REDUCING MORTALITY IN CRITICALLY III PATIENTS.

The 2nd edition of this book describes the recent techniques, strategies, and drugs that have been demonstrated by multicenter randomized trials to influence survival in critically ill, defined as those who have acute failure of at least one organ, due to either a pathological condition or a medical intervention, and require intensive care treatment. Each chapter focuses on a specific procedure, device, or drug. The scope is accordingly wide, with coverage of topics as diverse as noninvasive mechanical ventilation, protective ventilation, prone positioning, intravenous salbutamol in ARDS, high-frequency oscillatory ventilation, mild hypothermia after cardiac arrest, daily interruption of sedatives, tranexamic acid, diaspirin cross-linked hemoglobin, albumin, growth hormone, glutamine supplementation, tight glucose control, supranormal oxygen delivery, and hydroxyethyl starch in sepsis. The topics selection was performed with the help of hundreds of specialists from dozens of countries; they expressed via web if they agreed or not with these topics and if they used them in their daily clinical practice. The clear text is supported by'how to do'sections and'key point'boxes that provide easily accessible practical information. Written by acknowledged international experts, Reducing Mortality in Critically Ill Patients is of interest for a wide variety of specialists, including intensivists, emergency doctors, and anesthesiologists. Preface Contents 1: Decision-Making in the Democracy Medicine Era: The Consensus Conference Process 1.1 Systematic Review 1.2 Reaching Consensus in Democracy Medicine 1.3 The Identified Topics, the Book, and the Diffusion of the Evidence to the International Community of Colleagues 1.4 A Common Shell for a Flexible Process References 2: Non-invasive Ventilation 2.1 General Principles 2.2 Pathophysiological Principles 2.3 Main Evidences and Clinical Indications 2.3.1 Non-invasive Ventilation in Hypercapnic Patients 2.3.2 Non-invasive Ventilation to Treat Acute Respiratory Failure: Hypoxemic Patients 2.3.3 Non-invasive Ventilation in the Weaning from Mechanical Ventilation 2.3.3.1 Non-invasive Ventilation in the Weaning of Hypercapnic and Mixed Patients Non-invasive Ventilation in Patients after T-Piece Trial Failure Non-invasive Ventilation to Shorten Standard Weaning Non-invasive Ventilation to Prevent Post-Extubation Failure 2.3.3.2 Non-invasive Ventilation in the Weaning of Patients at Risk for Post-Extubation ARF 2.3.4 Non-invasive Ventilation to Treat Post-Extubation Respiratory Failure: Evidence of Increased Mortality 2.4 Three Issues To Be Considered 2.5 Conclusions References 3: High-Flow Nasal Cannulae 3.1 General Principles 3.2 Pathophysiological Principles 3.3 Main Evidence and Clinical Use 3.4 Therapeutic Use 3.5 State of the Art/Conclusions References 4: Restrictive Inspiratory Oxygen Fraction 4.1 General Principles 4.2 Main Evidences 4.3 Pathophysiological Principles: Possible Mechanisms of Reduced Mortality 4.4 Implications for Clinical Practice References 5: Mechanical Ventilation in ARDS 5.1 General Principles 5.2 Main Evidences 5.2.1 Lung-Protective Ventilation 5.2.2 Prone Positioning 5.2.3 Other Mechanical Ventilation Strategies 5.3 Pathophysiological Principles: Mechanisms of Reduced Mortality 5.4 Therapeutic Use References 6: Early Tracheostomy 6.1 General Principles 6.2 Physiological Advantages 6.3 Indications 6.4 Timing 6.5 Main Evidences on Mortality 6.6 Conclusions References 7: Pharmacological Management of Cardiac Arrest 7.1 General Principles 7.2 Pathophysiologic Principles 7.3 Main Evidences 7.3.1 Advanced Cardiac Life Support with/without Drugs 7.3.2 Antiarrhythmics 7.3.3 Inotropic/Vasopressor Drugs 7.3.3.1 Epinephrine 7.3.3.2 Vasopressin 7.3.4 Steroids 7.3.5 Other Drugs 7.4 Discussion and Conclusions References 8: Non-pharmacological Management of Cardiac Arrest 8.1 General Principles 8.2 Main Evidence References 9: Avoidance of Deep Sedation 9.1 General Principles 9.2 Light Versus Deep Sedation 9.3 Sedation-Sparing Protocols 9.4 Sedative Agents: Old School and New School 9.5 Monitoring of Sedation: Analogic and Digital 9.6 Limiting Physical Restraints 9.7 Conclusions References 10: Hydrocortisone in Sepsis 10.1 General Principles 10.2 Physiological Basis 10.3 Main Evidences on Mortality 10.4 Conclusions References 11: Goal-Directed Therapy 11.1 General Principles 11.2 Intravenous Fluids 11.3 Monitoring Fluid Response 11.4 Non-responders to Goal-Directed Therapy 11.5 Responders to Goal-Directed Therapy References 12: Levosimendan in Cardiogenic Shock and Low Cardiac Output Syndrome 12.1 General Principles 12.2 Pharmacologic Properties 12.3 Main Evidences 12.3.1 Perioperative Levosimendan in Cardiac Surgery 12.3.2 Levosimendan in Cardiogenic Shock and in Takotsubo Syndrome 12.4 Therapeutic Use 12.5 Discussion and Conclusion References 13: Drugs in Myocardial Infarction 13.1 General Principles 13.2 Pathophysiological Principles 13.3 Treatment 13.3.1 Primary Percutaneous Coronary Intervention (STEMI and NSTEMI) 13.3.2 Fibrinolytic Therapy (STEMI) 13.3.3 Different Perspectives (NSTEMI) 13.3.4 Other Medications 13.4 Main Evidences 13.4.1 Dual Anti-Platelet Therapy 13.4.2 Novel Anti-Platelet Medication 13.4.3 Thrombolysis References 14: Tranexamic Acid in Trauma Patients 14.1 General Principles 14.2 Main Evidences 14.3 Pharmacologic Properties and Physiopathological Principles 14.4 Therapeutic Use 14.4.1 Pharmacokinetics 14.4.2 Practical Application: Dosage and Timing 14.4.3 Indications and Contraindications 14.5 Conclusion References 15: Procalcitonin-Guided Antibiotic Discontinuation 15.1 General Principles 15.2 Main Evidences 15.2.1 The SAPS Trial and PCT Guidance in Critically Ill/Septic Patients 15.2.2 BPCTrea Trial and PCT Guidance in Respiratory Tract Infections 15.3 Pathophysiological Principles 15.4 Clinical Use 15.5 Conclusions References 16: Selective Decontamination of the Digestive Tract 16.1 General Principles 16.2 Main Evidence 16.3 Pharmacological Properties 16.4 Therapeutic Use 16.5 Conclusions References 17: Nutrition 17.1 General Principles of the Nutrition Therapy in the Critical Care Patient 17.2 Evidence in the General Principles of the Nutrition Therapy 17.2.1 Caloric Intake: Focus on Progressive Feeding and Prevent Refeeding Syndrome, Underfeeding and Overfeeding 17.2.2 The Route of Nutrition Therapy: Enteral Vs Parenteral 17.2.3 Appropriate Caloric and Protein Target 17.2.4 Nutrition Monitoring 17.3 Evidence in Immunonutrition Enteral Formulas 17.4 Evidence in Micronutrients and Antioxidants 17.5 Nutritional Management in ICU Patients Infected with SARS-COV-2 17.6 Conclusions References 18: ECMO and Survival 18.1 General Principles 18.2 VV ECMO for Respiratory Failure 18.3 VA ECMO for Cardiogenic Shock 18.4 Key Points References 19: Ultrasounds 19.1 General Principles 19.2 Main Evidences 19.2.1 Ultrasonography in Upper Airways Procedures 19.2.2 Ultrasonography in the Assessments of Lower Respiratory Tract 19.2.3 Ultrasonography in Intensive Care 19.3 Randomized-Controlled Studies of POCUS 19.3.1 POCUS in Percutaneous Dilatational Tracheostomy 19.3.2 POCUS in Respiratory Patients 19.3.3 POCUS Impact on Mortality and Complication Rates in Hip Fracture Patients 19.3.4 Impact of Ultrasound Protocol in Early ICU Stay 19.3.5 Echocardiography in the Treatment of Septic Shock 19.4 Conclusions References 20: Alternative Medicine 20.1 Introduction 20.2 Alternative Medicine and Mortality in the ICU Setting: Main Evidences 20.2.1 Traditional Chinese Medicine in Patients with Sepsis 20.2.2 SeptimebTM in Patients with Sepsis 20.2.3 Shenfu Injection After In-Hospital Cardiac Arrest 20.2.4 XueBiJing Injection in Patients with Severe Community-Acquired Pneumonia 20.3 Relevance to Clinical Practice: A Brief Comment References 21: Interventions Increasing Mortality 21.1 Patients with Acute Kidney Injury (AKI) 21.1.1 Thyroxine 21.2 Sepsis and Infectious Disease 21.2.1 Protein C Zymogen 21.2.2 Nitric Oxide Synthase Inhibitor 546C88 21.2.3 High-Dose Methylprednisolone 21.2.4 Hypothermia in Meningitis 21.2.5 Cytokine Hemoadsorption Device on IL-6 21.2.6 Early Resuscitation Protocol on Septic Patients with Hypotension 21.3 Acute Respiratory Distress Syndrome (ARDS) 21.3.1 Intravenous Salbutamol 21.3.2 Keratinocyte Growth Factor 21.3.3 Cysteine Prodrug (L-2-Oxothiazolidine-4-Carboxylic Acid) 21.3.4 Intensive Nutrition in Acute Lung Injury 21.3.5 High-Frequency Oscillation Ventilation (HFOV) 21.4 Perioperative Setting 21.4.1 Metoprolol Retard in Non-cardiac Surgery 21.4.2 Aprotinin in Cardiac Surgery 21.4.3 Prophylactic Bicarbonate to Prevent Acute Kidney Injury in Cardiac Surgery 21.5 Nutrition and Supplementation 21.5.1 Growth Hormone (GH) 21.5.2 Glutamine 21.5.3 High-Protein Enteral Nutrition Enriched with Immune-Modulating Nutrients 21.6 Trauma and Shock 21.6.1 Stress Ulcer Prophylaxis in Ventilated Trauma Patients 21.6.2 Systematic ICU Admission for Older Patients 21.6.3 Albumin in Patients with Traumatic Brain Injury 21.6.4 Dopamine Versus Noradrenaline as First-Choice Vasopressor in Patients with Shock 21.6.5 Diaspirin Cross-Linked Hemoglobin (DCLHb) 21.6.6 Methylprednisolone in Traumatic Brain Injury References 22: Conflicting Evidences 22.1 Tight Glycemic Control 22.1.1 Physiology 22.1.2 Stress-Induced Hyperglycemia 22.1.3 Tight Glycemic Control: Main Evidence 22.1.4 The Role of Nutrition and Diabetes 22.1.5 Continuous Glucose Monitoring and Automated Insulin Infusion 22.1.6 Conclusions 22.2 Hydroxyethyl Starches 22.2.1 General Considerations on Fluid Choice 22.2.2 Main Lines of Evidence 22.2.3 Physiologic Considerations 22.2.4 Therapeutic Use 22.2.5 Conclusions References 23: Latest Evidence 23.1 General Principles 23.2 Angiotensin II 23.3 Bicarbonate 23.4 Airway Management in Cardiac Arrest 23.5 Steroids in Acute Respiratory Distress Syndrome (ARDS) Including COVID-19 Patients 23.6 Tranexamic Acid 23.6.1 Tranexamic Acid in Post-Partum Hemorrhage 23.6.2 Tranexamic Acid in Intracerebral Hemorrhage 23.7 Point-of-Care Testing for Coagulation 23.8 Thrombolytic Removal in Intraventricular Bleeding 23.9 Other Evidence References