Intensiv medicin

The war between realism and conventionalism bitterly rages ever strong. We find early skirmishes in Plato's Cratylus, in which Socrates examines and demonstrates the problems with both of these views of language; and the contemporary realist-empiricist debates in the philosophy of science carry on that same traditional feud. The feud in both of these cases, and many historical links in between, is the same: do humankind's concepts pick out the real furniture of the world, or not? This discussion is of course only one facet of a broader dialogue that concerns the very relationship between mind and world, and what I would like to do in this dissertation is call to our attention (and challenge) a particular presupposition that underlies both realism and conventionalism, in the hopes that we might make some headway in the debate between those two rivals, both alike in dignity. Of course, to assume that I might settle the issue once and for all would be a very bold move indeed, and so for those who fancy boldness, I invite you to take up the charge that I will begin (or, as you will see, continue) in the following chapters. For those who prefer more of a restrained approach, please consider these remarks not as intending to settle the dilemma, but rather to offer a third option few give much attention these days.

This book should represent a guideline for launching an extracorporeal membrane oxygenation (ECMO) program. It describes in detail particularities and special features of planning, setting up, developing, structuring and maintaining of ECMO support program for instable patients with the need of transportation from peripheral hospitals to an experienced ECMO centre for further treatment.Authors have condensed both the current evidence and Guidelines on ECMO and eCPR support and have highlighted in detail the issue of planning, setting up, developing, structuring and maintaining this program with the view to helping other centres launching this life-saving service taking into account their experience in this important field of medicine. In this context, the main benefit of this book is the outstanding and particular aim to educate the reader in developing and maintaining a large-spectrum ECMO program. The volume, richly illustrated and written by KOLs using an expository writing style to promote the readability will appeal to intensivists, anesthesiologists and cardiologists as well as cardiac- and thoracic-surgeons and pneumologists

In this issue of Critical Care Clinics, guest editors Drs. Rishikesan Kamaleswaran and Andre L. Holder bring their considerable expertise to the topic of Data Science in Critical Care. Data science, the field of study dedicated to the principled extraction of knowledge from complex data, is particularly relevant in the critical care setting. In this issue, top experts in the field cover key topics such as refining our understanding and classification of critical illness using biomarker-based phenotyping; predictive modeling using AI/ML on EHR data; classification and prediction using waveform-based data; creating trustworthy and fair AI systems; and more. Contains 15 relevant, practice-oriented topics including AI and the imaging revolution; designing "living, breathing? clinical trials: lessons learned from the COVID-19 pandemic; the patient or the population: knowing the limitations of our data to make smart clinical decisions; weighing the cost vs. benefit of AI in healthcare; and more. Provides in-depth clinical reviews on data science in critical care, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Das Buch stellt die relevanten medizinischen Aspekte bei einem Unfall durch Blitzschlag praxisnah und mit Fallbeispielen belegt dar: Arten der Energieübertragung, meteorologische und elektrotechnische Grundlagen, notfallmedizinische Erstversorgung sowie Überblick über die häufigsten, in der internationalen Literatur beschriebenen Folgeerkrankungen und deren Behandlung. Weitere Themen sind die Besonderheiten der ärztlichen Leichenschau bei Tod durch Blitzschlag, pathophysiologische Aspekte der Todesursache sowie Wissenswertes zur Epidemiologie. Es wendet sich an Ärzte und Ärztinnen aller Fachdisziplinen, die in die Akutversorgung oder Nachsorge von Personen nach Unfällen durch Blitzschlag eingebunden sind, z.B. aus der Notfallmedizin, Rechtsmedizin, Intensivmedizin und Allgemeinmedizin.

This book provides an insight into state-of-art developments in pulmonary drug delivery systems. It comprises several chapters covering a wide range of promising technologies and novel materials explored for developing effective pulmonary drug delivery systems. The initial book chapters elucidate role of thin film freezing, supercritical fluid technology, nano-in-micro particles system, crystal-engineered microstructures and porous particles in pulmonary drug delivery. The subsequent book chapters elaborate on various functional excipients such as chitosan, cyclodextrins, and Vitamin E-TPGS to attain local and systemic therapeutic action. There are book chapters focused on diverse novel carrier systems such as hydrogels, quantum dots, metal-organic framework, and prodrug approach. Additionally, book also contains chapters, exclusively dedicated to biologicals and numerical simulation in pulmonary therapeutics.The book chapters follow a sequential order, beginning with the pulmonary relevance of technology or polymeric materials, carrier synthesis schemes, current technical state-of-art, along with clinical, industrial, and regulatory aspects. Each chapter contains a future perspective section that will systematically reflect the current state of advances in pulmonary drug delivery. It also offers a practical basis for audience to understand the design and function of the delivery systems for better therapeutic outcomes. The book provides balanced views by considering the investigations from various scientific domains and industrial knowledge. Briefly, this book aims to collect, analyse, and bring together the latest developments in pulmonary drug delivery with more focus on materials and technologies. Indeed, this book is a valuable source for readers and researchers who wish to learn more about the advances in pulmonary drug delivery systems.

Chapter ¿Aerosol Therapy and Humidification¿ is available open access under a Creative Commons Attribution 4.0 International License via link.springer.com.

The aim of this book is to inform nurses about the most common and the more serious errors made in caring for neonatal patients. Nurses play the largest role in patient care and their overwhelming workload may sometimes lead to errors that are, in some cases, irreversible or even fatal, putting a great deal of responsibility on nurses to avoid errors. And amongst patients that nurses care for, the most vulnerable of these are neonates. This book covers learnings about the uniqueness of neonatal patients and common conditions that are seen with patients in the neonatal intensive care unit (NICU). Factors that are predisposing and contributing factors for nursing errors are reviewed. The types of errors, consequences, detection, and monitoring for nursing errors are included. The book describes how errors can be avoided with necessary precautions, and managed appropriately based on current evidence-based practice. Recommendations for further study are also provided. This resource can be a useful tool for professional nurses, as well as nurse educators, leaders, and mentors to educate and guide their students and novice nurses.

This book on post-injury multiple organ failure (MOF) offers a comprehensive overview and clinically focused practical guide to treating the condition. MOF is arguably the most difficult complication to manage in polytrauma patients and is responsible for the majority of trauma deaths among patients who survived the first 24 hours after injury. Beyond mortality, it has a major impact on healthcare resource utilization and a persistent negative effect on patients' long-term reported outcomes. This book is edited by surgeons who are passionate about the topic, and about optimizing the outcomes for polytrauma patients. Grasping the fascinating pathophysiology of MOF is essential for providing patients with quality early care. Each chapter highlights key learning objectives, historical perspectives, diagnostic and therapeutic pearls, and includes a must-know summary, additional reading suggestions and future research directions. Flowcharts, decision-making guides, summary tables, graphics and clinical photographs help to maximize the learning experience and to ensure readers retain what they've learned. The book fills a unique niche area for many specialties dedicated to critical care of polytrauma patients and to their management before and beyond intensive care.  

This book describes a fully integrated approach to the management of elderly patients who are at risk of or suffer trauma, drawing on up-to-date knowledge from multiple specialties in recognition of the fact that the number and severity of comorbidities in this population requires expertise in many fields. Readers will find comprehensive and detailed coverage of the prevention of complications related to aging, geriatric care concepts, specific treatments in acute care, including fracture stabilization and diagnostic procedures, and the surgical management of different types of fracture and soft tissue trauma. Intensive care management of the geriatric patient is also extensively addressed. Information is provided on diverse aspects of the physiology of ageing, and the coverage is completed by discussion of fracture care service models and specific models of rehabilitation and aftercare designed to prevent further falls and adverse late outcomes. The authors are a group of renowned experts from each of the relevant fields, and the book will be a valuable asset for surgeons, intensivists, geriatricians, gerontologists, and rehabilitation specialists. 

This book aims to give a comprehensive overview of the current challenges and solution posed to the health care professionals who need to use mechanical ventilation to treat their patients.Mechanical ventilation is a cornerstone of the treatment of critically ill patients, as also dramatically underlined by the recent COVID-19 pandemic. The topic is not simple to approach, since it requires integration of multiple data which, in turn, result from complex interplays between patient's condition and ventilatory settings. While technological development empowered advanced monitoring and decision support, these also increase the burden of data on the practitioners. Furthermore, considering that sometimes mechanical ventilation is seen under two, apparently opposite, approaches, "e;physiology vs. protocols"e;, the book aims to reconcile these two aspects. And this has been done by each author following the above trajectory in their chapters. The exposure of the topic begins from the "e;pathophysiology"e; (i.e. the "e;physiology of the disease"e;) so that the reader can better understand the concept and rationale of any given approach. At the same time, any rationale or hypothesis (for as much as supported by physiology) must hold at the proof of clinical research and evidence, which is summarized in each chapter.In summary, the purposes is that the readers understand not only which is the best clinical practice to adopt but also why and which mechanisms this is based upon and how to approach a novel issue they might encounter. The book - addressed to physicians, nurses and respiratory therapist - features chapters on "e;novel"e; or "e;hot"e; topics like, obviously, COVID-19, ECMO, but also MV in low resource setting.

There is a growing need for a book on emergency general surgery in the elderly, as adults age 65 and older are the fastest growing segment of the population worldwide, and their number is expected to double to 89 million between now and 2050. Based on these changing demographics, it is expected that there will be a concurrent rise in the demand for a variety of surgical services, including vascular surgery (with a projected growth of 31%) and general surgery (with a projected growth of 18%), as well as in all sub-disciplines of surgery (thoracic, cardiac, oncology, hepatobiliary, transplant, plastic colorectal, orthopedic, gynecologic, urology and neurosurgery).In addition, older surgical patients often require a different level of care than younger patients during the preoperative, intraoperative and postoperative phases. Many of our geriatric population have multiple chronic illnesses beyond the one for which surgery is required, and therefore are prone to developing postoperative complications, functional decline, loss of independence, and other undesirable outcomes. In response, this book offers surgeons, geriatrists and nurses state-of-the-art surgical approaches and essential information on the complex perioperative care of the elderly.

This book, part of the European Society of Intensive Care Medicine (ESICM) textbook series, deals with dysregulated host response a relatively new term introduced by the Sepsis-3 definitions in 2016. In contrast to systemic inflammatory response syndrome (SIRS) that has been used for nearly 30 years, this is a fundamentally new concept, which requires some sort of a paradigm shift in the way of thinking of critical care physicians. This change obviously requires time and after 5 years, time is ripe to summarize the knowledge in the form of a comprehensive book.The book is split in 4 sections. In the first one, the host immune response is explained in 11 chapters, followed by the next part, summarizing the possible tools for assessment at the bedside. The third and the fourth parts focus on the effects of dysregulated immune response on vital organ function and on the possible ways of immunomodulation. Written by internationally acclaimed experts of the field, the bookis of value for all those intensivists and allied professionals working in ICUs.

In this issue of Clinics in Chest Medicine, guest editors Drs. Drew Harris, Emily Brigham, and Juan Celedon bring their considerable expertise to the topic of Aiming to Improve Equity in Pulmonary Health. Top experts discuss disparities in risk factors for respiratory diseases, how communities are affected unequally, interventions to mitigate disparities, and evidence of effects, if present. Contains 17 practice-oriented topics including racism and bias, tobacco use, air pollution and climate change, occupational hazards, access to care and rural health, asthma and COPD, lung cancer, pulmonary hypertension, migrants and refugees, sex and gender, homelessness and incarceration, mental illness, and more.  Provides in-depth clinical reviews of improving equity in pulmonary health, offering actionable insights for clinical practice.  Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

The evolution of Antimicrobial Resistance is outpacing the ability to create novel antibiotics, which is proving to be a global problem in the fact of climate change, population growth, demographic shifts toward aging populations, emerging infections, and other crises. Therefore, clinicians are forced to use the existing antimicrobials more responsibly to preserve their longevity for generations to come. In a parallel vein, there has been a recent regulatory acknowledgement of the importance of prudent antimicrobial prescribing, mandating the implementation of Antimicrobial Stewardship across all healthcare settings. This is harder to manage in a non-traditional setting, which include long-term care facilities, outpatient care clinics, urgent care centers, and others. Given the trends in patient care in these settings¿particularly where the aging community is concerned¿this is proving to be a growing problem. This is troublesome even for spaces that have university and large hospital affiliations. There is a plethora of data describing the implementation and outcomes of Antimicrobial Stewardship Programs in acute-care hospitals with open-access, evidence-based guidelines endorsed by the Infectious Diseases Society of America. However, non-traditional settings often find themselves struggling to implement the same practices and procedures due to their unique needs and limited resources. There may be variability in access to resources, applicability, and patient-type. This book seeks to inform those in non-traditional healthcare settings on the principles, practice, and outcomes of Antimicrobial Stewardship Programs to improve patient care across all settings. The text begins by unpacking Antimicrobial Stewardship in nontraditional settings then covers specific environments, including long-term care facilities, outpatient clinics, and emergency departments. The text also covers special topics, including veterinary medicine, HIV, oncology, and immunocompromised patients, pediatrics, neonates, transplant, and critical care patients.

This book showcases state-of-the-art techniques as well as various clinical, technical and non-technical skills. By highlighting the reliability of the new techniques compared to standard clinical methods of predicting peri-operative problems in the operating rooms, it enables better management and utilization of operating rooms.The combined use of knowledge and technology has resulted in improvements in healthcare services that are not achieved by the use of the best technology but by the best use of technology.Medicine is a continually advancing science, and healthcare providers constantly enhance their knowledge and develop their skills. While knowledge sharing is vital for humanity, technology has made the application of medical knowledge more versatile and more widely available.Written by leading anesthesiologists, anesthesia technicians and technologists, the book addresses the need for a ready reference for anesthesiologists, as well as anesthesia technical staff. It provides an easily navigated, pocket-sized reference resource featuring pictures, tables and schema.

Patients with difficult airways represent a clinical conundrum for anaesthetists. With a wide variety of presentations in both an elective and emergency setting, all anaesthetists need to be prepared to manage such a situation. This book consists of real-life clinical scenarios, describing how these were managed at the time and on reflection how their management could have been improved. Further discussion emphasises how any associated failures and complications could have been mitigated. Using a combination of up-to-date knowledge, advanced technology and clinical expertise, this book provides an invaluable resource for any specialist managing airways in a clinical environment. This book is an indispensable aide-mÃ(c)moire for postgraduate doctors, physicians practising in the emergency department, intensive care specialists, anaesthesia associates and allied healthcare professionals in managing patients with a difficult airway.

This book uses real-world clinical case analyses of hot topics to provide insights into noninvasive mechanical ventilation (NIV). Written by leading international teachers and experts, it features a selection of "e;major controversial topics in clinical practice"e; and demonstrates how these cases can be used to teach about NIV.  It then presents a discussion of the topics in various scenarios (anesthesiology, critical care, emergency, pneumology and sleep medicine, as well). The chapters allow readers to develop a case-by-case understanding of NIV in acute and chronic respiratory disorders, and perioperative and in intensive care patients, also thanks to Electronic Supplementary Materials. Lastly the authors summarize five key points / recommendations. This book is an attractive resource also for universities / educational seminars / national and international postgraduate courses and hot-topics sessions at national/international congresses.

This book covers the intersections between neurointervention and neurology, neurointervention and neurosurgery, and neurointervention and other specialties. It fills the gap in the literature by placing specific emphasis on appropriate patient selection, preparation, and post-procedural management. Concise and comprehensive, this text covers the increasingly important aspects of the neurointerventionalist profession, as it has moved away from a purely technical role to a focus on clinical care. In addition, the most rapidly expanding area of neurointervention, ischemic stroke, is thoroughly examined in this text, where other texts on this subject fail. It is also meant as a reference for non-neurointerventionalists who may desire to learn more about how their patients can benefit from the therapeutic or adjunctive techniques that the neurointerventionalist can provide. Neurointervention in the Medical Specialties, Second Edition is an essential guide written for neurointerventional specialists from all backgrounds, both in practice and in training

In this issue of Critical Care Clinics, guest editor Dr. Hannah Wunsch brings her considerable expertise to the topic of History of Critical Care Medicine. The term "Critical Care Medicine? was first introduced in the 1950s at the University of Southern California-making 2023 the 70th anniversary of this subspecialty.  This issue provides a fascinating look at important aspects of the history of the field, which originated with the concept that immediately life-endangered patients, the critically ill and injured, may have substantially better chances of survival if provided with professionally advanced minute-to-minute objective measurements.Contains 10 practice-oriented topics including early pediatric ICU care; mechanical ventilation: negative to positive and back again; airway management over the last 100 years; critical care nursing from the 1950s to the 2020s; from strict bedrest to early mobilization: a history of physiotherapy in the ICU; visiting hours and the changing place of family in the ICU; and more.

This book is a clinical manual that covers the whole spectrum of swallowing and its disorders. It starts with physiology of swallowing, pathophysiology of disordered deglutition, diagnostic methods (clinical and instrumental) and ends with an in-depth¿s and up-to-date presentation of current treatment options. The clinically most relevant topics of dysphagia management on the stroke unit and the intensive care unit are dealt with in separate chapters. Also the closely intertwined issue of nutritional management is specifically addressed. Most importantly, the book covers all obligatory topics of the Flexible Endoscopic Evaluation of Swallowing (FEES)-curriculum, an educational initiative that started in Germany in 2014 and is currently being extended to other European and non-European countries. The book is richly illustrated and an online video section provides a number of typical patient cases. FEES is probably the most commonly chosen method for the objective assessment of swallowing and its disorders. It is used in stroke units, intensive care facilities, geriatric wards but also in rehabilitation clinics and within dedicated outpatient services. This book on neurogenic dysphagia therefore addresses a wide range of different medical disciplines, such as neurologists, geriatricians, intensive care physicians, rehabilitation physicians, gastroenterologists, otolaryngologists, phoniatrists and also speech-language pathologists.

The book covers vigorously debated controversial topics in the field of critical care medicine over the years. It provides the reader with a balanced approach and guidance based on historical and currently available evidence in dealing with contentious clinical scenarios. The book reviews the most relevant, contemporaneous evidence on each topic and provides practical guidelines for clinical practice.The book includes chapters that follow a structured approach to controversies related to specific organ systems. The topics covered provide a summary of the most relevant, practice-changing studies in the field of critical care medicine. Each topic describes the basic applied physiology, points of controversy, the evidence base, and summarizes the key points at the end. It includes brief description of landmark studies on each controversial topic.The book serves as an important clinical guide to practitioners of critical care medicine when confronted with challenging clinical scenarios. Besides, it is a useful source of information to postgraduate trainees in various medical specialties. The topics addressed are among the most widely discussed during postgraduate examinations. It is also relevant for practitioners in general medicine and specialized areas of practice, including pulmonology (respiratory medicine), cardiology, neurology, nephrology, gastroenterology, and surgical specialties.

CVVH, CVVHD and CVVHDF: These terms will soon no longer be a "e;black box"e; for you! This book is aimed at physicians and nurses in intensive care units who want to both apply and understand continuous renal replacement procedures. Step-by-step, the functionalities and characteristics of all common renal replacement procedures, such as continuous veno-venous hemofiltration, hemodialysis, and hemodiafiltration, are explained in a comprehensible manner, and the clinical implications of the parameters to be set are described. A separate chapter is devoted to the topic of citrate anticoagulation, an understanding of which is essential when using continuous renal replacement procedures. With this knowledge, the most suitable therapy can be selected for each patient and optimally adapted to the patient's needs.

For decades heavily sedated ICU patients were assumed to be asleep.  However, in the past 20 years, physiologic and epidemiologic studies have established sleep is frequently disrupted in the ICU.  The inter-relationship between ICU sleep, delirium, and survivorship has come to the forefront of ICU practice.  We now routinely aim for lighter sedation, delirium assessment has become standardized, and knowledge regarding the ICU factors leading to Post- Intensive Care Syndrome (PICS) has evolved. The importance of sleep in routine ICU management was codified for the first time in SCCM's 2018 PADIS guidelines.  This state of the art book summarizes current knowledge regarding sleep during critical illness and recovery and how the risk factors, recognition, and outcomes associated with sleep in the ICU differ from those of healthy adults. Chapters address sleep quality in both the research environment and during routine care, the factors that disrupt sleep architecture and circadian biology in the ICU setting, medications that alter sleep architecture and those that can be used to improve it, the relationship between sleep and sedation and between sleep and delirium, and current strategies that can be used to improve sleep in the vulnerable ICU population. Written by experts in the field, Sleep in Critical Illness is a valuable resource for all members of the ICU interprofessional team including critical care physicians, nurses, physician assistants, pharmacists, and respiratory therapists as well as clinicians who consult in the ICU and post-ICU settings. 

This book offers an essential guide to managing the most-debated hot topics of practical interest in anesthesia and intensive care. Part I reviews the state of the art in issues concerning both intensive care medicine and anesthesia, such as perioperative medicine, acute liver failure, anesthesia monitoring and ERAS in hepatic surgery. Part II focuses on microbiome in critically ill patients, on COVID-19 aspects and related issues, on sepsis in pediatric patients and ventilatory management in obese patients. Written by leading experts and including updated references, it provides a comprehensive, easy-to-follow update on anesthesia and intensive care. The book clearly explains complex topics, offering practicing clinicians valuable insights into the latest recommendations and evidence in the field while, at the same time, making it a vital resource for students new to the fields of anesthesia and intensive care.

In dealing with the unprecedented COVID-19 pandemic, there are an increased number of patients requiring personalized management as the disease pathology varies. With variable lung compliance and airway resistance as well as the severity of the disease, one size will not fit all patients.   This book is problem-oriented with evidence-based discussions of the daily encountered scenarios in the ICU for mechanically ventilated patients, dealing with the pathology, monitoring and troubleshooting facing intensivists daily. These scenarios are managed utilizing a goal-directed approach and algorithms to achieve these goals. All chapters contain an explanation of a different solution illustrating the respiratory mechanics, physiology and pathology involved in such a scenario. Each chapter also closes with a take-home message to summarize the content. In addition to describing the ventilation of different patient categories, this text also features ventilation cases specific to COVID-19 including airway management in the enhanced air born isolated patient, pulmonary embolism, different states of shock and differential lung ventilation. There is also a specific chapter on monitoring mechanical ventilation with point of care ultrasound, which is an available modality in most ICUs. Another unique chapter describes how to connect more than one patient to one ventilator in case of a shortage of machines.  Written by experts in the field, Personalized Mechanical Ventilation is a timely and valuable resource for critical care physicians, nurses and respiratory therapists on the front lines of both COVID-19 and day-to-day care of mechanically ventilated patients in the ICU.