART 4.15

Pleural cavity problems  
123Pathophysiology of pleural cavity disorders   571
Davide Chiumello and Cristina Mietto

124Management of pneumothorax
and bronchial fistulae   575
Wissam Abouzgheib and Raquel Nahra

125Management of pleural effusion
and haemothorax   579
Davide Chiumello and Silvia Coppola
PART 4.16

Haemoptysis  
126Pathophysiology and causes of haemoptysis   584
Francesco Blasi and Paolo Tarsia

127Therapeutic approach in haemoptysis   588
Francesco Blasi and Paolo Tarsia

SECTION 5

The cardiovascular system
PART 5.1

Physiology  
128Normal physiology of the
cardiovascular system   595
Hugh Montgomery and Rónan Astin
PART 5.2

Cardiovascular monitoring  
129ECG monitoring in the ICU   599
Sanjay Gandhi and William R. Lewis

130Arterial and venous cannulation in the ICU   602
Ronan O’Leary and Andrew R. Bodenham

131Blood pressure monitoring in the ICU   608
Stefano Romagnoli and Giovanni Zagli

132Central venous pressure
monitoring in the ICU   613
Sheldon Magder

133Pulmonary artery catheterization in the ICU   618
Efrat Orenbuch-Harroch and Charles L. Sprung

135Right ventricular function in the ICU   627
Antoine Vieillard-Baron

136Cardiac output assessment in the ICU   632

Nishkantha Arulkumaran and Maurizio Cecconi

137Oxygen transport in the critically ill   636
Stephan M. Jakob and Jukka Takala

138Tissue perfusion monitoring in the ICU   640
Eric Kipnis and Benoit Vallet

139Lactate monitoring in the ICU   644
Tim C. Jansen and Jan Bakker

140Measurement of extravascular
lung water in the ICU   649
Danny F. McAuley and Thelma Rose Craig

141Doppler echocardiography in the ICU   652
Julien Maizel and Michel Slama

142Monitoring the microcirculation in the ICU   659
Can Ince and Alexandre Lima

143Imaging the cardiovascular
system in the ICU   662
Richard Paul and Susanna Price
PART 5.3

Acute chest pain and coronary
syndromes  
144Causes and diagnosis of chest pain   669
Caroline Patterson and Derek Bell

145Pathophysiology of coronary
syndromes   674
Robert M. Bell

146Diagnosis and management of
non-STEMI coronary syndromes   678
David Erlinge and Göran Olivecrona

147Diagnosis and management of ST-elevation
of myocardial infarction   682
David Erlinge and Göran Olivecrona
PART 5.4

Aortic dissection  
148Pathophysiology, diagnosis, and
management of aortic dissection   689
Samuel J. Youssef and John A. Elefteriades


contents
PART 5.5

PART 5.10

The hypotensive patient  

Endocarditis  

149Pathophysiology of shock   696

Antoine Kimmoun and Bruno Levy

150Diagnosis and management of
shock in the ICU   700

160Pathophysiology and causes
of endocarditis   744
Franck Thuny and Didier Raoult

161Prevention and treatment of endocarditis   753

Antoinette Spevetz and Joseph E. Parrillo

Dominique Grisoli and Didier Raoult

PART 5.6

PART 5.11

Cardiac failure  

Severe hypertension  

151Pathophysiology and causes
of cardiac failure   705
Alexandre Mebazaa and Mervyn Singer

152Therapeutic strategy in cardiac failure   709
Alexandre Mebazaa and Mervyn Singer

153Intra-aortic balloon counterpulsation
in the ICU   713
Alain Combes and Nicolas Bréchot

154Ventricular assist devices in the ICU   716
Alain Combes

162Pathophysiology and causes of
severe hypertension   763
Jerrold H. Levy and David Faraoni

163Management of severe
hypertension in the ICU   767
Jerrold H. Levy
PART 5.12

Severe capillary leak  
164Pathophysiology of severe capillary leak   772
Anatole Harrois and Jacques Duranteau

PART 5.7

Tachyarrhythmias  
155Causes and diagnosis of tachyarrhythmias   722
Allan J. Walkey and David D. McManus

156Therapeutic strategy in tachyarrhythmias   726
Allan J. Walkey and Jared Magnani
PART 5.8

Bradyarrhythmias  
157Causes, diagnosis, and therapeutic
strategy in bradyarrhythmias   730
Harminder S. Gill and Jaswinder S. Gill
PART 5.9

Valvular problems  
158Causes and diagnosis of valvular problems   737
Jason F. Deen and Karen K. Stout

159Therapeutic strategy in valvular problems   741
Jason F. Deen and Karen K. Stout

165Management of acute non-cardiogenic
pulmonary oedema   776
Sébastien Tanaka and Jacques Duranteau
PART 5.13

Pericardial tamponade  
166Pathophysiology and causes
of pericardial tamponade   780
John R. Schairer and Steven J. Keteyian

167Management of pericardial tamponade   784
Santanu Biswas and John J. Frank
PART 5.14

Pulmonary hypertension  
168Pathophysiology and causes of
pulmonary hypertension   788

Laura Price and S. John Wort

169Diagnosis and management of
pulmonary hypertension   794
Philip Marino and Laura Price

xv


xvi

contents
PART 5.15

Pulmonary embolus  
170Pathophysiology and causes of
pulmonary embolism   801
Mervyn Singer

171Diagnosis and management of
pulmonary embolism   805
Mervyn Singer

SECTION 6

180Diagnosis and management of
lower gastrointestinal haemorrhage
in the critically ill   847
Leslie M. Kobayashi and Raul Coimbra
PART 6.4

Disordered gastric motility  
181Vomiting and large nasogastric
aspirates in the critically ill   852
Tong J. Gan and John T. Lemm

The gastrointestinal system

182Ileus and obstruction in the critically ill   856

PART 6.1

183Diarrhoea and constipation
in the critically ill   860

Physiology  
172Normal physiology of the
gastrointestinal system   811
Annika Reintam Blaser and Adam M. Deane

173Normal physiology of the
hepatic system   815
William Bernal and Alberto Quaglia
PART 6.2

Gastrointestinal monitoring  
174Imaging the abdomen in the critically ill   820
Imran Khalid Niazi and Navin Ramachandran

175Hepatic function in the critically ill   826

Andreas Kortgen and Michael Bauer

Philip Stevens and Paul Dark

Geoffrey J. Dobb
PART 6.5

The acute abdomen in the ICU  
184Pathophysiology and management
of raised intra-abdominal pressure
in the critically ill   866
Inneke E. De laet and Manu L. N. G. Malbrain

185Perforated viscus in the critically ill   872
Ori D. Rotstein

186Ischaemic bowel in the critically ill   877
A. G. Peppelenbosch and Martijn Poeze

187Intra-abdominal sepsis in the critically ill   880
Jeffrey D. Doyle and John C. Marshall

PART 6.3

Gastrointestinal haemorrhage  
176Pathophysiology and causes of upper
gastrointestinal haemorrhage   831
Tasneem Pirani and Tony Rahman

177Diagnosis and management of

upper gastrointestinal haemorrhage
in the critically ill   833
Tasneem Pirani and Tony Rahman

178Diagnosis and management of variceal
bleeding in the critically ill   838
Deanna Blisard and Ali Al-Khafaji

179Pathophysiology and causes of lower
gastrointestinal haemorrhage   843
Leslie M. Kobayashi and Raul Coimbra

188Acute acalculous cholecystitis
in the critically ill   885
Vanessa P. Ho and Philip S. Barie

189Management of the open abdomen and
abdominal fistulae in the critically ill   889
Philip Stevens and Gordon Carlson
PART 6.6

Pancreatitis  
190Pathophysiology, diagnosis, and
assessment of acute pancreatitis   894
James R. A. Skipworth and Stephen P. Pereira

191Management of acute pancreatitis
in the critically ill   900
Rajkumar Rajendram

contents
PART 6.7

Jaundice  
192Pathophysiology and causes of
jaundice in the critically ill   905
Anand D. Padmakumar and Mark C. Bellamy

193Management of jaundice
in the critically ill   911

202The metabolic and nutritional
response to critical illness   956
Linda-Jayne Mottram and Gavin G. Lavery
PART 7.2

Nutritional failure  

Anand D. Padmakumar and Mark C. Bellamy

203Pathophysiology of nutritional
failure in the critically ill   961

PART 6.8

204Assessing nutritional status in the ICU   964

Acute hepatic failure  
194Pathophysiology and causes of

acute hepatic failure   916
Sameer Patel and Julia Wendon

195Diagnosis and assessment of acute
hepatic failure in the critically ill   920
Sameer Patel and Julia Wendon

196Management of acute hepatic
failure in the critically ill   925
Deepak Joshi and Georg Auzinger

197The effect of acute hepatic failure on
drug handling in the critically ill   930
Andreas Kortgen and Michael Bauer

198Extracorporeal liver support
devices in the ICU   934
Rajiv Jalan and Banwari Agarwal
PART 6.9

Acute on chronic hepatic failure  
199Pathophysiology, diagnosis, and assessment of
acute or chronic hepatic failure   940
Alastair O’Brien

200Management of acute or chronic hepatic
failure in the critically ill   944
Alastair O’Brien

SECTION 7

Nutrition
PART 7.1

Physiology  
201Normal physiology of nutrition   951
Annika Reintam Blaser and Adam M. Deane

Jan Wernerman
Pierre-Yves Egreteau and Jean-Michel Boles

205Indirect calorimetry in the ICU   969
Joseph L. Nates and Sharla K. Tajchman

206Enteral nutrition in the ICU   973
Shaul Lev and Pierre Singer

207Parenteral nutrition in the ICU   977
Jonathan Cohen and Shaul Lev

SECTION 8

The renal system
PART 8.1

Physiology  
208Normal physiology of the renal system   983
Bruce Andrew Cooper
PART 8.2

Renal monitoring and risk
prediction  
209Monitoring renal function in the critically ill   988
Paul M. Palevsky

210Imaging the urinary tract in the critically ill   992
Andrew Lewington and Michael Weston
PART 8.3

Oliguria and acute kidney injury  
211Pathophysiology of oliguria and
acute kidney injury   999
Rinaldo Bellomo and John R. Prowle

212Diagnosis of oliguria and acute
kidney injury   1003
John A. Kellum

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213Management of oliguria and acute
kidney injury in the critically ill   1008
Mohammed Ahmed and Sean M. Bagshaw
PART 8.4

Renal replacement techniques  
214Continuous haemofiltration techniques
in the critically ill   1014
Zaccaria Ricci and Claudio Ronco

215Haemodialysis in the critically ill   1018
Rolando Claure-Del Granado and Ravindra L. Mehta

216Peritoneal dialysis in the critically ill   1022
Jeffrey C. Sirota and Isaac Teitelbaum
PART 8.5

Established renal failure  
217The effect of renal failure on drug
handling in critical illness   1027
Myrna Y. Munar and Ali J. Olyaei

218The effect of chronic renal failure
on critical illness   1032
Sinead Kinsella and John Holian

223Intracranial pressure monitoring
in the ICU   1059
Jonathan K. J. Rhodes and Peter J. D. Andrews

224Imaging the central nervous system
in the critically ill   1063
Olivier Bodart and Steven Laureys
PART 9.3

Sleep disturbance  
225Pathophysiology and therapeutic strategy
for sleep disturbance in the ICU   1068
Louise Harder and Atul Malhotra
PART 9.4

Agitation, confusion, and
delirium  
226Causes and epidemiology of agitation,
confusion, and delirium in the ICU   1073
Eduard E. Vasilevskis and E. Wesley Ely

227Assessment and therapeutic
strategy for agitation, confusion,
and delirium in the ICU   1076
Michele C. Balas and E. Wesley Ely

SECTION 9

PART 9.5

The neurological system

The unconscious patient  

PART 9.1

Anatomy and physiology  
219Normal anatomy and physiology
of the brain   1039

Simona Ferioli and Lori Shutter

220Normal anatomy and physiology of the
spinal cord and peripheral nerves   1043

228Causes and diagnosis of unconsciousness   1083
Robert D. Stevens and Joshua Kornbluth

229Management of unconsciousness
in the ICU   1088
Joshua Kornbluth and Robert D. Stevens

230Non-pharmacological neuroprotection
in the ICU   1093
Niklas Nielsen and David B. Seder

Steve Casha and Philippe Mercier
PART 9.6
PART 9.2

Neurological monitoring  
221Electroencephalogram monitoring
in the critically ill   1050
Paul M. Vespa

222Cerebral blood flow and perfusion
monitoring in the critically ill   1056
Samson Sujit Kumar Gaddam and Claudia S. Robertson

Seizures  

231Pathophysiology and causes of seizures   1098
Thomas P. Bleck

232Assessment and management of
seizures in the critically ill   1101
Thomas P. Bleck


contents
PART 9.7

PART 9.12

Intracranial hypertension  

Neuromuscular syndromes  

233Causes and management of
intracranial hypertension   1106

243Epidemiology, diagnosis, and assessment
of neuromuscular syndromes   1154

Nino Stocchetti and Andrew I. R. Maas

David Orlikowski and Tarek Sharshar

244Diagnosis, assessment, and
management of myasthenia gravis and
paramyasthenic syndromes   1160

PART 9.8

Stroke  

Ugan Reddy and Nicholas Hirsch

234Epidemiology of stroke   1112

245Diagnosis, assessment, and management
of tetanus, rabies, and botulism   1164

Candice Delcourt and Craig Anderson

235Diagnosis and assessment of stroke   1115

Jeffrey Lipman and Robert J. Boots

Candice Delcourt and Craig Anderson

246Diagnosis, assessment, and management
of Guillain–Barré syndrome   1168

236Management of ischaemic stroke   1117
Sully Xiomara Fuentes Patarroyo and Craig Anderson

237Management of parenchymal haemorrhage  

David Brealey and Nicholas Hirsch
1121

Candice Delcourt and Craig Anderson
PART 9.9

Non-traumatic subarachnoid
haemorrhage  
238Epidemiology, diagnosis, and assessment on
non-traumatic subarachnoid haemorrhage   1126
Chethan P. Venkatasubba Rao and Jose Ignacio Suarez

239Management of non-traumatic subarachnoid
haemorrhage in the critically ill   1131
Chethan P. Venkatasubba Rao and Jose Ignacio Suarez
PART 9.10

Meningitis and encephalitis  
240Epidemiology, diagnosis, and assessment
of meningitis and encephalitis   1138
Simon Nadel and Johnny Canlas

241Management of meningitis and
encephalitis in the critically ill   1143
Simon Nadel and Johnny Canlas
PART 9.11

Non-traumatic spinal injury  
242Pathophysiology, causes, and management
of non-traumatic spinal injury   1149
Oliver Flower and Matthew Mac Partlin

247Diagnosis, assessment, and management
of hyperthermic crises   1172
Kevin Thornton and Michael Gropper

248Diagnosis, assessment, and management
of ICU-acquired weakness   1176
Nicholas Hart and Tarek Sharshar

SECTION 10

The metabolic and endocrine systems
PART 10.1

Physiology  
249Normal physiology of the
endocrine system   1183
Simon Baudouin and Steve Ball
PART 10.2

Electrolyte disturbance  
250Disorders of sodium in the critically ill   1189
Howard L. Corwin and John K. McIlwaine

251Disorders of potassium in the critically ill   1193
Matthew C. Frise and Jonathan B. Salmon

252Disorders of magnesium in the critically ill   1198
Figen Esen

253Disorders of calcium in the critically ill   1202

Matthew R. Rosengart

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contents

254Disorders of phosphate in the critically ill   1206
Daniël A. Geerse and Marcus J. Schultz
PART 10.3

Metabolic acidosis and alkalosis  
255Pathophysiology and causes of metabolic
acidosis in the critically ill   1211
Patrick J. Neligan and Clifford S. Deutschman

256Management of metabolic acidosis
in the critically ill   1215
Patrick J. Neligan and Clifford S. Deutschman

257Pathophysiology, causes, and management of
metabolic alkalosis in the critically ill   1220
Serge Brimioulle
PART 10.4

Blood glucose control  
258Pathophysiology of glucose control   1226
Ulrike Madl

259Glycaemic control in critical illness   1230
Simon Finfer

260Management of diabetic emergencies
in the critically ill   1234
Dieter Mesotten and Sophie Van Cromphaut
PART 10.5

Endocrine disorders  
261Pathophysiology and management of
adrenal disorders in the critically ill   1241
Bala Venkatesh and Jeremy Cohen

262Pathophysiology and management of
pituitary disorders in the critically ill   1246
Yves Debaveye and Greet Van den Berghe

263Pathophysiology and management of
thyroid disorders in the critically ill   1251

SECTION 11

The haematological system
PART 11.1

Laboratory monitoring  
265The blood cells and blood count   1263
Tyler J. Albert and Erik R. Swenson

266Coagulation monitoring   1267
Gerhardus J. A. J. M. Kuiper and Hugo ten Cate
PART 11.2

Haematological therapies  
267Blood product therapy in the ICU   1272
Lirong Qu and Darrell J. Triulzi

268Apheresis in the ICU   1276
Marion Sternbach
PART 11.3

Disordered coagulation  
269Pathophysiology of disordered coagulation   1282
Simon Stanworth and Stuart McKechnie

270Disseminated intravascular coagulation
in the critically ill   1287
Marcel Levi and Marcus J. Schultz

271Prevention and management of
thrombosis in the critically ill   1292
Chee M. Chan and Andrew F. Shorr

272Thrombocytopenia in the critically ill   1295
Jaimal Kothari and Marie Scully
PART 11.4

Disorders of the blood cells  

Michael O’Dwyer and David Watson

273Pathophysiology and management of
anaemia in the critically ill   1299

264Pathophysiology and management of
functional endocrine tumours
in the critically ill   1256

274Pathophysiology and management of
neutropenia in the critically ill   1304

Sara Nikravan and Frederick Mihm

Timothy Walsh

Benoit Champigneulle and Frédéric Pène


contents

275Sickle crisis in the critically ill   1308
Shilpa Jain and Mark T. Gladwin

SECTION 12

The skin and connective tissue
PART 12.1

Skin and connective tissue

disorders  
276Assessment and management of
dermatological problems in the
critically ill   1315
Richard Groves

277Vasculitis in the critically ill   1320
Karina A. Keogh

278Rheumatoid arthritis in the
critically ill   1325
Rodrigo Cartin-Ceba and Udaya B. S. Prakash

PART 13.2

Nosocomial infection  
283Definition, epidemiology, and general
management of nosocomial infection   1352
Caroline Landelle and Didier Pittet

284Healthcare worker screening for
nosocomial pathogens   1356
Paul Van Buynder and Elizabeth Brodkin

285Environmental decontamination and
isolation strategies in the ICU   1359
Leigh Ann Slater and Pamela A. Lipsett

286Antimicrobial selection policies in the ICU   1363
David L. Paterson and Yoshiro Hayashi

287Oral, nasopharyngeal, and gut
decontamination in the ICU   1369
Evelien Oostdijk and Marc Bonten

288Diagnosis, prevention, and treatment of
device-related infection in the ICU   1374
Walter Zingg and Stephan Harbarth

PART 12.2

Wound and pressure sore
management  
279Principles and prevention of
pressure sores in the ICU   1330
Laura Crawford and Ruth Kleinpell

280Dressing techniques for wounds
in the critically ill   1334
Ruth Kleinpell and Laura Crawford

289Antibiotic resistance in the ICU   1378
Jonathan Edgeworth
PART 13.3

Infection in the
immunocompromised  
290Drug-induced depression of immunity
in the critically ill   1383
Russell J. McCulloh and Steven M. Opal

291HIV in the critically ill   1389

SECTION 13

Infection
PART 13.1

Diagnosis and surveillance  
281Microbiological surveillance
in the critically ill   1345
A. P. R. Wilson

282Novel biomarkers of infection
in the critically ill   1348
David T. Huang and Ayan Sen

Mark Hull and Steven C. Reynolds
PART 13.4

Tropical diseases  
292Diagnosis and management of
malaria in the ICU   1396
Christopher J. M. Whitty

293Diagnosis and management of viral
haemorrhagic fevers in the ICU   1400
Emersom C. Mesquita and Fernando A. Bozza

294Other tropical diseases in the ICU   1404

Arjen M. Dondorp

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contents
PART 13.5

Sepsis  
295Assessment of sepsis in the
critically ill   1408
Osamudiamen Idahosa and David T. Huang

296Management of sepsis in the
critically ill   1412
Jon Sevransky

297Pathophysiology of septic shock   1416
John M. Litell and Nathan I. Shapiro

298Management of septic shock
in the critically ill   1420
Sandra L. Peake and Matthew J. Maiden

SECTION 14

306Host–pathogen interactions
in the critically ill   1462

Guillaume Geri and Jean-Paul Mira

307Coagulation and the endothelium in
acute injury in the critically ill   1466
Marcel Levi and Tom van der Poll

308Ischaemia-reperfusion injury
in the critically ill   1471
Mitchell P. Fink

309Repair and recovery mechanisms
following critical illness   1476
Geoffrey Bellingan and Brijesh V. Patel

310Neural and endocrine function in the
immune response to critical illness   1481
Gareth L. Ackland

Inflammation

311Adaptive immunity in critical illness   1485

PART 14.1

312Immunomodulation strategies
in the critically ill   1488

Physiology  
299Innate immunity and the
inflammatory cascade   1427

Marianna Parlato and Jean-Marc Cavaillon
PART 14.2

Organ-specific biomarkers  
300Brain injury biomarkers in the critically ill   1432
Patrick M. Kochanek and Rachel P. Berger

301Cardiac injury biomarkers in
the critically ill   1437
Anthony S. McLean and Stephen J. Huang

302Renal injury biomarkers in the critically ill   1443

Sean F. Monaghan and Alfred Ayala

Aline B. Maddux and Gordon R. Bernard

313Immunoparesis in the critically ill   1493
Fabienne Venet and Alain Lepape
PART 14.4

Anaphylaxis  
314Pathophysiology and management of
anaphylaxis in the critically ill   1498
James Keegan and Charles D. Deakin

SECTION 15

Poisoning

John R. Prowle

PART 15.1

PART 14.3

Principles of management  

Host response  
303The host response to infection
in the critically ill   1449
W. Joost Wiersinga and Tom van der Poll

304The host response to trauma and
burns in the critically ill   1455
Edward A. Bittner and Shawn P. Fagan

305The host response to hypoxia
in the critically ill   1459
Raghavan Raju and Irshad H. Chaudry

315Role of toxicology assessment in poisoning   1505
Albert Jaeger

316Decontamination and enhanced
elimination of poisons   1509
Darren M. Roberts
PART 15.2

Management of specific poisons  

317Management of salicylate poisoning   1515
Brenna M. Farmer and Neal Flomenbaum


contents

318Management of acetaminophen
(paracetamol) poisoning   1518
Michael Levine

319Management of opioid poisoning   1522
Alison L. Jones

320Management of benzodiazepine poisoning   1526
Philippe Lheureux and Marc Van Nuffelen

321Management of tricyclic
antidepressant poisoning   1530
Giorgio Berlot and Ariella Tomasini

322Management of poisoning by
amphetamine or ecstasy   1534
Enno Freye

323Management of digoxin poisoning   1540
Frédéric Lapostolle and Stephen W. Borron

324Management of cocaine poisoning   1545
Nicholas J. Johnson and Judd E. Hollander

325Management of β-blocker and calcium
channel blocker poisoning   1549
Geoffrey Isbister and Colin Page

326Management of cyanide poisoning   1552
Stephen W. Borron

327Management of alcohol poisoning   1556
Knut Erik Hovda and Dag Jacobsen

328Management of carbon
monoxide poisoning   1560
Djillali Annane and B. Jérôme Aboab

329Management of corrosive poisoning   1564
Ram E. Rajagopalan

330Management of pesticide and
agricultural chemical poisoning   1568
Elspeth J. Hulse and Michael Eddleston

331Management of radiation
poisoning   1573

333Pathophysiology and management
of thoracic injury   1588
Graciela Bauzá and Ayodeji Nubi

334Pathophysiology and management
of abdominal injury   1593

Steven B. Johnson

335Management of vascular injuries   1597
Ramyar Gilani and Kenneth L. Mattox

336Management of limb and
pelvic injuries   1601
Omar Sabri and Martin Bircher

337Assessment and management
of fat embolism   1607
Neil Soni

338Assessment and management
of combat trauma   1611
Sara J. Aberle and Donald H. Jenkins
PART 16.2

Ballistic trauma  
339Pathophysiology of ballistic trauma   1615
Michael C. Reade and Peter D. Thomas

340Assessment and management
of ballistic trauma   1621
Timothy Hooper and David Lockey
PART 16.3

Traumatic brain injury  
341Epidemiology and pathophysiology
of traumatic brain injury   1626

Imoigele Aisiku and Claudia S. Robertson

342Assessment of traumatic brain injury   1630
Peter J. D. Andrews and Jonathan K. J. Rhodes

343Management of traumatic brain injury   1635

Francis Chin Kuok Choon and Phua Dong Haur

Alistair A. Gibson and Peter J. D. Andrews

SECTION 16

PART 16.4

Trauma
PART 16.1

Multiple trauma  
332A systematic approach to the
injured patient   1581
Clay Cothren Burlew and Ernest E. Moore

Spinal cord injury  
344Assessment and immediate management
of spinal cord injury   1642
Simon Finfer and Oliver Flower

345Ongoing management of the tetraplegic
patient in the ICU   1647

Oliver Flower and Raymond Raper

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contents
PART 16.5

PART 17.5

Burns  

Rhabdomyolysis  

346Pathophysiology and assessment
of burns   1653
John A. M. Paro and Geoffrey C. Gurtner

347Management of burns in the ICU   1658
Shahriar Shahrokhi and Marc G. Jeschke

SECTION 17

Physical disorders
PART 17.1

Drowning  
348Pathophysiology and management

of drowning   1665
Jerome H. Modell and Sean Kiley
PART 17.2

Electrocution  
349Pathophysiology and management
of electrocution   1669
Jeffrey S. Neiger and Richard G. Trohman

355Pathophysiology and management
of rhabdomyolysis   1695
Josep M. Grau and Esteban Poch

SECTION 18

Pain and sedation
PART 18.1

Pain  
356Pathophysiology and assessment of pain   1703
Rebecca E. Martin and Ross D. MacPherson

357Pain management in the critically ill   1707
Ross D. MacPherson
PART 18.2

Sedation  
358Sedation assessment in the critically ill   1712
Giovanni Mistraletti and Gaetano Iapichino

359Management of sedation in the
critically ill   1716
Bhakti K. Patel and John P. Kress

PART 17.3

Altitude- and depth-related
disorders  
350Pathophysiology and management of
altitude-related disorders   1674
Daniel S. Martin and Michael P. W. Grocott

351Pathophysiology and management
of depth-related disorders   1678
Peter Radermacher and Claus-Martin Muth
PART 17.4

Temperature related disorders  
352Pathophysiology and management
of fever   1683

SECTION 19

General surgical and obstetric
intensive care
PART 19.1

Optimization strategies for the
high-risk surgical patient  
360Identification of the high-risk

surgical patient   1721
Rupert Pearse and Stephen James

361Peri-operative optimization of the
high risk surgical patient   1725
Monty Mythen and Michael P. W. Grocott

Gabriele Bassi and Roberto Fumagalli

353Pathophysiology and management
of hyperthermia   1686
Abderrezak Bouchama

354Pathophysiology and management
of hypothermia   1690
Colin Ferguson

PART 19.2

General post-operative
intensive care  
362Post-operative ventilatory dysfunction
management in the ICU   1730
Paolo Chiarandini and Giorgio Della Rocca


contents

363Post-operative fluid and circulatory
management in the ICU   1733

Claudia Ebm and Andrew Rhodes

364Enhanced surgical recovery
programmes in the ICU   1737
Michael J. Scott and Monty Mythen
PART 19.3

Obstetric intensive care  
365Obstetric physiology and special
considerations in ICU   1745
Patrick J. Neligan and John G. Laffey

366Pathophysiology and management
of pre-eclampsia, eclampsia, and
HELLP syndrome   1749
Muna Noori and Catherine Nelson-Piercy

367Obstetric Disorders in the ICU   1754

PART 20.2

Oncological intensive care  
374ICU selection and outcome of patients
with haematological malignancy   1790
William M. Townsend and Emma C. Morris

375Management of the bone marrow
transplant recipient in ICU   1795
Andrew Retter

376Management of oncological
complications in the ICU   1800
Niall S. MacCallum

SECTION 21

Recovery from critical illness

Andrew Levinson and Ghada Bourjeily

PART 21.1

SECTION 20

In-hospital recovery from critical
illness  

Specialized intensive care
PART 20.1

Specialized surgical intensive care  
368Intensive care management after
cardiothoracic surgery   1763
Matthew Barnard and Nicola Jones

369Intensive care management
after neurosurgery   1768
Kamalakkannan Subhas and Martin Smith

370Intensive care management after

vascular surgery   1772
Alexander Timothy Dewhurst and Brigitta Brandner

371Intensive care management in
hepatic and other abdominal
organ transplantation   1776
Ivonne M. Daly and Ali Al-Khafaji

372Intensive care management in
cardiac transplantation   1781
Keshava Rajagopal and Bartley P. Griffith

373Intensive care management in
lung transplantation   1785
Keshava Rajagopal and Bartley P. Griffith

377Chronic critical illness   1809
Catherine L. Hough

378Promoting physical recovery
in critical illness   1812
Gregory A. Schmidt and Kevin Doerschug

379Promoting renal recovery in
critical illness   1816
Nattachai Srisawat and John A. Kellum

380Recovering from critical illness
in hospital   1822
Saxon Ridley

PART 21.2

Complications of critical illness  
381Physical consequences of critical
illness   1827
Margaret S. Herridge and Jane Batt

382Neurocognitive impairment
after critical illness   1832
Ramona O. Hopkins and James C. Jackson

383Affective and mood disorders
after critical illness   1836
Daniel W. Klyce and James C. Jackson

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PART 21.3

Out-of-hospital support after critical
illness  
384Long-term weaning centres in critical care   1841
Jeremy M. Kahn

385The ICU survivor clinic   1845
Priya Das and Carl Waldmann

386Rehabilitation from critical illness
after hospital discharge   1849
Laura Vincent and Carl Waldmann

388Management of the dying patient   1860
Judith E. Nelson and Aluko A. Hope
PART 22.2

Management of the potential organ
donor  
389Beating heart organ donation   1866
Martin Smith

390Non-heart-beating organ donation   1870
Mohamed Y. Rady and Ari R. Joffe
PART 22.3

SECTION 22

End-of-life care
PART 22.1

Withdrawing and withholding
treatment  
387Ethical decision making in withdrawing
and withholding treatment   1855
Margaret Isaac and Jared Randall Curtis

Post-mortem diagnosis  

391Post-mortem examination in the ICU   1874
Eva Tejerina and Andrés Esteban

Index   1879