Cardiovascular Critical Care E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 863

Veröffentlichungsjahr: 2011

Beschreibung

Remarkable improvements in cardiac survival rates have made cardiovascular critical care much more common, but no less challenging for the practitioner. This important volume draws on the skills of an expert team of editors and contributors to present a timely overview of clinical practice. The book covers the full range of the field, from pre-operative assessment and the haematological complications of cardiovascular surgery and critical care to the care of patients with: · Arrhythmias · Heart Failure · Adult Congenital Heart Disease · Mitral Valve Disease · Aortic Valve Disease · Infective Endocarditis · Vasculitis The authors also address the special problems associated with the management of conditions consequent upon pregnancy, eclampsia, and the hypertensive crisis. With high-quality illustrations and a helpful index, Cardiovascular Critical Care gives you access to information that helps you provide the best possible care to your patients.

Leseprobe

Contents

Cover

Half Title Page

Dedication

Title Page

Copyright

Contributors

Introduction

1 Shock

1.1 Introduction

1.2 Low output states

1.3 High output states

1.4 The pathway to organ failure

1.5 Conclusion

2 Resuscitation in Intensive Care

2.1 Introduction

2.2 Recognition of an imminent cardiac arrest

2.3 In-hospital resuscitation

2.4 Management of arrest rhythms

2.5 Drugs

2.6 Peri-arrest arrhythmias

2.7 Other interventions

2.8 Post-resuscitation care

2.9 Ethical issues

2.10 Summary

3 Cardiovascular Monitoring in Critical Care

3.1 Introduction

3.2 Static haemodynamic monitoring of single variables

3.3 Haemodynamic profile analysis: grouping of static variables

3.4 Functional haemodynamic monitoring: response to therapy

3.5 Conclusion

4 Cardiovascular Investigation of the Critically Ill

4.1 Introduction

4.2 Electrocardiography (ECG)

4.3 Critically ill patient with device implanted

4.4 Haemodynamic investigations

4.5 Ultrasound

4.6 Radiography

4.7 Invasive catheterisation procedures

4.8 Cardiac magnetic resonance scanning and nuclear medicine

4.9 Biochemistry

4.10 Summary

5 Haematological Aspects of Cardiovascular Critical Care

5.1 Introduction

5.2 Management of bleeding

5.3 Thromboprophylaxis in the ICU

5.4 Anticoagulation of patients with prosthetic heart valves

5.5 Heparin-induced thrombocytopenia (HIT)

5.6 Near patient testing

5.7 Blood sparing techniques for surgery

5.8 Conclusion

6 Cardiovascular Support: Pharmacological

6.1 Introduction

6.2 Cardiovascular physiology

6.3 Therapeutic pharmacological intervention

6.4 A rational approach to managing haemodynamic impairment?

7 Arrhythmias

7.1 Introduction

7.2 Incidence of arrhythmias

7.3 Arrhythmias and morbidity

7.4 Modifiable risk factors for arrhythmia

7.5 Management of arrhythmias

7.6 Conclusion

8 Mechanical Heart Failure Therapy

8.1 Introduction

8.2 The physics of mechanical assist

8.3 Types of assist devices

8.4 Indications for use

8.5 Short-term/long-term implantation

8.6 Methods of implantation

8.7 Weaning and device removal

8.8 Conclusion

9 Care of the High Risk Patient Undergoing Surgery

9.1 Introduction

9.2 Identification of high-risk patients

9.3 Intervention strategies

9.4 Conclusions

10 Adult Congenital Heart Disease: Principles of Management in Critical Care

10.1 Introduction

10.2 Principles of management of the critically ill ACHD patient

10.3 Anaesthesia in the critically ill ACHD patient

10.4 Medical indications for ICU admission

10.5 Post-operative admissions

10.6 Conclusions

11 Common Complications of Cardiovascular Critical Illness

11.1 Introduction

11.2 Systemic disorders

11.3 Cardiovascular dysfunction

11.4 Renal dysfunction

11.5 Respiratory dysfunction

11.6 Gastrointestinal dysfunction

11.7 Neurological dysfunction

11.8 Sternal wound complications

11.9 Conclusion

12 Haemodynamic Management of Severe Sepsis

12.1 Introduction

12.2 Haemodynamic alterations in severe sepsis and septic shock

12.3 Haemodynamic management of severe sepsis

12.4 Endpoints of resuscitation

12.5 Conclusion

13 Acute Coronary Syndromes and Myocardial Infarction

13.1 Introduction

14 Cardiogenic Shock

14.1 Causes and epidemiology

14.2 Pathophysiology

14.3 Clinical manifestations and diagnosis

14.4 Management of cardiogenic shock

14.5 Specific conditions

15 Peri-operative Care of the Heart Transplant Recipient

15.1 Introduction

15.2 General principles

15.3 Haemodynamic management

15.4 Immunosuppression after heart transplantation

15.5 Anti-infective therapy

15.6 Conclusion

16 Adult Congenital Heart Disease Syndromes

16.1 Introduction

16.2 Pre-operative risk assessment

16.3 Simple congenital heart disease

16.4 Moderately complex congenital heart disease

16.5 Complex congenital heart disease

16.6 Conclusion

17 Management of Arrhythmias in Adults with Congenital Heart Disease

17.1 Introduction

17.2 Tachycardia

17.3 Acute treatment

17.4 Bradycardia

17.5 Post-acute treatment care

17.6 Summary

18 Mitral Valve Disease

18.1 Introduction

18.2 Mitral regurgitation

18.3 Mitral stenosis

18.4 Prosthetic mitral valve disease

18.5 Post-operative management of mitral valve surgery

18.6 Conclusions

19 Aortic Valve Disease

19.1 Introduction

19.2 Aortic stenosis

19.3 Aortic regurgitation

19.4 Aortic valve replacement

19.5 Management of the patient immediately post AVR

19.6 Conclusion

20 Infective Endocarditis

20.1 Introduction

20.2 Definition and incidence

20.3 Pathogenesis

20.4 Susceptible patients

20.5 Prevention

20.6 Diagnosis

20.7 Causative organisms (Table 20.4)

20.8 Complications

20.9 Management

20.10 Outcome and prognosis

20.11 Summary

21 Pulmonary Hypertension and Right Ventricular Failure

21.1 Introduction

21.2 Definitions

21.3 Classification of pulmonary hypertension

21.4 Pathophysiology

21.5 Diagnosis

21.6 Treatment

21.7 Summary

22 Aortic Dissection

22.1 Introduction

22.2 Aetiology, pathology and pathophysiology

22.3 Classification

22.4 Clinical presentation

22.5 Management

22.6 Outcomes

22.7 Other acute aortic syndromes

22.8 Summary

23 Emergency Management of Cardiac Trauma

23.1 Introduction

23.2 Blunt cardiac injury

23.3 Aortic injury

23.4 Penetrating cardiac and great vessel injury

23.5 Summary

24 Hypertensive Crises

24.1 Introduction

24.2 Hypertensive crises

24.3 Hypertension complicating cardiovascular conditions

24.4 Management

24.5 Conclusions

25 Pregnancy

25.1 Introduction

25.2 General principles

25.3 Specific cardiovascular disorders in pregnancy

25.4 Delivery in a critically unwell patient

25.5 Conclusion

26 Vasculitis

26.1 Introduction

26.2 Cardiovascular system involvement

26.3 General features

26.4 Specific vasculitides

26.5 Treatment

26.6 Summary

27 Endocrine Problems and Cardiovascular Critical Care

27.1 Introduction

27.2 Adrenal failure and insufficiency

27.3 Thyroid dysfunction

27.4 Conclusion

28 Haemodynamic Monitoring and Therapy: A Personal History 1961–1994

Color Plates

Index

Cardiovascular Critical Care

To our teachers and colleagues, many of whom are contributors to this book.

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Library of Congress Cataloging-in-Publication Data

Cardiovascular critical care / edited by Mark J.D. Griffiths … [et al.].

p. ; cm.

Includes bibliographical references.

ISBN 978-1-4051-4857-3

1.Cardiac intensive care. I. Griffiths, M. J. D.

[DNLM:1.Cardiovascular Diseases. 2. Critical Care. WG 120 C26716 2010]

RC684.C36C377 2010

616.1′2028–dc22

2009029876

ISBN: 978-1-4051-4857-3

A catalogue record for this book is available from the British Library.

Contributors

David Alexander MBChB, FRCA Consultant Anaesthetist, Department of Anaesthesia and Critical Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Joseph E. Arrowsmith MB BS, MD, FRCP, FRCA, FHEA Consultant in Cardiothoracic Anaesthesia & Intensive Care, Papworth Hospital, Cambridge, UK

Nicole Assmann MD, FRCA Consultant Anaesthetist, Royal Free Hospital, London, UK

Robert S. Bonser MD, FRCP (Lon), FRCS (Eng), FRCS (C/Th), FESC Consultant Cardiothoracic Surgeon, University Hospital Birmingham NHS Trust, Birmigham, UK

Ronald Bradley FRCP Emeritus Professor, Intensive Care Medicine, St Thomas’ Hospital, London, UK

Gerald S. Carr-White MD Department of Cardiology, Guys’ and St Thomas’ NHS Foundation Trust, London, UK

Katerina Chamaidi MD Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton & Harefield NHS Foundation Trust, London, UK and General Hospital of Trikala, Greece

Nick Curzen PhD, FRCP, FESC Wessex Cardiac Unit, Southampton University Hospitals NHS Trust, Southampton, UK and Southampton University Medical School, Southampton, UK

Barbara J. Deal MD M.E. Wodika Professor of Cardiology, Feinberg School of Medicine, Northwestern University, Children’s Memorial Hospital, Chicago, IL, USA

Antonia Pijuan Domènech MD Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton & Harefield NHS Foundation Trust, London, UK and Adult Congenital Heart Disease Unit, Hospital Vall d’Hebron, Barcelona, Spain, UK

Vamsidhar B. Dronavalli MRCS (Edin) Research Fellow Cardiothoracic Surgery, Department of Cardiothoracic Surgery, University Hospital Birmingham NHS Trust, Birmingham, UK

John Dunning MD Papworth Hospital, Cambridge, UK

Florian Falter MD, FRCA, PhD Consultant in Cardiothoracic Anaesthesia & Intensive Care, Department of Anaesthesia, Papworth Hospital, Cambridge, UK

Simon J. Finney PhD, MSc, MRCP, FRCA Consultant in Intensive Care and Anaesthesia, Adult Intensive Care Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Michael Gatzoulis MD Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton & Harefield NHS Foundation Trust, London, UK and National Heart & Lung Institute, Imperial College, London, UK

Derek Gibson MD Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Alex Hobson PhD, FRCP, FESC Wessex Cardiac Unit, Southampton University Hospitals NHS Trust, Southampton, UK and Southampton University Medical School, Southampton, UK

David Hunter MD, MBBS, FRCA Consultant Anaesthetist & Intensivist, Anaesthetic Department, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Maninder S. Kalkat FRCS (Cardiothoracic) Consultant Cardiothoracic Surgeon, Department of Cardiothoracic Surgery, Birmingham Heartlands Hospital, Birmingham, UK

Brian Keogh MD Consultant Anaesthetist and Intensivist, Department of Intensive Care and Anaesthesia, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Philip Marino BSc (Hons), MRCP (UK) Specialist Registrar in Respiratory & Intensive Care Medicine, Kingston Hospital, Kingston-upon-Thames, UK

Keith McNeil MB, BS, FRACP Head of Transplant Services, The Prince Charles Hospital, Brisbane, Australia

Mark Messent MD Consultant Anaesthetist & Intensivist, Intensive Care Unit, St Bartholomew’s Hospital, London, UK

Hugh Montgomery MB BS, BSc, FRCP, MD Director, Institute for Human Health and Performance, University College London, London, UK

James Napier MBChB, FRCS, FCEM, EDICM Intensive Care Unit, St Bartholomew’s Hospital, London, UK

John Pepper M.Chir, FRCS Professor of Cardiothoracic Surgery, Department of Surgery, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Divaka Perera MD Department of Cardiology, Guys’ and St Thomas’ NHS Foundation Trust, London, UK

Liao Pinhu MD, PhD Unit of Critical Care, National Heart and Lung Institute, Imperial College London, London, UK and Youjiang Medical University for Nationalities, Baise, PR, China

Michael R. Pinksy MD, CM, DM, MC Professor of Critical Care Medicine, Department of Critical Care Medicine, Bioengineering and Anesthesiology, Univerity of Pittsburgh School of Medicine, Pittsburgh, PA, USA

Kanchan Rege MA, MRCP, FRCPath Consultant Haematologist, Papworth Hospital, Cambridge, UK

Andrew Rhodes MD Consultant in Intensive Care Medicine, Department of Anaesthesia and Intensive Care Medicine, St George’s Hospital, London, UK

Vivek Sivaraman MBBS, MRCP, MD Specialty Trainee, Anaesthetics and Critical Care, Central London School of Anaesthesia, London, UK

Lorna Swan MB ChB, MRCP, MD Consultant Cardiologist, Adult Congenital Heart Disease Unit, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Marius Terblanche MBChB, FRCA, EDIC, Dip(Epid) Consultant in Critical Care Medicine, Guy’s & St Thomas’ Hospital, London, UK

Richard Trimlett MD Consultant Cardiac Surgeon, Royal Brompton & Harefield NHS Foundation Trust, London, UK

Jean-Louis Vincent MD, PhD Professor of Intensive Care Medicine; Head, Department of Intensive Care, Erasme University Hospital, University of Brussels, Belgium

Alain Vuylsteke MD, FRCA Consultant Anaesthesia and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London and Cardiothoracic Anaesthesia and Intensive Care, Papworth Hospital, Cambridge, UK

Justin Woods FRCA Clinical Research Fellow in Intensive Care Medicine, Department of Anaesthesia and Intensive Care Medicine, St George’s Hospital, London, UK

David A. Zideman MD Chief of Service, Department of Anaesthetics, Imperial College Healthcare NHS Trust and Hammersmith Hospital, London, UK

Introduction

More than 850,000 people in the United Kingdom suffer from heart failure, at a cost to the NHS of an estimated £625 million per year. Approximately 2.65 million people have coronary artery disease, accounting for 13% of all deaths in England, many of them premature. It has been calculated that the cost of heart disease in the UK today is over £7 billion, a sum that includes the financial burden of informal care provided by more than 400,000 families and friends. Cardiac pathology is also no respecter of age. Thus, the increasing success of surgery provided to children born with heart defects in the 1980s and 1990s has delivered a generation of young adults who require on-going monitoring and treatment. There are approximately 250,000 such adults in the UK.

The burden of disease is therefore significant. The common thread that binds together individuals who suffer from these conditions is both the adverse quality of life that it brings, and the need to design, validate and apply effective therapeutic interventions to extend both life and quality of life. The successes in this area have been legion and include cardiopulmonary bypass surgery, conducted successfully for the first time only in the 1950s; a large and increasing variety of percutaneous interventions both for coronary artery disease and valvular pathologies; the management of arrhythmias both malignant and benign; and novel cardiopulmonary support systems up to and including ventricular assist devices and extracorporeal membrane oxygenation. The development and application of these support systems and therapeutic interventions necessitates the provision of intensive care of the highest quality.

On the Department of Health’s Census Day (15 January 2008), there were 3473 Level 2 and Level 3 intensive care unit (ICU) beds occupied in NHS Trusts in England. Sixteen percent (552) of these beds were in cardiothoracic units, although it is almost certain that significant numbers of patients not requiring surgical interventions, but with cardiovascular pathologies, were being cared for in general intensive care or high dependency areas. In certain respects, cardiovascular ICU might be regarded as routine. Thus, for the year ending March 2007, 35,487 cardiac operations were performed with a 96.6% survival rate in over 40 centres in the UK as a whole [1]. These remarkable survival results, comparable to those achieved by the best healthcare systems across the world, are a reflection of the skill not only of surgical and anaesthetic practitioners but also of those involved in the provision of intensive care.

Rapid advances in research and clinical practice in this arena mandate the development of first-rate educational resources for those involved in clinical practice. I am delighted therefore to be able to introduce this volume, edited by three of my colleagues, which provides a superb overview of contemporary cardiovascular critical care. The clinical field involved is broad. Effective pre-operative assessment of patients by intensivists is a skill that all should possess. A working knowledge of the haematological complications of cardiovascular surgery and critical care is mandatory. Care of the medical patient with ischaemic heart disease or in acute cardiogenic shock has progressed in leaps and bounds, and now spills over into the use of adjunct support such as non-invasive respiratory support [2]. The particular problems associated with the management of the patient with adult congenital heart disease are recognised in this volume, together with those consequent upon pregnancy, eclampsia and the hypertensive crisis. Mark Griffiths and colleagues have recruited authors with recognised expertise in their subject, who together have produced a volume that should assist greatly those practising in cardiovascular critical care to the benefit of their patients.

Timothy W. Evans DSc FRCP FRCA FMedSci

Professor of Intensive Care Medicine, Imperial College School of Medicine;

Consultant in Intensive Care Medicine, Royal Brompton Hospital, London

References

1. UK Healthcare Commission statistics, 2008.

2. New Engl J Med 2008; 259: 142–51.