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Modern Concepts and Practices in Cardiothoracic Critical Care

Book Description

With an increase in admission to intensive care units, medical professionals must search for the best practices and procedures to provide efficient medical care to each patient. Despite medical advances, there is still a need for well-trained cardiovascular intensivists to meet the needs of patients. Modern Concepts and Practices in Cardiothoracic Critical Care brings together the most recent research and current issues facing medical professionals and patients in intensive cardiovascular care to provide the necessary tools and resources for improved health and medical care. Including chapters on safety, ethics, and specific surgical techniques, this book is an essential reference source for medical students, residents, fellows, anesthesiologists, cardiac surgeons, nurses, physician assistants and pharmacists who all care for patients following cardiothoracic surgery. This collection serves as a reference on topics such as patient care, preoperative assessments, pharmacology, surgical technologies and techniques, postoperative patient monitoring, and best practices in cardiothoracic critical care.

Table of Contents

  1. Cover
  2. Title Page
  3. Copyright Page
  4. Book Series
    1. Mission
    2. Coverage
  5. Dedication
  6. List of Reviewers
    1. List of Reviewers
  7. Foreword
  8. Preface
  9. Section 1: Introduction to Care of the Cardiac Surgical Patient
    1. Chapter 1: Epidemiology of Cardiac Surgery and the Cardiac Surgical Patient
      1. ABSTRACT
      2. INTRODUCTION
      3. EVOLVING CARE FOR THE PATIENT WITH CORONARY ARTERY DISEASE
      4. EVOLUTION IN NON-CORONARY CARDIAC SURGICAL CARE
      5. NOVEL OPERATIONS, PATIENTS, AND PRIORITIES FOR CARDIAC CARE
      6. EMERGING NEEDS IN THE POST-OPERATIVE CARDIOTHORACIC INTENSIVE CARE UNIT
      7. CONCLUSION AND FUTURE DIRECTIONS
      8. REFERENCES
      9. ADDITIONAL READING
    2. Chapter 2: Quality and Safety
      1. ABSTRACT
      2. INTRODUCTION
      3. CURRENT QUALITY IMPROVEMENT APPROACHES IN THE CARDIOTHORACIC ICU
      4. CURRENT AND FUTURE QUALITY CONTROVERSIES
      5. CONCLUSION
      6. REFERENCES
      7. KEY TERMS AND DEFINITIONS
    3. Chapter 3: Education and Training
      1. ABSTRACT
      2. INTRODUCTION
      3. KNOWLEDGE
      4. SKILLS
      5. ATTITUDES
      6. REFERENCES
    4. Chapter 4: Organization and Structure of the Cardiothoracic Intensive Care Unit
      1. ABSTRACT
      2. INTRODUCTION
      3. HIGH-RELIABILITY ORGANIZATIONS (ICUs)
      4. TEAM MEMBERS
      5. ICU PHYSICIAN STAFFING MODELS
      6. BILLING
      7. FUTURE RESEARCH DIRECTIONS
      8. CONCLUSION
      9. REFERENCES
      10. ADDITIONAL READING
      11. KEY TERMS AND DEFINITIONS
    5. Chapter 5: Palliative Care
      1. ABSTRACT
      2. INTRODUCTION
      3. I. WHAT IS PALLIATIVE CARE?
      4. II. EVIDENCE FOR PALLIATIVE CARE IN THE ICU
      5. III. BARRIERS TO DELIVERY OF PALLIATIVE CARE
      6. IV. ISSUES SPECIFIC TO CARDIOTHORACIC CRITICAL CARE
      7. V. METHODS TO IMPROVE DELIVERY OF PALLIATIVE CARE IN THE CARDIOTHORACIC ICU
      8. VI. FUTURE DIRECTIONS
      9. VII. CONCLUSION
      10. REFERENCES
      11. ADDITIONAL READING
      12. KEY TERMS AND DEFINITIONS
    6. Chapter 6: Ethics
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. FUTURE RESEARCH DIRECTIONS
      5. CONCLUSION
      6. REFERENCES
      7. KEY TERMS AND DEFINITIONS
  10. Section 2: Preoperative Assessment and Optimization
    1. Chapter 7: Acute Coronary Syndrome
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. RISK STRATIFICATION
      5. TREATMENT OVERVIEW
      6. PHARMACOTHERAPY: ANTIPLATELET AGENTS
      7. PHARMACOTHERAPY: ANTICOAGULANTS
      8. PHARMACOTHERAPY: ADJUNCT AGENTS
      9. REVASCULARIZATION
      10. POST-MI CARE
      11. FUTURE RESEARCH DIRECTIONS
      12. CONCLUSION
      13. REFERENCES
      14. ADDITIONAL READING
      15. KEY TERMS AND DEFINITIONS
    2. Chapter 8: Valvular Heart Disease
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. AORTIC STENOSIS
      5. AORTIC REGURGITATION
      6. MITRAL STENOSIS
      7. MITRAL REGURGITATION
      8. PULMONIC STENOSIS
      9. PULMONIC REGURGITATION
      10. TRICUSPID STENOSIS
      11. TRICUSPID REGURGITATION
      12. INFECTIVE ENDOCARDITIS
      13. CONCLUSION
      14. REFERENCES
      15. ADDITIONAL READING
    3. Chapter 9: Advanced Heart Failure Management and Selection for Advanced Therapies
      1. ABSTRACT
      2. INTRODUCTION
      3. CONCLUSION
      4. REFERENCES
      5. ADDITIONAL READING
      6. KEY TERMS AND DEFINITIONS
  11. Section 3: Pharmacology in the Cardiothoracic ICU
    1. Chapter 10: Antiarrhythmics, Inotropes, and Vasopressors
      1. ABSTRACT
      2. BACKGROUND
      3. ANTIARRHYTHMIC AGENTS
      4. VASOACTIVE AGENTS
      5. VASOPRESSORS
      6. CONCLUSION
      7. REFERENCES
      8. ADDITIONAL READING
    2. Chapter 11: Anticoagulation Options
      1. ABSTRACT
      2. INTRODUCTION
      3. Background
      4. STATE OF THE ART APPROACHES
      5. FUTURE RESEARCH DIRECTIONS
      6. CONCLUSION
      7. REFERENCES
      8. KEY TERMS AND DEFINITIONS
    3. Chapter 12: Sedation and Analgesia
      1. ABSTRACT
      2. INTRODUCTION AND BACKGROUND
      3. ASSESSMENT OF LEVEL OF ANALGESIA/SEDATION
      4. ANALGESICS
      5. OPIOIDS
      6. KETAMINE
      7. ADJUVANTS
      8. REGIONAL ANALGESIA
      9. SEDATIVES
      10. BENZODIAZEPINES
      11. PROPOFOL
      12. DEXMEDETOMIDINE
      13. ANTIPSYCHOTICS
      14. TRENDS IN ANALGESIA AND SEDATION
      15. CHOICE OF MEDICATIONS: IS THERE A “BEST AGENT?”
      16. CHOICE OF SEDATIVE STRATEGY
      17. NON-PHARMACOLOGIC APPROACHES
      18. CONCLUSION/DIRECTIONS FOR FURTHER RESEARCH
      19. REFERENCES
      20. ADDITIONAL READING
      21. KEY TERMS AND DEFINITIONS
    4. Chapter 13: Vasodilating Agents
      1. ABSTRACT
      2. INTRODUCTION
      3. MOLECULAR MECHANISMS: SMOOTH MUSCLE
      4. MOLECULAR MECHANISMS: MYOCARDIAL CONTRACTILITY AND AUTOMATICITY
      5. MOLECULAR MECHANISMS: NITRIC OXIDE
      6. MOLECULAR MECHANISMS: PULMONARY HYPERTENSION
      7. NITROPRUSSIDE
      8. HYDRALAZINE
      9. PHENTOLAMINE
      10. MINOXIDIL
      11. CALCIUM CHANNEL BLOCKER – DIHYDROPRIDINE CLASS: AMLODIPINE, NICARDIPINE, NIFEDIPINE, NIMODIPINE
      12. CALCIUM CHANNEL BLOCKER – BENZOTHIAZEPINE CLASS: DILTIAZEM
      13. CALCIUM CHANNEL BLOCKER – PHENYLALKYLAMINE CLASS: VERAPAMIL
      14. NITRIC OXIDE (NO)
      15. PHOSPHODIESTERASE INHIBITORS
      16. PROSTANOIDS
      17. ENDONTHELIN RECEPTOR ANTAGONISTS(ERA): BOSENTAN
      18. REFERENCES
      19. KEY TERMS AND DEFINITIONS
  12. Section 4: A Systematic Approach to Cardiothoracic Critical Care
    1. Chapter 14: Neurologic Complications in the Cardiac Surgery Patient
      1. ABSTRACT
      2. INTRODUCTION
      3. STROKE
      4. THE CLINICAL CONSEQUENCES OF PERIOPERATIVE STROKE
      5. THE MANAGEMENT OF PERIOPERATIVE STROKE
      6. AIRWAY AND VENTILATION
      7. CIRCULATION
      8. GLUCOSE CONTROL
      9. TEMPERATURE
      10. ROLE OF THROMBOLYTIC THERAPY
      11. ANTICOAGULATION
      12. ROLE OF SURGICAL AND ENDOVASCULAR PROCEDURES IN CARDIAC SURGICAL PATIENTS AT RISK FOR STROKE
      13. INTRA-OPERATIVE STRATEGIES TO REDUCE THE RISK OF STROKE OR NEUROLOGIC INJURIES
      14. CARDIOPULMONARY BYPASS
      15. AORTIC ATHEROMATOUS DISEASE AND RISK FACTORS FOR STROKE
      16. SURGICAL STRATEGIES TO REDUCE THROMBOEMBOLIC EVENTS
      17. TECHNIQUES TO DECREASE THE SEVERITY OF NEUROLOGIC INJURY DURING CARDIAC OPERATIONS
      18. CEREBRAL HYPOPERFUSION
      19. PREVENTING POSTOPERATIVE THROMBOEMBOLIC COMPLICATIONS
      20. SEIZURES
      21. ENCEPHALOPATHY
      22. DELIRIUM
      23. POST OPERATIVE COGNITIVE DECLINE
      24. BRACHIAL PLEXUS INJURIES
      25. CONCLUSION
      26. REFERENCES
      27. APPENDIX
    2. Chapter 15: Perioperative Respiratory Care and Complications
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. FUTURE RESEARCH DIRECTIONS
      5. CONCLUSION
      6. REFERENCES
      7. ADDITIONAL READING
      8. KEY TERMS AND DEFINITIONS
    3. Chapter 16: Cardiovascular System
      1. ABSTRACT
      2. INTRODUCTION
      3. BASIC PHYSIOLOGIC PRINCIPLES
      4. POSTOPERATIVE PHYSIOLOGY
      5. REFERENCES
    4. Chapter 17: Acute Kidney Injury following Cardiac Surgery
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. RENAL ANATOMY AND PHYSIOLOGY
      5. ACUTE KIDNEY INJURY
      6. BIOMARKERS OF RENAL INJURY
      7. MECHANISMS OF INJURY IN CSA-AKI
      8. RISK FACTORS FOR CSA-AKI
      9. IMPACT OF PHARMACOLOGIC AGENTS
      10. IMPACT OF ANESTHETIC AND SURGICAL MANAGEMENT
      11. PREVENTION AND TREATMENT OF CSA-AKI
      12. RENAL REPLACEMENT THERAPY
      13. FUTURE RESEARCH DIRECTIONS
      14. CONCLUSION
      15. REFERENCES
      16. ADDITIONAL READING
      17. KEY TERMS AND DEFINITIONS
    5. Chapter 18: Gastrointestinal Issues in the Cardiothoracic ICU
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. SPECIFIC GASTROINTENSTINAL COMPLICATIONS
      5. NUTRITION IN THE CRITICALLY ILL
      6. STRESS ULCER PROPHYLAXIS
      7. FUTURE RESEARCH
      8. CONCLUSION
      9. REFERENCES
      10. ADDITIONAL READING
      11. KEY TERMS AND DEFINITIONS
    6. Chapter 19: Infection and Immune System
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. GENERAL MEASURES OF INFECTION CONTROL AND PREVENTION
      5. GENERAL PRINCIPLES OF ANTIBIOTIC THERAPY
      6. SPECIFIC INFECTIONS
      7. SYSTEMIC INFLAMMATORY RESPONSE FOLLOWING CARDIAC SURGERY
      8. FUTURE RESEARCH DIRECTIONS
      9. CONCLUSION
      10. REFERENCES
      11. ADDITIONAL READING
      12. KEY TERMS AND DEFINITIONS
    7. Chapter 20: Hematology and Transfusion
      1. ABSTRACT
      2. INTRODUCTION
      3. BLEEDING, COAGULOPATHY, AND ANEMIA
      4. CONCLUSION
      5. REFERENCES
      6. KEY TERMS AND DEFINITIONS
    8. Chapter 21: Endocrine and Metabolic Management in the Cardiothoracic ICU
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. GLYCEMIC CONTROL
      5. NUTRITION SUPPORT
      6. ADRENAL INSUFFICIENCY
      7. ABNORMAL THYROID FUNCTION
      8. FUTURE RESEARCH DIRECTIONS
      9. CONCLUSION
      10. REFERENCES
      11. ADDITIONAL READING
      12. KEY TERMS AND DEFINITIONS
  13. Section 5: Surgical Techniques and Postoperative Concerns
    1. Chapter 22: Coronary Artery Disease
      1. ABSTRACT
      2. INTRODUCTION
      3. TYPES OF CONDUITS USED FOR CABG
      4. WHO SHOULD BE UNDERGOING CABG?
      5. PERCUTANEOUS CORONARY INTERVENTION (PCI) OR CABG?
      6. OFF-PUMP CORONARY ARTERY BYPASS GRAFTING (OPCAB)
      7. MINIMALLY INVASIVE DIRECT CORONARY ARTERY BYPASS (MIDCAB)
      8. COMPLICATIONS FOLLOWING CORONARY ARTERY BYPASS SURGERY
      9. PERIOPERATIVE MYOCARDIAL INJURY
      10. POSTOPERATIVE CARDIAC ARREST
      11. NEUROLOGIC COMPLICATIONS
      12. CARDIAC SURGERY ASSOCIATED ACUTE KIDNEY INJURY
      13. BLEEDING AND TRANSFUSION
      14. CONCLUSION
      15. ACKNOWLEDGMENT
      16. REFERENCES
    2. Chapter 23: Aortic Valvular Disease
      1. ABSTRACT
      2. INTRODUCTION
      3. SURGICAL AORTIC VALVE REPLACEMENT (SAVR)
      4. INTRAOPERATIVE COMPLICATIONS
      5. TRANSCATHETER AORTIC VALVE REPLACEMENT (TAVR)
      6. OPERATIVE TECHNIQUES
      7. TAVR COMPLICATIONS
      8. LESS COMMON COMPLICATIONS
      9. FUTURE DIRECTIONS
      10. REFERENCES
    3. Chapter 24: Surgical Management of Mitral Valve Disease
      1. ABSTRACT
      2. INTRODUCTION
      3. EPIDEMIOLOGY
      4. VALVE ANATOMY
      5. ETIOLOGY OF MITRAL VALVE DISEASE
      6. PREOPERATIVE PRESENTATION AND HEMODYNAMICS
      7. INDICATIONS FOR SURGICAL INTERVENTION
      8. SURGICAL TECHNIQUES AND CONTROVERSIES
      9. COMPLICATIONS
      10. REFERENCES
      11. ADDITIONAL READING
    4. Chapter 25: Thoracic Aortic Disease
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. ASCENDING AORTIC ANEURYSMS
      5. ASCENDING AORTIC DISSECTION
      6. THORACOABDOMINAL ANEURYSMS
      7. DESCENDING AORTIC DISSECTION
      8. FUTURE RESEARCH DIRECTIONS
      9. CONCLUSION
      10. REFERENCES
      11. ADDITIONAL READING
      12. KEY TERMS AND DEFINITIONS
    5. Chapter 26: Heart Transplantation
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. PRETRANSPLANT MANAGEMENT
      5. OPERATIVE MANAGEMENT
      6. IMMEDIATE POSTTRANSPLANT MANAGEMENT
      7. FUTURE CHALLENGES
      8. CONCLUSION
      9. ACKNOWLEDGMENT
      10. REFERENCES
    6. Chapter 27: Lung Transplantation
      1. ABSTRACT
      2. INTRODUCTION
      3. OPERATIVE PROCEDURE
      4. EARLY POSTOPERATIVE CRITICAL CARE
      5. OTHER POST-OPERATIVE CONSIDERATIONS AFTER LUNG TRANSPLANTATION
      6. CONCLUSION/FUTURE DIRECTIONS FOR RESEARCH
      7. REFERENCES
    7. Chapter 28: Mechanical Circulatory Support
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. TEMPORARY MECHANICAL CIRCULATORY SUPPORT
      5. DURABLE MECHANICAL CIRCULATORY SUPPORT
      6. FUTURE RESEARCH DIRECTIONS
      7. CONCLUSION
      8. REFERENCES
      9. ADDITIONAL READING
      10. KEY TERMS AND DEFINITIONS
    8. Chapter 29: Critical Care of the Thoracic Surgical Patient
      1. ABSTRACT
      2. INTRODUCTION
      3. PRE-OPERATIVE ASSESSMENT
      4. GENERAL POST-OPERATIVE CARE
      5. PROCEDURES REQUIRING ICU CARE
      6. CONCLUSION
      7. REFERENCES
  14. Section 6: Monitoring the Postoperative Cardiac Patient
    1. Chapter 30: Physiologic Monitoring
      1. ABSTRACT
      2. INTRODUCTION
      3. BACKGROUND
      4. IMPORTANCE OF ARTERIAL WAVEFORM INTERPRETATION
      5. CARDIAC OUTPUT AND OUTCOME AFTER CARDIAC SURGERY
      6. MIXED VENOUS OXYGEN TENSION AND MIXED VENOUS OXYGEN SATURATION
      7. LACTIC ACIDOSIS AND CARDIAC SURGERY
      8. HISTORY OF CARDIAC OUTPUT MEASUREMENT
      9. METHODS FOR CARDIAC OUTPUT MEASUREMENT
      10. INDICATOR DILUTION METHOD FOR CARDIAC OUTPUT MEASUREMENT
      11. THERMODILUTION CARDIAC OUTPUT MEASUREMENT
      12. ECHO TECHNOLOGY FOR CARDIAC OUTPUT MEASUREMENT
      13. THE IDEAL CARDIAC OUTPUT MONITOR
      14. CIRCULATORY MONITORING IN THE POST CARDIAC SURGERY PATIENT
      15. PiCCO FOR MEASUREMENT OF CARDIAC OUTPUT AND HEMODYNAMIC MONITORING
      16. LiDCO FOR MEASUREMENT OF CARDIAC OUTPUT AND HEMODYNAMIC MONITORING
      17. FLOTRAC FOR CARDIAC OUTPUT MEASUREMENT AND HEMODYNAMIC MONITORING
      18. NICOM FOR CARDIAC OUTPUT MEASUREMENT AND HEMODYNAMIC MONITORING
      19. ESOPHAGEAL DOPPLER MONITOR FOR CARDIAC OUTPUT MEASUREMENT AND HEMODYNAMIC MONITORING
      20. FUTURE RESEARCH DIRECTIONS
      21. CONCLUSION
      22. REFERENCES
      23. ADDITIONAL READING
      24. KEY TERMS AND DEFINITIONS
    2. Chapter 31: Management of Bleeding in the Postoperative Cardiac Patient
      1. ABSTRACT
      2. DIAGNOSING THE COAGULOPATHY
      3. DIAGNOSING THE COAGULOPATHY POSTOPERATIVELY BY STANDARD LABORATORY OR POINT-OF-CARE TESTING
      4. TREATMENT STRATEGIES FOR COAGULOPATHY IN THE POST-CARDIAC SURGICAL PATIENT
      5. DIAGNOSTIC CRITERIA FOR SIGNIFICANT BLEEDING IN THE POSTOPERATIVE CARDIAC PATIENT
      6. REFERENCES
    3. Chapter 32: Echocardiography and Ultrasound in the Intensive Care Unit
      1. ABSTRACT
      2. INTRODUCTION
      3. SONOGRAPHY FOR PROCEDURES
      4. SONOGRAPHY AS A TOOL FOR PATIENT ASSESSMENT: LUNG
      5. SONOGRAPHY AS A TOOL FOR PATIENT ASSESSMENT: FOCUSED CARDIAC EXAMINATION
      6. SONOGRAPHY AS A TOOL FOR PATIENT ASSESSMENT: DEEP VENOUS THROMBOSIS (DVT)
      7. TRAINING FOR CRITICAL CARE ULTRASOUND
      8. SONOGRAPHY IN CARDIOVASCULAR ICU: COMPREHENSIVE APPROACH
      9. SUMMARY
      10. REFERENCES
      11. KEY TERMS AND DEFINITIONS
  15. Compilation of References
  16. About the Contributors