The Intensive Care Manual, MICHAEL J. APOSTOLAKOS

384 Index Nasogastric intubation, in NNIS. See National Nosocomial gastrointestinal bleeding, Infections Surveillance 245 System Nasogastric suctioning, 116 Nocardiosis, 152 Nasopharyngeal bleeding, 246 Noninvasive mechanical ventilation. Nasotracheal intubation, sinusitis See Mechanical ventilation, and, 145 noninvasive National Nosocomial Infections Norepinephrine, for shock, 67–68, 67t Surveillance System, 120, Norfloxacin, for prevention of 120t spontaneous bacterial Needle-stick injury, 17 peritonitis, 279 Neomycin, for hepatic Normal saline, for volume encephalopathy, 286 resuscitation, 245 Neostigmine, for colonic pseudo- Nosocomial infections, 119–164, obstruction, 289 120t Nephrotic syndrome, 264, 275 NSAIDs, bleeding complications of, Nephrotoxic agents, 107, 109 247, 301 Neuroendocrine system, in shock, 5′-NT. See 5′-Nucleotidase 59t Nuclear studies: Neurogenic shock, 60, 62 in acute myocardial infarction, 216 Neuroleptic malignant syndrome, in renal failure, 109 121t, 354 Nucleic acids, dietary, 178 Neurologic disorder, in HIV-infected 5′-Nucleotidase, serum, 262, 265t patients, 152 Nutritional assessment, 170–172, Neurologic examination, in coma, 171t 330–335 Nutritional support, 169–184. See Neuromuscular blockade, also Enteral nutrition; monitoring of, 356–357 Parenteral nutrition Neuromuscular disease, mechanical for acute pancreatitis, 260 ventilation in, 90–91 for burn patient, 175t, 179 Neutropenia, 148–149 comparison of formulations, 173t Nicardipine, for lowering blood pres- determining adequacy of, 180 sure, 339 goals of, 170 NIMV. See Mechanical ventilation, for hepatic encephalopathy, 286 noninvasive improving outcome with, 181–184 Nitric oxide, 56 for infection and inflammation, for hypoxemia, 8 179 Nitrogen balance, 171, 180 for inflammatory bowel disease, Nitrogen sources, 177 175t, 179 composition of parenteral and for liver failure, 175t, 178 enteral formulations, 173t macronutrient requirements of Nitroglycerin, for acute myocardial adults, 174t infarction, 221 for major surgery, 175t Nitroprusside test, 239

for multiple organ failure, 180 Index 385 overfeeding. See Overfeeding for pancreatitis, 175t, 179 Ornithine aspartate, for hepatic quantity of nutrients, 174–177 encephalopathy, 286 for renal failure, 175t, 178 specific nutrients, 177–178 Osborne wave, 206–207 timing of, 172 Oscillating ventilation, 8 for trauma patient, 175t Osler’s nodes, 330t for wound healing, 179 Osmotic agents, for increased Nystagmus, 333–334 intracranial pressure, O 338–339 Obstructive shock: Osmotic diuresis, 116 Overfeeding, 173, 175–176, 180 differential diagnosis of, 63 Oxacillin, 157 hemodynamic profile in, 57, 57t Oxazolidinones, for vancomycin- patient history in, 58 resistant enterococcal symptoms of, 60 infections, 155 Obtundation, 322 Oxygen concentration: Occlusive dressing, 121t in arterial blood, 10 Octreotide, for variceal bleeding, in venous blood, 11 Oxygen consumption, 11–13, 56, 247, 251–252 171, 312–313 Ocular bobbing, 333 oxygen delivery vs., 12f Ocular injury, airway management Oxygen debt, 56 Oxygen delivery, 1–13, 4f, 11f, 49–50, in, 358 56, 312 Ocular motility, evaluation of, oxygen consumption vs., 12f Oxygen extraction ratio, 12, 49, 313 333–334 Oxygen kinetics, pulmonary artery Oculocephalic reflex, 333–334, 346 catheters and, 49–50, 50f Ofloxacin, 160 Oxygen saturation, 10–13, 28, 82 Ohm’s law, 44 Oxygen uptake, 49, 56 Oliguria, 61 Oxyhemoglobin, 28 Omega-3 fatty acids, 177 Oxyhemoglobin dissociation curve, Omega-6 fatty acids, 177 10–11, 11f Opioids, 354–355, 354f, 359 P general guidelines for, 355 P wave, 194, 199 prescribing in renal failure, 111 PAC. See Pulmonary artery catheter reversal of, 355, 355f Pacemaker wire, insertion of side effects of, 354–355 Opsonins, ascitic fluid, 279 temporary wire, 20 Organ donor, care of potential Pacing, 191–193 donors, 346 “oversensing,” 192 Organ failure, signs of, 258t permanent, 191 Organ transplant recipient, sensing threshold of pacemaker, infections in, 153 192

386 Index Pacing (cont.) nondepolarizing agents, 356, 356f sensitivity of pacemaker, 192 Parenteral nutrition, 109–110 temporary, 190–193, 190f, 193–194t composition of formulations, 173t for torsades de pointes, 204 enteral nutrition vs., 172–174, transcutaneous pacemaker, 191, 193t 173–175t transvenous pacemaker, 191, 194t total. See Total parenteral “undersensing,” 192 ventricular demand mode, 192 nutrition Paroxysmal sinus bradycardia, 186 Packed red blood cells, 315 Partial thromboplastin time, 300t, Pancreas: 301–302, 306–309 anatomy of, 238–239 Patent foramen ovale, 7 laboratory testing, 239 PAWP. See Pulmonary artery wedge physiology of, 239 Pancreatic abscess, 260 pressure Pancreatic cancer, 266 PBC. See Primary biliary cirrhosis Pancreatic necrosis, 259–260 PCP. See Pneumocystis carinii Pancreatitis, 63, 107, 266, 275 acute, 256–261 pneumonia PCV. See Pressure-control APACHE II score for, 258 clinical presentation of, 256 ventilation complications of, 261 PCWP. See Pulmonary capillary determining severity of, wedge pressure 257–259, 257t, 260t PEEP. See Positive end-expiratory laboratory diagnosis of, pressure 256–257 Penicillin(s), 156–157 radiologic diagnosis of, 257 Ranson criteria for, 257–258, intravenous dosages of, 163t penicillinase-resistant, 157 259t prescribing in renal failure, 111 treatment of, 259–261 side effects of, 311 nutritional support in, 173, 175t, Penicillin resistance, 155 Pentamidine: 179 arrhythmias and, 205t Pancuronium, 356, 356f for Pneumocystis carinii Papilledema, 330, 341 Paracentesis: pneumonia, 151–152 Pentobarbital, for increased intracra- diagnostic, 277–278, 278t large-volume. See Large-volume nial pressure, 339 Peptic ulcer disease, 246–247 paracentesis Percutaneous transluminal coronary Paradoxical pulse, 60 Paralysis, therapeutic, 90 angioplasty, 216–219, 217t, Paralytic agents, 355–357 223–224 Pericarditis, 63, 198 depolarizing agents, 355–356, 356f Perinephric abscess, 280 monitoring of, 356–357 Peripheral blood smear, 302, 312 Peripheral edema, 281 Peripherally inserted central catheter, 34

Peritoneal dialysis, 110 Index 387 Peritoneovenous shunt, 283 Peritonitis, 130t in secondary bacterial peritonitis, 280 secondary bacterial, 280 spontaneous bacterial, 275–280 Pneumocystis carinii pneumonia, Permissive hypercapnia, 87–90 150–152, 151t Pernicious anemia, 232–233 Persistent vegetative state. See Pneumonia, 2t, 120t in acute liver failure, 272 Vegetative state causative microorganisms, 134, Petechiae, 329t 134t Petechial-purpuric rash, 329t criteria for clinical suspicion of, Phenothiazines, 205t 132t Phenylephrine, for shock, 67–68, 67t criteria for confirming or ruling Phenytoin, for status epilepticus, 341 out, 131t Pheochromocytoma, 121t diagnosis of, 130–133, 130–133t Phlebotomy, 312 bronchoscopic techniques, Physical examination, in renal 132–133, 133t endotracheal aspiration, 132, failure, 108 133t Physiologic monitoring, 21–22 fever in, 122 Physiologic sodium, fluid in immunocompromised patients, 149 management in shock, 65 lobar, 91 PICC. See Peripherally inserted nosocomial, 128–135 pathogenesis of, 128 central catheter prevention of, 128–130 Pinpoint pupil, 332, 332f risk factors for, 128, 128t Piperacillin, 127t, 157, 163t shunt in, 7 Piperacillin-tazobactam, 127t, 157, therapy for, 127t, 134–135 empiric antibiotics, 131, 163t 134–135 Plasma protein solution, fluid ventilator-related, 127t, 128–135, 249 management in shock, 65 Plasmapheresis, 304 Pneumothorax, 30, 60, 63 Plateau pressure, 81, 83f Poiseuille-Hagen formula, 19, 45 Platelet count, 300, 300t, 302–304, Pontine lesions, 327, 333–334 Porphyria, 329t 309 Portal hypertension, 254, 275, 330 Platelet disorders, 300–305, 309 Portal hypertensive gastropathy, laboratory studies in, 300t 250–252, 254 uremia-related, 305 Positive end-expiratory pressure, 39, Platelet glycoprotein IIb/IIIa 41, 47–48 inhibitors, 219 in acute respiratory distress Platelet transfusion, 247, 302, syndrome, 86–87 305–306, 309, 314t auto-PEEP, 78, 78f, 80, 83f, 84, Plethysmography, thoracic 85f, 86, 88–90 bioimpedance, 51–52 PMN count: ascitic fluid, 278–279

388 Index Positive end-expiratory pressure for supraventricular arrhythmias, (cont.) 196, 198 “best-PEEP” approach, 87 for ventricular arrhythmias, 203 “open lung” approach, 87 Prone positioning, 8 removal of, 96 Propafenone, for supraventricular in restrictive lung disease, 91, arrhythmias, 196 92f Propofol, 352–353, 359 in unilateral lung disease, 92 settings for mechanical ventilation, and acute pancreatitis, 260 effects on organ systems, 352–353 81–82t, 82–84, 85f and increased intracranial “sneaky-PEEP,” 8 treatment of hypoxemia, 8 pressure, 339 Positive fluid wave, 276 Propranolol, to prevent variceal Positive pressure ventilation, 35 Post-transfusion purpura, 303–304, bleeding, 254 Propylthiouracil, for thyrotoxicosis, 303t Postrenal renal failure, 107–108 234 Posturing, 334 Prosthetic valve failure, 51 Potassium chloride, for metabolic Protamine: alkalosis, 114 reversal of heparin action, PR interval, 187–188 307–308 Pre-albumin, 171, 171t, 180 Prednisone, for immune hemolytic side effects of, 311 Protected specimen brush technique, anemia, 311 Preload, 96 133, 133t Protein: assessment of, 35 optimal, 38 ascitic fluid, 278–280 pharmacologic intervention, daily requirement for, 174–175t, 45–46 175–176 Prerenal renal failure, 106–107 dietary, 177 Pressure-control ventilation, 74t, 75f, restriction in hepatic 79–80, 82 encephalopathy, 285 Pressure-support ventilation, 74t, Protein-losing enteropathy, 264 75f, 80, 81t, 82 Proteinuria, 288t Pressure transducer, 20–22 Prothrombin time, 250, 261, 265t, Primaquine, for Pneumocystis carinii 269, 275, 300–302, 300t, pneumonia, 152 306–309 Primary biliary cirrhosis, 263–264, PSC. See Primary sclerosing cholangitis 267 Pseudocyst, pancreatic, 256–257, 261 Primary sclerosing cholangitis, Pseudomembranes, 148 Pseudomonas aeruginosa, 156 264–266 Pseudomonas infection, 329t Procainamide: PSV. See Pressure-support ventilation for arrhythmias, 210t Psychogenic unresponsiveness, 325 arrhythmias and, 205t PT. See Prothrombin time

Index 389 PTCA. See Percutaneous trans- elevated, 40–41 luminal coronary angioplasty Pulmonary edema, 41–42, 215 PTT. See Partial thromboplastin time cardiogenic. See Cardiogenic Puddle sign, 277 pulmonary edema Pulmonary artery, blood gas analysis, noncardiogenic, 317 8 Pulmonary embolism, 2t, 51, 63, 124, Pulmonary artery catheter, 20, 36 130t, 198, 268 assessment of cardiac pharma- Pulmonary fibrosis, 130t cologic intervention, 45–47 Pulmonary hypertension, 35–36, 63 Pulmonary infiltrate, 130, 130t assessment of cardiopulmonary Pulmonary system, in shock, 58t interaction, 47–48 Pulmonary vascular resistance, 44, in cardiogenic shock, 223 46t, 47 continuous cardiac output, 48 Pulse oximetry, 27–29 derived cardiac indexes, 43–45 Pulse pressure, 24, 26 erroneous data from, 21 Pupillary reactivity, 332–333 mixed venous oximetry, 48 Pupillary size, 332–333, 332f monitoring in shock, 57, 65 Purpura fulminans, 329t overwedging, 38 PVR. See Pulmonary vascular oxygen kinetics and, 49–50, 50f percentage of ICU patients with, resistance Pyrimethamine, for toxoplasmosis, 121t physiology and analysis of PAC 152 data, 38–50 Q placement of, 37–38, 37f QRS complex, 188–189, 189f, pseudo-wedging, 37–38 pulmonary capillary wedge 191–192, 199–200 QT interval, 354 pressure and acute Quinidine, 303t, 311 respiratory distress syndrome, 41–42 arrhythmias and, 205t pulmonary capillary wedge for supraventricular arrhythmias, pressure and cardiac function, 38–41, 39–40f 196 thermodilution cardiac output, Quinupristin-dalfopristin: 42–43, 43f volumetric ejection fraction and, for methicillin-resistant 48–49 Staphylococcus aureus Pulmonary artery wedge pressure, 35 infections, 154 Pulmonary capillary filtration pressure, 41 for vancomycin-resistant Pulmonary capillary wedge pressure, enterococcal infections, 155 35, 40 acute respiratory distress R syndrome and, 41–42 Radial artery cannulation, 24 cardiac function and, 38–41, 39–40f Radiation colitis, 246 Radiation enteritis, 246

390 Index causes of: postrenal, 107–108 Radiographic studies, for prerenal, 106–107 gastrointestinal bleeding, 255 renal, 107 Radiologic studies, in acute definition of, 104–106 pancreatitis, 257 diagnostic considerations in, Ramsay scale, 350, 350f 108–109 Ranitidine, 129 intravenous dosages of for Helicobacter pylori infection, antimicrobials in, 163–164t 249t long-term outcome in, 112 management of. See also Dialysis Ranson criteria, for acute pancreatitis, 257–258, 259t diuretics and dopamine, 109 “soft” interventions, 109–110 Rapid-cycle breathing, 327 nutritional support for, 175t, 178 Rapid sequence induction, 357, 357f prescribing common drugs in, Rapid shallow breathing index, 96t, 111 97 quantification of, 104–106 Raynaud’s disease, 24 Renal function, in shock, 58–59t, 61 Recombinant tissue plasminogen Renal tubular acidosis, 113 Renin-angiotensin-aldosterone activator, for stroke, 340 Rectal examination, 255 system, 236, 276 Red blood cell(s): Reperfusion therapy, 216–219 Respiration, in coma, 327, 328f decreased production of, 310 Respiratory acidosis, 112t, 114 increased destruction of, 310–311 Respiratory alkalosis, 93, 112t, 115, Red blood cell enzyme deficiencies, 339 311 Respiratory failure, 1–13. See also Red blood cell transfusion, 19, 313, Hypercapnia; Hypoxemia; 314t Mechanical ventilation frozen cells, 314t, 316 acid-base abnormalities in, 112t irradiated cells, 314t, 316 colonic pseudo-obstruction in, leukocyte-reduced cells, 314t, 315 288 packed cells, 315 in HIV-infected patients, 150–152, washed cells, 314t, 316 151t Red man syndrome, 159 stress-induced ulcers and, 247 Reentrant supraventricular Respiratory quotient, 9, 171–172, 180 Respiratory rate, settings for tachycardia, 209t mechanical ventilation, 81, Reflectance spectrophotometry, 27, 81–82t Respiratory workload, inspiratory 48 muscle strength and, 95, 95f Reflex ocular testing, 333–334 Resting metabolic expenditure, 175, Remifentanil, 354 176t Renal colic, 256 Restrictive eye disease, 334 Renal failure, 103–117 acid-base abnormalities and, 112–115, 112t acute, 62 in acute liver failure, 272–273 anemia in, 310

Index 391 Restrictive lung disease, mechanical Sclerotherapy, for variceal bleeding, ventilation in, 91, 92f 252–254 Reticular formation, brainstem, Sebum, 16 322–323 Secondary bacterial peritonitis, 280 Sedation: Reticulocyte count, 312 Retinal hemorrhage, 341 for increased intracranial pressure, Retinol-binding protein, 171, 171t 339 Revascularization, with cardiogenic for vascular access, 22 shock, 223 Sedation agents, 350–357 Reverse T3, 230–231 Sedation scale, 350, 350f Reye’s syndrome, 268 Seizure, 122t Rhabdomyolysis, 105, 107 Seldinger technique, 21 Rifampin, 311 Self-awareness, 322 Sengstaken tube, 253 for diarrhea, 148 Sepsis, 48, 51, 107, 122–123, 288, Rifampin-impregnated catheter, 136 Right ventricular ejection fraction, 325–326, 328 in HIV-infected patients, 152 48–49 Sepsis syndrome, 112t Right ventricular end-diastolic Septic shock, 61–62, 65 Serotonin antagonists, 205t volume, 48 Serum-ascites albumin gradient, RME. See Resting metabolic expendi- 278 ture Serum sickness, 329t Rocky Mountain spotted fever, 329t Shaken baby syndrome, 330 Rocuronium, 358 Shock, 10, 12, 328. See also specific Romano-Ward syndrome, 205t Roving eye movements, 333 types of shock RQ. See Respiratory quotient complications of, 62 rt-PA. See Recombinant tissue definition of, 56 diagnostic testing in, 60–61 plasminogen activator differential diagnosis of, 62–64 RVEDV. See Right ventricular end- general principles of, 57 hemodynamic profile in, 57, 57t diastolic volume history of disease process, 58–59 RVEF. See Right ventricular ejection management and therapy for: fraction fluid management, 64–67 goals for, 64, 65t S monoclonal antibodies, 68 SAAG. See Serum-ascites albumin vasoactive drugs, 67–68, 67t pathophysiology of, 56–57 gradient renal failure in, 107 Sagittal sinus thrombosis, 326 symptoms of, 57, 58t Salicylate intoxication, 121t evaluation of, 58–60 Salivary disease, 256 Short-chain fatty acids, 177 Sarcoidosis, 187, 263 Short-gut syndrome, 173–174 SBP. See Spontaneous bacterial peritonitis SCFA. See Short-chain fatty acids

392 Index Shunt, 2, 4f, 6f, 7–8 urine, 104, 106, 281–282 extrapulmonary, 7 Sodium benzoate, for hepatic intrapulmonary, 7 encephalopathy, 286 SI. See Stroke index Sodium bicarbonate, for Sick sinus syndrome, 187 Sickle cell disease, 311 hyperkalemia, 206 Sigmoidoscopy, 255 Sodium citrate, in venous flushing Silver sulfadiazine-impregnated solutions, 20 catheter, 136 Sodium nitroprusside: SIMV. See Synchronized intermittent for hypertensive encephalopathy, mandatory ventilation 342 Sinus arrest, 222 Sinus bradycardia, 193–194t for lowering blood pressure, 339 Sinus node, 186–187 Sodium polystyrene sulfonate, for Sinus puncture, 145 Sinus rate, 186–187 hyperkalemia, 206 Sinus tachycardia, 186, 194, 199 Somatostatin: Sinusitis, 145–146 for acute pancreatitis, 260 antibiotic therapy for, 127t for variceal bleeding, 247, 251 causative microorganisms, 146 Sotalol, for supraventricular arrhyth- diagnosis of, 145–146, 146t pulmonary infiltrate in, 130t mias, 196 risk factors for, 145 Spironolactone, for ascites, 281 therapy for, 146 Splenic laceration, 124 SIRS. See Systemic inflammatory Splinter hemorrhage, 330t Spontaneous bacterial peritonitis, response syndrome Skew deviation, 333 275–280 Skin: Sputum culture, 130–131, 149–150 Staphylococcal toxic shock, 329t biopsy in disseminated Staphylococcemia, 329t candidiasis, 144 Staphylococci, coagulase-negative, rashes in coma patient, 328, 126, 138, 160 329–330t Staphylococcus aureus: in shock, 58t catheter-related bloodstream Skin-fold thickness, 170 infections, 139–140, 139t Small-bowel feeding tube, 173–174, methicillin-resistant, 126, 134, 181 143, 154 “Sneaky PEEP,” 8 Sodium: oxacillin-resistant, 126 Starling’s law of the heart, 38, 39f ascitic fluid, 282 Status epilepticus, 341 blood. See Hypernatremia; nonconvulsive, 326, 333, 336, 341 Hyponatremia Steatohepatitis, nonalcoholic, 267 dietary restriction for ascites, Sterile technique, 16–19, 136 Stool guaiac, 313 280–281 Stool sample, 147–148 fractional excretion of, 104, 106 Strabismus, 333 Streptococci: beta-hemolytic, 123

Index 393 drug-resistant, 155–156 “Synchronization period,” 79 Streptokinase, 307 Synchronized intermittent Stress echocardiography, 224 Stress-induced ulcers, 247–250, mandatory ventilation, 74t, 75f, 79, 81t 260 Syncope, 191 prophylaxis for, 249, 250t, 271 Systemic arterial pressure, Stress thallium echocardiography, monitoring of, 24 Systemic inflammatory response syn- 224 drome, 56. See also Shock Stroke, 90, 122t, 340 Systemic lupus erythematosus, 329t Stroke index, 46t Systemic vascular resistance, 27, Stroke volume, 43–45, 46t, 51 44–45, 46t Stupor, 322 Systolic amplification, arterial Subacute bacterial endocarditis, pressure monitor, 27 329–330t T Subarachnoid hemorrhage, 326–328, T3. See Triiodothyronine T3 resin-uptake test, 230 330, 342 T4. See Thyroxine Subclavian catheter, 137 Tachybradycardia syndrome. See Subclavian vein cannulation, 22 Sick sinus syndrome placement of central venous Tachycardia, 234 catheter, 30, 32–33, 33f in coma, 328 Subfalcial brain herniation, 335 Taurine, 177 Succinylcholine, 355–356, 356f TBG. See Thyroxine-binding Sucralfate, 129 globulin to prevent stress-induced ulcers, Technetium-labeled RBC scan, for 250 gastrointestinal bleeding, Sulbactam, 126 255 for urinary tract infections, 143 TEE. See Transesophageal echocardiography Sulfa drugs, 303t, 311 Telangiectasia, 329t Sulfadiazine, for toxoplasmosis, 152 Tension pneumothorax, 60 Superior vena cava cannulation, Tetracyclic antidepressants, 205t Tetracycline, for Helicobacter pylori 29–32, 33f infection, 249t Supratentorial lesion, 326 Thermocoagulation, for Supraventricular tachycardia, 187, gastrointestinal bleeding, 248 Thermodilution cardiac output, 193–199, 195f, 197f, 209–210t 42–43, 43f Surgical shunt, for variceal bleeding, Thiamine, for coma, 326 Thiopental, 357 253 Third spacing, 63 Surgical site infection, 120t SV. See Stroke volume SVR. See Systemic vascular resistance SVT. See Supraventricular tachycardia Swan-Ganz catheter. See Pulmonary artery catheter Sympathetic tone, 186

394 Index Thoracic artery aneurysm, 51 Tidal volume, settings for mechanical Thoracic bioimpedance ventilation, 81, 81–82t plethysmography, 51–52 TIPS. See Transjugular intrahepatic Thoracic fluid index, 51 portacaval shunt Thrombin time, 300t, 302 Thrombocytopenia, 300t Tirofiban, for acute myocardial infarction, 219 acquired, 302, 302t causes of, 303t Tissue oxygenation, 313 in cirrhosis, 275 TMP/SMX, for Pneumocystis carinii heparin-induced, 20, 304 immune-mediated, 302 pneumonia, 151–152 Thrombocytopenic purpura: TNF. See Tumor necrosis factor idiopathic, 303, 303t, 309 Tonometry, mucosal, 52 thrombotic, 300t, 303t, 304, Torsades de pointes, 198, 204, 205t, 308–309, 329t 210t Thrombolytic therapy, 300t, 307, 340 Total bilirubin, 257, 261–263, 269 Total minute ventilation, 9 for acute myocardial infarction, Total parenteral nutrition, 136, 216–219, 218–219t 172–174, 173–175t, 179, 263 contraindications to, 218–219 for acute pancreatitis, 260 regimens, patency rates, and costs, central venous catheter for, 30 Total peripheral resistance, 26 219t Total urinary nitrogen, 171 Thrombosis, 122t Toxoplasmosis, 150, 152, 329t Thrombotic thrombocytopenic TPN. See Total parenteral nutrition TPP. See Thrombotic purpura, 300t, 303t, 304, 308–309, 329t thrombocytopenic purpura Thyroglobulin, 229 TPR. See Total peripheral resistance Thyroid gland: Trace elements: anatomy of, 229 disorders of, 230–234 composition of parenteral and general considerations, 228–229, enteral formulations, 173t, 229f 177 laboratory tests, 230 physiology of, 229–230 daily requirement for, 177 Thyroid-stimulating hormone, Tracheal aspirate, purulent, 130 230–231, 233 Tracheostomy, 129 Thyroid storm, 228, 233–234 Train-of-four monitor, 356 Thyrotoxicosis, 121t, 228, 233–234 Transerythrin, 230–231 Thyrotropin-releasing hormone, Transesophageal Doppler 230 Thyroxine, 229–231, 233 technology, 51–52 Thyroxine-binding globulin, Transesophageal echocardiography, 230–231 Ticlopidine, for acute myocardial 50–51, 61 infarction, 220 Transferrin, 171, 171t, 180 Transfusion reaction, 122t Transfusion therapy. See also specific blood products; Post- transfusion purpura

Index 395 administration of blood products, U 316 Ulnar artery cannulation, 24 Ultrasonography: for anemia, 313–316 blood products for, 314–315t in acute pancreatitis, 257 for gastrointestinal bleeding, in ascites, 277 Uncal herniation, 333, 335 246–247 Unilateral posturing, 334 massive, 107, 306, 308 Universal precautions, 17 risks of, 316–318 Ureidopenicillins, 157 Transjugular intrahepatic portacaval Uremia, 305, 313 Ureteral obstruction, 107 shunt: Urethral obstruction, 107 for ascites, 283 Urinalysis, in renal failure, 108 for hepatorenal syndrome, 288 Urinary catheter, 140–141 for variceal bleeding, 253 percentage of ICU patients with, Transthoracic echocardiography, 121t 50 silver-impregnated, 141 Trauma patient, 48 Urinary tract infection, 120t, airway management in, 358 140–143 nutritional support for, 175t in acute liver failure, 272 renal failure in, 107 causative microorganisms, 143t shock and, 63 definition of, 142t TRH. See Thyrotropin-releasing hor- diagnosis of, 141–142 prevention of, 140–141 mone pulmonary infiltrate in, 130t Tricuspid regurgitation, 43 risk factors for, 140, 141t Tricyclic antidepressants, 205t therapy for, 142–143 Trigger sensitivity, settings for Urine: osmolarity in renal failure, 104 mechanical ventilation, output in renal failure, 104 81–82t, 84 UTI. See Urinary tract infection Triglycerides, ascitic fluid, 279 Triiodothyronine, 229–231 V Troponins, 64, 215–216 V/Q mismatch. See Trovafloxacin, 164t Trypsinogen-2, urine, 257 Ventilation/perfusion TSH. See Thyroid-stimulating mismatch hormone Vagal tone, increased, 186–188 TT. See Thrombin time Valium. See Diazepam TTE. See Transthoracic Vancomycin, 127t, 158–159, 164t. echocardiography See also Enterococci, TTP. See Thrombotic vancomycin-resistant thrombocytopenic purpura for catheter-related bloodstream Tuberculosis, 63, 150, 152, 263 infection, 139 Tumor necrosis factor, 56–57 Turner’s sign, 256 Typhoid, 329t Typhus, 329t

396 Index Vancomycin (cont.) diagnosis of, 323–324, 324t for diarrhea, 148 prognosis of, 345 for infection in Venous air embolism, 29–30 immunocompromised Venous blood gas analysis, 23 patients, 149 Venous cannulation, 20 for methicillin-resistant Venous return, 47 Staphylococcus aureus Ventilation/perfusion mismatch, 2, infection, 154 for pneumonia, 135 4–5f, 7–8 prescribing in renal failure, 111 Ventricular ejection time, 51 for sinusitis, 146 Ventricular fibrillation, 199, 203, for urinary tract infections, 143 208–209, 209–210t, 215, 222 Variceal bleeding, 246–247, 250, 279 Ventricular hypertrophy, 196 balloon tamponade for, 252–253 Ventricular septal rupture, 222 in cirrhosis, 275 Ventricular tachycardia, 199–200, endoscopic treatment of, 252 liver transplantation for, 254 201f, 202–203, 202t, medical treatment of, 251–252 209–210t, 215, 222 nasogastric intubation in, 245 polymorphic, 203–204, 203f prevention of recurrent bleeding, Verapamil, for arrhythmias, 198, 254 210t surgical shunt for, 253 Versed. See Midazolam suspected, 251 Vesicular rash, 329t transjugular intrahepatic Vincristine, for idiopathic thrombo- portacaval shunt for, 253 cytopenic purpura, 303 Viral hepatitis, 244, 265, 266t, 268 Varicella, 329t hepatitis A, 268 Vascular access, 15–53. See also hepatitis B, 268 hepatitis C, 268 Arterial cannulation; Central hepatitis D, 268 venous catheter; Pulmonary hepatitis E, 268 artery catheter transmission of, 17 analgesia and sedation for, 22 Visceral proteins, 171, 171t, 180 choice of catheter, 19–21 Vitamin(s): informed consent for, 22–23 composition of parenteral and for monitoring, 21–22 enteral formulations, 173t sterile and aseptic techniques in, recommended daily intake, 176 16–19 Vitamin B12, 312 Vascular surgery, nutritional support deficiency of, 303t, 310 for, 175t Vitamin K, 263–264, 265t, 272, 306, Vasoactive drugs, for shock, 67–68, 308 67t deficiency of, 264, 307 Vasopressin, 235 Volume control ventilation, 74, 74t, for variceal bleeding, 251 75f, 81t Vecuronium, 356, 356f Volume depletion, intravascular, 26 Vegetative state: Volume resuscitation, 20

von Willebrand’s disease, 300t, 307 Index 397 VRE. See Enterococci, vancomycin- Wernicke’s disease, 326 resistant White blood cell count, 122–123, 147 vWD. See von Willebrand’s disease Whole blood, 313–315, 314t Wide complex tachycardia, 199–204, W Warfarin, 308 201f, 202t, 203f Washed red blood cells, 314t, 316 Wilson’s disease, 264–268 Water, daily requirement for, 176 Wound drain, percentage of ICU pa- WBC count. See White blood cell tients with, 121t count Wound healing, nutritional support Weaning, from mechanical for, 179 ventilation: invasive, 94–97, 95f, 96t Y noninvasive, 100 Yersinia enterocolitica, 317 Wenckebach block. See Z Atrioventricular block, Zinc, in hepatic encephalopathy, 286 second-degree, type I

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