REVISION NOTES IN INTENSIVE CARE MEDICINE Xu.rt Gill°"' Htrk MtPk1ll o.n ~ I C ._ ICMm I WW C rota Revision Notes in Intensive Care Medicine Revision Notes in Intensive Care Medicine Stuart Gillon Specialty Registrar in Intensive Care Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK Chris Wright Consultant in Intensive Care Medicine, Queen Elizabeth University Hospital, Glasgow, UK Cameron Knott Consultant in Intensive Care Medicine & Medical Donation Specialist, Austin Hospital & Austin Clinical School, The University of Melbourne, Heidelberg, Victoria, Australia Mark McPhail Speciality Registrar and Honorary Clinical Lecturer, Liver Intensive Therapy Unit, Kings College Hospital NHS Foundation Trust, London, UK Luigi Camporota Consultant in Intensive Care Medicine, Guy’s and St Thomas NHS Foundation Trust, London, UK 1 Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2016 The moral rights of the authors have been asserted First Edition published in 2016 Impression: All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2015960795 ISBN 978–0–19–875461–9 Printed in Great Britain by Ashford Colour Press Ltd, Gosport, Hampshire Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations The authors and the publishers not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding Links to third party websites are provided by Oxford in good faith and for information only Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work Dedication The authors would like to thank their families for the support provided and patience shown through the many hours it took to put this book together To Chloe, Leena, Claire, Lawrie, Ann, Rachel, Anabel, Hamish, Joshua, and all others Thank you Contents Abbreviations  viii Introduction  xi 1 Respiratory  2 Cardiovascular  63 Renal and metabolic  111 Gastroenterology and hepatology  151 5 Neurosciences  189 6 Infection  229 7 Haematology  275 Injury: trauma and environmental  297 9 Toxicology  327 10 Obstetrics  347 11 Dying, death, organ, and tissue donation  367 12 Organizational issues  383 13 Ethics, law, and communication  411 14 Perioperative care  423 Key papers  445 Index  451 Abbreviations 2,3-DPG 2,3-diphosphoglyceric acid AC activated charcoal ACS abdominal compartment syndrome ACT activated clotting time AKI acute kidney injury ALF acute liver failure APACHE acute physiology and chronic health evaluation APC activated protein C APRV airway pressure release ventilation APTT activated partial thromboplastin time ARDS acute respiratory distress syndrome ATLS advanced trauma life support ATN acute tubular necrosis AVN atrio-ventricular node BAL broncho-alveolar lavage CABG coronary artery bypass grafting CAM-ICU confusion assessment method for ICU CCOT critical care outreach team CPB cardiopulmonary bypass Cdyn dynamic compliance CIT cold-ischaemia time CKD chronic kidney disease CMRO2 cerebral oxygen consumption CO cardiac output CPAP continuous positive airway pressure CPB cardiopulmonary bypass CPET cardiopulmonary exercise testing CPP cerebral perfusion pressure CSF cerebrospinal fluid Cstatic static compliance CTG cardiotocography CVC central venous catheter DBD donation after brain death DBP diastolic blood pressure DCD donation after circulatory death DIC disseminated intravascular coagulation DO2 oxygen delivery ECD extended criteria donation ECMO extracorporeal membrane oxygenation EOLC end-of-life care ERCP endoscopic retrograde cholangiopancreatography EVAR endovascular aneurysm repair f frequency FFP fresh frozen plasma FiO2 fractional inspired O2 FRC functional residual capacity GCS Glasgow coma score GFR glomerular filtration rate Hb haemoglobin HFNC high-flow nasal cannulae HFOV high-frequency oscillatory ventilation HIT heparin-induced thrombocytopenia HRS hepato-renal syndrome HUS haemolytic uraemic syndrome IABP intra-aortic balloon pump IAP intra-abdominal pressure ICM intensive care medicine ICP intracranial pressure ICU intensive care unit IMCA independent mental capacity advocate INR international normalized ratio ISS injury severity score IVD intraventricular drain MAP mean arterial pressure MDRO multidrug-resistant organisms MELD model for end-stage liver disease (score) MET medical emergency team MTC major trauma centre ix   Abbreviations MV minute volume NAC n-acetylcysteine NAVA neurally adjusted ventilatory assist NIV non-invasive ventilation NMS neuroleptic malignant syndrome PACU post-anaesthesia care unit PaCO2 arterial partial pressure CO2 PAO2 alveolar partial pressure O2 PaO2 arterial partial pressure O2 PAOP pulmonary artery occlusion pressure PATM atmospheric pressure PCI percutaneous coronary intervention PiO2 inspired partial pressure O2 PEEP positive end expiratory pressure PEFR peak expiratory flow rate PERT patient emergency response team POD paracetamol overdose PPeak peak pressure PPlat plateau pressure PT prothrombin time PTSD post-traumatic stress disorder RAI relative adrenal insufficiency RASS Richmond agitation and sedation score RER respiratory exchange ratio ROC receiver operator curve ROTEM rotational thromboelastometry RRT renal replacement therapy RRT rapid response team RSI rapid sequence induction SAH subarachnoid haemorrhage SAPS simplified acute physiology score SBP systolic blood pressure SBT spontaneous breathing trial SCD sickle cell disease SD standard deviations SIRS systemic inflammatory response syndrome SLE systemic lupus erythematosis SMR standardized mortality ratio SOFA sequential organ failure assessment SVR systemic vascular resistance TBI traumatic brain injury TEG thromboelastogram TIPSS transjugual intrahepatic portosystemic shunt TISS therapeutic intervention scoring system TPP trans-pulmonary pressure TTP thrombotic thrombocytopenia purpura TTS track and trigger system UPS uninterruptable power supply VH variceal haemorrhage Vd dead space V/Q ventilation/perfusion Vt tidal volume WCC white cell count WIT warm ischaemia time WPW Wolf–Parkinson–White syndrome Introduction Intensive care medicine (ICM) is a specialty on the rise Borne of the need for respiratory support in the polio epidemics of the mid-twentieth century, ICM has evolved from an ad hoc extension of anaesthetic practice to one of the most rapidly growing and advancing areas of healthcare ICM is integral to the care of the seriously ill and injured patient, working in partnership with traditional medical and surgical specialties to deliver increasingly complex and ambitious interventions The significant decrease in morbidity and mortality associated with, for example, major trauma, severe sepsis, and acute severe asthma, owes much to the evolution of ICM as a specialty Additionally, ICM is key to perioperative medicine: complex, invasive surgical procedures that significantly derange physiology are only routinely survivable with high-quality, intensive, post-operative care Many patients previously deemed too frail to undergo life-prolonging surgery, can now expect a safe and smooth perioperative journey due to the expertise within the intensive care unit (ICU) The role of ICM extends beyond the walls of the ICU Mobile intensive care teams identify and support patients deteriorating on general wards This external role is not limited to the hospital: ICM has made large contributions to pre-hospital and transfer medicine Finally, a greater appreciation of the impact of critical illness on patients and their families has led to the development of rehabilitation and follow-up services within intensive care This necessitates a different range of skills amongst staff Not only is ICM increasing in terms of breadth of practice, it is increasing in its depth of understanding and complexity of intervention Consider respiratory failure as an example Over a relatively short period of time, simple bag-in-bottle ventilators have evolved into complex, multimodal systems with an array of adjustable parameters This technological advance has been accompanied by huge strides in the understanding of the pathophysiology of respiratory failure and how this is affected by positive pressure ventilation Various ventilation ‘strategies’ have come and gone Numerous adjunctive pharmacological therapies have been proposed And other forms of mechanical support, such as oscillation and extracorporeal oxygenation, have joined traditional ventilators This expansion in breadth and depth requires delivery by an expert multi-disciplinary team ICM has always relied upon the input of enthusiastic doctors, nurses, pharmacists, physiotherapists, dieticians, and other professionals But the explosion in scope of ICM has meant that, in many regions, on-job learning is no longer sufficient and formal training is either highly desirable or mandated Numerous professional bodies have formed to provide guidance and oversight; curricula have been developed, remarkably similar between regions in their content; and systems of assessment, to judge competency and ensure quality, have been introduced It is for professionals working through these programmes of training and undertaking these tests of competency that this book is intended xii   Introduction The content of Revision Notes in Intensive Care Medicine is largely guided by the three major English language medical exams related to ICM: the Fellowship of the College of Intensive Care Medicine (FCICM), set by the college of Australia and New Zealand and undertaken by candidates from that region; the British Fellowship of the Faculty of Intensive Care Medicine (FFICM); and the European Diploma of Intensive Care (EDIC) We have sought to provide a broad overview of the curricula but with particular focus on those areas that appear to be common examination subjects (it should be noted that, at the time of writing, none of the authors have any role in the setting or assessment of these exams; our involvement has been solely as candidates or in supporting colleagues who are candidates) Despite the medical origins of this publication, we believe it to be highly relevant to the other professions The National Competency Framework produced by the British Association for Critical Care Nursing has many similarities to the medical curricula mentioned above; comparable critical care frameworks have been proposed for pharmacists In addition, many universities offer postgraduate ICM qualifications up to Masters level Revision Notes in Intensive Care Medicine would provide a useful companion to these programmes We have aimed to incorporate the ever-expanding evidence-base underpinning ICM practice We have not imposed any in-depth analysis of these papers Rather we have sought to contextualize what we believe to be the key papers, and would encourage readers to explore the original publications themselves and to draw their own conclusions regarding the quality and validity of the evidence Finally, we must acknowledge the changing face of medical education, in particular the rise in prominence of online resources, and consider the role of the book There are those who would argue that in the Internet age the book, less dynamic and less frequently updated than website resources, is of little or no use We would, however, (perhaps unsurprisingly) disagree The book provides a palpable structure to training, and a solid base upon which to build revision The vast majority of the content will not change: the principles of physics, physiology, and pharmacology are unlikely to be revoked prior to the next edition And whilst new evidence will emerge, new technologies will evolve, and existing practices will adapt over the lifetime of this book, these developments are best understood in the context of current understanding of the bigger picture Revision Notes in Intensive Care Medicine provides this base and context We wish all readers the very best in their training and careers, and welcome all feedback on this inaugural edition 450   Key papers TRICC Hebert PC, Wells G, Blajchman MA, et al A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care New England Journal of Medicine 1999; 240: 409–17 TRISS Holst LB, Haase N, Wetterslev J, et al Lower versus higher hemoglobin threshold for transfusion in septic shock New England Journal of Medicine 2014; 371: 1381–91 TTM Nielsen N, Wetterslev J, Cronberg T, et al Targeted temperature management at 33°C versus 36°C after cardiac arrest New England Journal of Medicine 2013; 369(23): 2197–206 Van den Berghe study Van den Berghe G, Woulters P, Weekers F, et al Intensive insulin therapy in the critically ill patients New England Journal of Medicine 2001; 34519: 1359–67 VASST Russell JA, Walley K.R, Singer J, et al Vasopressin versus norepinephrine infusion in patients with septic shock New England Journal of Medicine 2008; 358(9): 877–87 VISEP Brunkhorst FM, Engel C, Bloos F, et al Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis New England Journal of Medicine 2008; 358(2): 125–39 Index Tables, figures and boxes are indicated by an italic, t, f and b following the page number A A–a gradient  12 abdominal aortic aneurysm repair  435 abdominal compartment syndrome  181–3 abdominal perfusion pressure  181 acid 135 acid–base theories  136–8 acidosis, metabolic  136–7 Acinetobacter baumannii 268 action potential, cardiac  89–90 activated charcoal  329 activated clotting time  290 activated protein C  253–4 actual base excess  136 acute chest crisis  293 acute coagulopathy of trauma  281 acute coronary artery occlusion  100 acute coronary syndromes  98–100 acute heart failure  103–5 acute kidney injury  111–21 acute liver failure  153 aetiology 113–14 complications 112–13 definition 111–12 detection 114 drug-related 114 epidemiology 111 fluid therapy  117 follow-up 119 haemodynamic support  117 history 117–18 investigations 118 nephrology referral  118 outcomes 111 pathophysiology 114 prevention 115 renal replacement therapy  118 resuscitation 116–17 risk factors  113 urology referral  118 acute liver failure  151–6 acute kidney injury  153 aetiology 151t, 152–3 coagulopathy  153, 155 clinical manifestations  153–4 defining features  152t definition 152 emergency liver transplantation  155, 156t encephalopathy  153–4, 155 management 154–6 raised intracranial pressure  155 timing 152 acute liver failure early dynamic (ALFED) model 155 acute pancreatitis  177–81 Acute Physiology and Chronic Health Evaluation (APACHE)  179, 392–3 acute respiratory distress syndrome (ARDS)  40–4, 116 acute tubular necrosis  114 acyclovir 241–2 adenosine 95t admission scores  392–4 adrenaline 80t endotherapy 168 adrenal system  148–50 advanced directives  414–15 advanced life-support algorithm bradycardia 93f tachyarrhythmia 94f aggregated parameter track and trigger systems 389 AIDS-defining illnesses  258–9b air transport  402t airway advanced manoeuvres  28–31 basic manoeuvres  27 452   Index airway (continued) burns 315–16 emergencies 30–1 obesity 406 old age  404 paediatrics 403 pregnancy 347 spinal cord injury  306–7, 310–11 airway pressure release ventilation  24 akinetic mutism  194t albumin  137, 160 alcohol poisoning  336–7 ALFED model  155 alfentanil 192t allied professionals  387–8 α2 receptor agonists  191t altitude 402–3 alveolar–arterial (A–a) gradient  12 alveolar dead space  alveolar ventilation  6–7 American Society of Anesthesiologists Physical Status Classification (ASA) score  424, 425t American Spinal Injury Association (ASIA) classification 304 aminoglycosides  237, 363 aminophylline 47t, 50t amitriptyline 192t amniotic fluid embolus  361–2 amoxicillin 234 amphotericin B  244 ampicillin 234 amyl nitrate  338 anaemia 275–6 anaemic hypoxia  analgesics 192 anatomical dead space  anidulafungin 244 anion gap  137 antepartum haemorrhage  359–60 anterior cord syndrome  304 anti-arrhythmic drugs  94–5 antibiotics 231–41 acute pancreatitis  180 agents 233–41 asthma 47t COPD  50t dosing regimens  232 meningitis prophylaxis  227 pharmacology 232 pneumonia 55 pregnancy 363 resistance 233 anti-cholinergic toxidrome  331t anticoagulation lumbar puncture  224 pulmonary embolus  58 renal replacement therapy  125–6 reversal 289 antifungals 243–5 antihypertensives 102t antivirals 241–3 ANZICS-CORE 397 aortic dissection  102–3 aortic surgery  435–7 aorto-caval compression  348 APACHE  179, 392–3 apparent strong ion difference  138 area under the receiver operator curve  392 L-arginine 186 arrhythmias 88–98 anti-arrhythmic drugs  94–5 bradyarrhythmia  91–2, 93f, 95t, 430 electrical conduction  90–1 post-cardiac surgery  430, 434t tachyarrhythmia  92, 94t arterial catheter  67 arterial waveform  67–8 artesunate 257 ASA score  424, 425t ascites 161–2 ASIA classification  304 aspirin poisoning 333 stroke 210 asthma 46–9 Atlanta criteria  177 atrial fibrillation  90, 92, 430 atrial flutter  90 atrio-ventricular node conduction abnormalities 91 atrio-ventricular node re-entrant tachycardia  91 Australia and New Zealand Intensive Care Society Centre for Outcome and Resource Evaluation (ANZICS-CORE)  397 autonomic dysreflexia  308 auto PEEP  48 azithromycin 237 azoles 243 B bacteraemia 246 base 136 base excess  136 bed space  385–6 benzodiazepines 191t benzylpenicillin 234 Berlin criteria  40t best interests  413 beta agonists  43t, 47t beta blocker poisoning  340–2 β-D glucan  230 beta lactams  233–6, 363 Index   453 biliary leak  165 biochemistry 66–7 biomarkers of infection  229–30 biomedical ethics  411 birth on ICU  351 bispectral index  208 blood glucose target  140 blood pressure arterial waveform  68 shock 63 target in sepsis  249 body temperature control  320 botulism 261–2 bradyarrhythmia  91–2, 93f, 95t, 430 brain death 372–3 herniation 199 post-anoxic prognostication  108, 109t tissue oxygenation sensor  204 see also traumatic brain injury brainstem death  373b breast-feeding 351 broad-range bacterial PCR  230 bronchopleural fistula  61 bronchoscopy  39, 62 Brown–Sèquard syndrome  305 bundle branch block  91 burns 314–18 C Caesarean section  352 calcium channel antagonist poisoning  340–2 CAM-ICU 221t capacity 412–14 capnography  13, 30b capnometry 13 capture threshold  97 carbapenem-resistant enterobacteriaceae  268 carbapenems 235–6 carbon dioxide difference between venous and arterial pCO2 67 monitoring 13 carbon monoxide poisoning  45, 338–9 cardiac action potential  89–90 cardiac arrest  105–9 management 106 maternal 351–2 post-cardiac arrest syndrome  106 prognostication  108, 109t cardiac assist devices  87, 88t, 105 cardiac filling pressure  74 cardiac output monitoring  69–73 cardiac pacing  96–8 cardiac surgery  116, 428–32, 433–4t cardiac tamponade  430, 431, 434t cardiogenic shock  65 cardioplegia 429 cardiopulmonary bypass  429–30 cardiopulmonary exercise testing  425 cardiopulmonary resuscitation decisions  416–17 cardio-respiratory interactions  74–5 cardiovascular assessment and monitoring  65–78 cardiovascular support  79–88 Case Mix Programme (Database)  397 caspofungin 244 catatonia 195t catheter-related blood stream infections  268–71 cauda equina lesion  305 caval filter  58 cefepime 235 cefotaxime 235 cefradine 235 ceftaroline 235 ceftriaxone 235 cefuroxime 235 cellulitis 264 central cord syndrome  304 central line associated bloodstream infection  269 central nervous system infections  223–8 central pontine myelinolysis  129 central venous catheters  268–71 central venous oxygen saturation  66 cephalosporins 235 cerebral perfusion  197–9 cerebral perfusion pressure  196 cerebral salt-wasting  206 cerebral spinal fluid analysis  223–5 chain of survival  106 chest drains  299b Child–Pugh–Turcotte score  157, 158t cholinergic toxidrome  330t chronic kidney disease  119–20 chronic liver failure/cirrhosis  156–63 aetiology 151t ascites 161–2 cardiovascular changes  156–7 defining features  152t hepatic encephalopathy  162–3 mortality scoring  157–8 renal dysfunction  159–61 chronic obstructive pulmonary disease (COPD) 49–51 ciprofloxacin 238 circulatory death  372 cirrhosis, see chronic liver failure/cirrhosis citrate anticoagulation  126 clarithromycin 236 clearing the spine  312 clindamycin  240, 363 clonidine 191t 454   Index Clostridium botulinum 261 Clostridium difficile 175 Clostridium tetani 262 CNS infection  223–8 coagulopathy 287–92 acute liver failure  153, 155 anticoagulation-induced 289 lumbar puncture  224 plasma component transfusion  288 point-of-care testing of coagulation  290–1 pre-eclampsia/eclampsia 358 trauma  281, 300 cocaine overdose  103 cold ischaemia time  375 cold water immersion  323 coma  153–4, 193, 194t coma-like states  194–5t communicating hydrocephalus  214 communication donation conversations  381–2 end-of-life care  370–1 family meetings  420–2 community-acquired pneumonia  51, 53, 55 compartment syndrome, abdominal  181–3 competence 412–14 compliance 10 computed tomography (CT)  300–1, 311 conduction action potential  89–90 Confusion Assessment Method for the ICU (CAM-ICU) 221t Conn’s syndrome  129, 130 consent 412–14 continuous renal replacement therapy  123–4 contrast, iodinated  115 contrecoup injury  196 conus medullaris syndrome  305 cooling methods  322–3 coronary artery occlusion  100 cor pulmonale  57–8 corrected sodium  142 corticosteroids, see steroids craniectomy 438 craniotomy 437 critical illness myoneuropathy  219–20 critical illness-related corticosteroid insufficiency (CIRCI) 149–50 cruciate paralysis  304 cryoprecipitate 288 Cryptococcus neoformans 261 CSF analysis  223–5 CT imaging  300–1, 311 CURB 65 score  53t Cushing’s response  199 cyanide poisoning  45, 337–8 cytotoxic hypoxia  cytotoxic therapy  116 D damage control resuscitation  300 damage-control surgery  300 damping 67 dantrolene 323 dead space  6–7 death 371–4 care of the dying  368–70 diagnosis of  371 family considerations  370–1, 373, 374 maternal 352–4 neonatal 353 process 367–8 withdrawal of cardio-respiratory support  370–1 decision-making 417–20 documentation 419–20 fluid therapy  76f patient-centred 418 resuscitation 416–17 decompressive craniectomy  203t, 210 decontamination of the digestive tract  273–4 deferoxamine 340 delayed cerebral ischaemia  214–15 delirium 220–3 deprivation of liberty (DoLS)  415–16 deteriorating patients systems  388–90 dexmedetomidine 191t, 192 diabetes insipidus  129, 130, 205–6 diabetic ketoacidosis  140–2 diarrhoea 174–6 diary-keeping 409 diazepam 191t dichrotic notch  68 dicobalt edetate  338 dieticians 387 Difficult Airway Society algorithm  31f digoxin 95t poisoning 342–3 discharge from ICU  407–10 disease-specific scores  395–6 disproportionate care  411 disseminated intravascular coagulation  288–9 distributive shock  65 dobutamine 81t dopamine 81t Doppler ultrasound  72–3, 204 doxapram 50t drains chest 299b extra-ventricular  201, 214 for paracentesis  162b spinal 437 drowning 318–20 drug-related conditions acute kidney injury  114 acute liver failure  152–3 Index   455 coagulopathy 289 diarrhoea 176 hypercalcaemia 134 hyperkalaemia 131 hyperthermia 321–2 hypocalcaemia 134 hypomagnesaemia 133 hyponatraemia 128 platelet dysfunction  286 thyroid axis  146t dying, see death dynamic compliance  10 dynamic hyperinflation  48 E early rehabilitation  409 Eaton–Lambert syndrome  262 echinocandins 244–5 echocardiography 77–8 eclampsia 354–8 ectopic pregnancy  358–9 effective strong ion difference  138 elastance 10 elderly patients  404–5 electrocardiogram (ECG)  90–1 electroencephalogram (EEG)  208, 209t electrolytes 127–35 embolectomy 59 embolus amniotic fluid  361–2 pulmonary 56–9 emergencies airway-related 30–1 hypertensive 102–3 liver transplantation  155, 156t encephalitis 227–8 encephalopathy hepatic  153–4, 155, 162–3 hypertensive 101 end-of-life care  368–71, 380–2 endoscopic band ligation  171–2 endoscopic retrograde cholangiopancreatography 180 endotoxins 265 endotracheal intubation  28 failed 30–1 endovascular aneurysm repair  435–6 endovascular coiling  214t energy requirements  184 enhanced recovery after surgery (ERAS)  427–8 enteral nutrition  176, 185–6 Enterococcus, vancomycin-resistant  267 ephedrine 83t epicardial pacing  96t erythromycin 236 esmolol 102t ethanol poisoning  336–7 ethical principles  411 ethylene glycol poisoning  336–7 etomidate 191t expiration 15t expiratory hold  48 extended sigh  21 extended-spectrum beta-lactamase-producing enterobacteriaceae 268 extracorporeal membrane oxygenation  25–7, 87, 88t extra-ventricular drain  201, 214 extubation failure 36 post-extubation stridor  36–7 exudates 60 eye donation  379–80 F family considerations death and dying  370–1, 373, 374 family meetings  420–2 organ donation  376–7, 379, 380–2 post-intensive care syndrome  409 FAST scan  301 fentanyl 192t fidaxomicin 175 first-degree heart block  91 Fisher scale  213t fistula, bronchopleural  61 fixed performance mask  14 fixed-wing aircraft  402t FloTrac 72 flucloxacillin 234 fluconazole 243 fluid challenge  75 fluid therapy acute kidney injury  117 burns 316 decision-making 76f hypothermia 325 intracranial surgery  439 post-cardiac surgery  431 sepsis 249–52 Focused Assessment with Sonography in Trauma (FAST) scan  301 foetal assessment  350 foeto-maternal haemorrhage  365 follow-up clinics  410 fondiparinux 58 forced alkaline diuresis  329–30 Frank–Starling curve  75f free flap surgery  440–1 free water deficit  130 freeze-dried products  288 frequency 15t 456   Index fresh frozen plasma  288 fulminant colitis  175 fulminant liver failure, see acute liver failure G gabapentin 192t galactomannan 230 gallstone pancreatitis  180 gancyclovir 241–2 gas-trapping 48 gastric lavage  329 gastrointestinal haemorrhage  165–74 non-variceal  165–8, 173t small or large bowel  173–4 stress ulceration  168–9 variceal  170–2, 173t gastroscopy 167 gentamicin 237 Glasgow Blatchford Score  166 Glasgow Coma Score (GCS)  195t Glasgow–Imrie score  179 glucagon 83t, 341 β-D glucan  230 glutamine 186 glycaemic control  139–45 glyceryl trinitrate  102t, 104 glycopeptides 239–40 graft dysfunction  164 Gram-negative bacilli, multidrug-resistant  268 guanosine analogues  241–2 Guillain–Barre syndrome  218–19 gut decontamination  329 H HAART 259 haematological malignancy  294–6 haemodiafiltration 122 haemodialysis 121–2 intermittent 124 haemofiltration 121 haemolysis 279–80 haemolytic uraemic syndrome  285–6 haemoperfusion 330 haemoptysis 61–2 haemorrhage antepartum 359–60 foeto-maternal 365 gastrointestinal 165–74 intracerebral 211–12 major 280–2 obstetric 358–60 postpartum 360 subarachnoid 212–16 Haldane effect  10 healthcare associated pneumonia  53 heart block  91 heart failure, acute  103–5 heat exhaustion  321 heat oedema  321 heat-related injury  320–3 heatstroke 321 heat syncope  321 helicopters 402t heliox 47t HELLP syndrome  356–7 Henderson–Hasselbalch equation  136 heparin-induced thrombocytopenia  284, 285t hepatic artery thrombosis  165 hepatic encephalopathy  153–4, 155, 162–3 hepatorenal syndrome  159, 160b high dose insulin therapy  341–2 high flow nasal cannulae  14–15 high-frequency oscillatory ventilation  22–4 highly active antiretroviral treatment  259 high-risk surgical patients  423–4 Hill–Burton formula  385 HIV 258–61 hospital acquired pneumonia  51 hospital episode statistics procedure groups  425 Hudson mask  14 hydrocephalus 214 hydroxocobalamin 338 hypercalcaemia 134–5 hyperdynamic shock  65 hyperglycaemia 139 hyperkalaemia 131 hypermagnesaemia 133 hypernatraemia 129–30 hyperosmolar hyperglycaemic state  142–4 hyperosmolar non-ketotic coma  143 hyperphosphataemia 132 hypertension crises 101–2 emergencies 102–3 encephalopathy 101 ICU admission  101 intra-abdominal  181, 182t malignant 101 pregnancy-induced 354 hyperthermia 320–3 hyperventilation 203t hypno-sedative toxidrome  331t hypocalcaemia 133–4 hypodynamic shock  65 hypoglycaemia 139 hypokalaemia 130–1 hypomagnesaemia 132–3 hyponatraemia 127–9 hypophosphataemia 132 hypotension permissive 300 severe sepsis  246 spinal cord injury  307 hypothalamic–pituitary–adrenal axis  148–9 Index   457 hypothalamic–pituitary–thyroid axis  145–6 hypothermia 324–5 post-cardiac surgery  430 therapeutic 106–8 hypovolaemic shock  64 hypoxaemia  1–5, 57, 58 hypoxaemic hypoxia  hypoxia  1, hypoxic respiratory drive  7, 10 I I:E ratio  15t imidazoles 243 imipenem 235–6 immune-enhancing nutrition  186 immune reconstitution inflammatory syndrome (IRIS) 259–60 immunocompromised 53 immunosuppression 164 Impella 88t incremental PEEP  21 Independent Mental Capacity Advocate  413, 415 induced emesis  329 infection biomarkers 229–30 burns 317 catheter-related blood stream  268–71 central nervous systems  223–8 control 231 definition 246 diarrhoea 175–6 failure to respond to treatment  230–1 metastatic in pneumonia  55 multidrug-resistant organisms  266–8 nosocomial 265–74 risk factors in critical illness  229 inferior vena cava diameter 75 filters 58 influenza 255–6 inhalation injury  44–5 inhaled nitric oxide  43t Injury Severity Score (ISS)  394 inotropes  79–85, 105 inspiration 15t inspiration time  15t insulin 83t high dose therapy  341–2 Intensive Care National Audit and Research Centre (ICNARC)  397 intensive care unit (ICU) bed space  385–6 calculated capacity  385 design 385–6 discharge from  407–10 history of intensive care medicine  383 levels of care  384 nurse to patient ratio  386–7 open and closed units  384–5 performance indicators  396–7 side rooms  386 staffing 386–8 inter-hospital transfer  398 intermittent haemodialysis  124 intra-abdominal hypertension  181, 182t intra-abdominal pressure  181 intra-aortic balloon pump  85–7 intracerebral haemorrhage  211–12 intracranial bolts  201, 204 intracranial pressure consequences of raised pressure  199 determinants 196–7 lumbar puncture  224 management of raised pressure  203t manipulation 202–3 monitoring 201 waveform  201, 202f, 202t intracranial surgery  437–9 intra-hospital transfer  398 intraparenchymal transducer (bolt)  201, 204 intra-unit transfer  398 intravenous immunoglobulin  255 intravenous iodinated contrast  115 intrinsic PEEP  48 intubation 28 failed 30–1 iodinated contrast  115 ipratropium bromide  47t iron toxicity  339–40 ischaemia–reperfusion injury  429–30 ischaemia time  375 ischaemic stroke  209–10 itraconazole 243 J jejunal feeding  185 jugular venous bub oximetry  204 K ketamine 191t ketoconazole 243 key papers  445–50 key quality indicators  396 Kidney Disease Improving Global Outcome (KDIGO) 112 King’s College criteria  155, 156t Kocher’s point  214 L labetolol 102t labour on ICU  351 lactate 66 lactic acidosis  66, 67t 458   Index large bowel GI haemorrhage  173–4 L-arginine 186 lasting power of attorney  415 left-sided heart failure  103 left ventricular end diastolic volume  74, 75f legal issues advanced directives  414–15 capacity, competence and consent  412–14 deprivation of liberty  415–16 frameworks 411–12 lasting power of attorney  415 Legionella 55–6 levels of care  384 levofloxacin 238 levosimendan  79, 82t, 105 LiDCO 71–2 Light’s criteria  59 lincosamides 240–1 linezolid 241 lipopolysaccharides 265 lithium poisoning  343–4 liver disease coagulopathy 289 renal protection  116 see also acute liver failure; chronic liver failure/cirrhosis liver transplantation  163–5 emergency  155, 156t locked-in syndrome  194t lorazepam 191t lower gastrointestinal bleeding  173–4 low molecular weight heparin  58, 125 low T3 syndrome  146 lumbar puncture  223–4 Lundberg waves  201, 202t lung compliance curve  11f lung injury score  12 M Maastricht classification  378t macrolides  236–7, 363 magnesium sulphate  47t, 95t magnetic resonance imaging  311–12 major haemorrhage  280–2 major trauma  297–301 malaria 256–8 malignant hypertension  101 mannitol 203t massive haemoptysis  61–2 massive transfusion  281 maternal cardiac arrest  351–2 maternal death  352–4 mechanical cardiovascular support  85–8, 105 mechanical ventilation adverse effects  17 airway pressure release  24 ARDS patients  42t asthma 48–9t cardiovascular support  85 CO2 clearance  17 COPD 50 dead space  dynamic hyperinflation  48 failure to wean  35–6t heart failure  105 high-frequency oscillatory  22–4 intracranial surgery  438 invasive 20 mandatory modes  16 modes 15–16 neutrally adjusted ventilatory assist  17t, 24–5 non-invasive  18, 19t oxygenation 17 PEEP titration  20–1 pneumonia management  55 pressure controlled  16t pressure regulated volume control  16t pressure support  17t principles 15–17 prone positioning  21–2 recruitment manoeuvres  20–1 spontaneous modes  16, 17t terminology 15t titration 32 ventilator-associated pneumonia  51–2, 271–4 ventilator-induced lung injury  17 volume assist  17t volume controlled  16t weaning 32–6 medical staff  387 MELD score  157, 158b membrane potential  88–9 meningitis 225–7 meropenem 236 metabolic acidosis  136–7 metaraminol 83t methanol poisoning  336–7 methicillin-resistant Staphylococcus aureus 267 metronidazole  238–9, 363 micafungin 244 micoconazole 243 micro-dialysis catheter  205 midazolam 191t Miller–Fisher syndrome  262 milrinone 82t minimally conscious state  195t minute ventilation  7, 8f, 9f minute volume  mixed venous oxygen saturation  66 Model for End-stage Liver Disease (MELD) score  157, 158b MODS 395 Index   459 monitoring carbon dioxide  13 cardiac output  69–73 cardiovascular 65–78 delayed cerebral ischaemia  215t flaps 440 intracranial pressure  201 oxygen 12 post-intracranial surgery  439 respiratory 12–13 status epilepticus  208 traumatic brain injury  204–5 Monro–Kellie doctrine  196–7 morphine 192t mortality, see death MRI 311–12 MRSA 267 multidrug-resistant organisms  266–8 multi-organ dysfunction syndrome  247 Multiple Organ Dysfunction Score (MODS)  395 multiple parameter track and trigger systems  389 Murray score  12 myasthenia gravis  217–18 myasthenic crisis  218 myocardial infarction  98–100 myxoedema coma  147–8 N N-acetylcysteine (NAC)  332–3 nasal cannulae  14–15 National Poisons Information Service  327 near infra-red spectroscopy  204 necrotic pancreatitis  180–1 necrotizing fasciitis  263–4 neomycin 237 neonatal death  353 neuraminidase inhibitors  242–3, 256 neurogenic shock  307 neuroleptic malignant syndrome  335–6 neurological death  372–3 neurological monitoring post-intracranial surgery  439 traumatic brain injury  204–5 neuromuscular disorders  216–20 neuro-protective strategy  200t neutrally adjusted ventilatory assist  17t, 24–5 neutropaenic sepsis  294–5 nitric oxide  43t non-invasive ventilation  18, 19t non-ST elevation acute coronary syndromes  100 non-steroidal anti-inflammatory drugs (NSAIDs) 192t non thyroid illness  146 non-variceal GI haemorrhage  165–8, 173t noradrenaline 80t norfloxacin 238 nosocomial infections  265–74 nurse to patient ratio  386–7 nursing staff   386–7 nursing workload scores  395 nutrition 183–7 acute pancreatitis  180 burns 317 daily nutritional requirements  184t early versus late  186 energy requirements  184 enteral  176, 185–6 hepatic encephalopathy  163 immune-enhancing 186 obesity 406 parenteral 185–6 refeeding syndrome  186–7 O obesity 405–7 obstetric haemorrhage  358–60 occupational therapists  388 oesophageal Doppler  72–3 oesophageal varices  170 old age  404–5 omega-3 186 opiates 192t opioid toxidrome  331t opportunistic infections  260–1 organ donation  374–82 after brain death  377–8 after circulatory death  378–9 conversations about  381–2 end-of-life care and  380–2 eyes 379–80 families and  376–7, 379, 380–2 perinatal 354 tissues  354, 379–80 organ-specific scores  395–6 oseltamivir  242, 256 osmolality 143 outcome acute kidney injury  111 traumatic brain injury  205 oxazolidinones 241 oxygenation index  12 oxygenation scores  12 oxygen cascade  1, 2f, 3–4t oxygen delivery (DO2)  6, 64 oxygen monitoring  12 oxygen therapy  14–15 oxyhaemoglobin dissociation curve  5f P pacemaker action potential  89 pacemaker codes  97t pacing 96–8 460   Index paediatrics 403–4 palliative care  368–70 pancreatitis 177–81 paracentesis 161–2 paracetamol 192t poisoning 331–3 paralytic ileus  308–9 parapneumonic effusion  55 paraquat poisoning  339 parenteral nutrition  185–6 Parkland formula  316 patient-centred decision-making  418 patient diary  409 peak pressure  15t PEEP 15t incremental 21 intrinsic (auto)  48 titration 20–1 penicillins 234–5 peramivir 242 percutaneous coronary intervention  99 percutaneous tracheostomy  38–9 performance indicators  396–7 pericardial tamponade  430, 431, 434t pericarditis 430 perioperative care  423–8 aortic surgery  435–7 cardiac surgery  428–32, 433–4t enhanced recovery after surgery  427–8 free flap surgery  440–1 haemodynamic optimization  426–7 high-risk surgical patients  423–4 intracranial surgery  437–9 pneumonectomy 441–3 surgical risk prediction  424–5 peripartum cardiomyopathy  364 peritoneal dialysis  123 permanent pacing  96t permissive hypotension  300 persistent vegetative state  194t P:F ratio  12 pH  135, 136 pharmacists 387 physiological dead space  6–7 physiotherapists 387 PiCCO 71–2 piperacillin 234–5 placental abruption  359 placenta praevia  359–60 plain X-ray  301, 311 plasma component transfusion  288 plateau pressure  15t platelets disorders of function  286 point-of-care testing  286 transfusion  283, 284t pleural effusions  59–60 pleural fluid analysis  59 Pneumocystis jiroveci 260 pneumonectomy 441–3 pneumonia 51–6 assessment 53 community-acquired  51, 53, 55 complications 55–6 healthcare associated  53 hospital acquired  51 immunocompromised 53 management 55 severity score  53 ventilator-associated  51–2, 271–4 pneumothorax 60 point-of-care systems  286, 290–1 poisoning alcohols 336–7 beta blockers  340–2 calcium channel antagonists  340–2 carbon monoxide  45, 338–9 cyanide  45, 337–8 digoxin 342–3 iron 339–40 lithium 343–4 management principles  327–30 National Poisons Information Service  327 paracetamol 331–3 paraquat 339 salicylates 333 serotonergic agents  334–5, 336t toxidromes 330–1t tricyclic anti-depressants  333–4 polyenes 244 Portsmouth Physiological and Operative Severity Score for the Enumeration of Morbidity and Mortality (P-POSSUM)  424 positive end expiratory pressure (PEEP)  15t incremental 21 intrinsic (auto)  48 titration 20–1 post-anaesthetic care unit (PACU)  426–7 post-cardiac arrest syndrome  106 posterior cord syndrome  304 post-intensive care syndrome  407–9 post-operative care aortic surgery  436–7 cardiac surgery  431–2 free flap surgery  440 intracranial surgery  438 pneumonectomy 442 postpartum haemorrhage  360 post-pneumonectomy syndrome  442 P-POSSUM 424 pre-eclampsia 354–8 pregabalin 192t Index   461 pregnancy anatomical and physiological changes  347–9 antibiotics in  363 cardiac disease  363–4 eclampsia 354–8 ectopic 358–9 foetal assessment  350 high-risk 349 hypertension 354 incidental critical illness  362–5 in intensive care  350–1 pre-eclampsia 354–8 sepsis 362–3 trauma 365–6 pre-hospital transfer  398 preload responsiveness  73–7 pressure adjusted heart rate  395 pressure controlled ventilation  16t pressure regulated volume control  16t pressure support  17t primary survey  298–9 procalcitonin 230 prognostication  108, 109t prolonged QT interval  91 prone positioning  21–2 propofol 191t propofol infusion syndrome  344 prostaglandins 126 Pseudomonas aeruginosa 268 pulmonary artery catheter  69–71 pulmonary embolus  56–9 pulse contour analysis  71–2 pulse oximetry  12 Q QT prolongation  91 quality control  396 quinine 257 quinolones  238, 363 R raised intracranial pressure consequences 199 lumbar puncture  224 management 203t ramp-down and ramp-up systems  390 Ranson score  178–9 rapid sequence induction  28–9 rapid shallow breathing index  34 ‘reasonable patient’ test  414 receiver operator curve  392 recombinant factor VII  282 recruitment manoeuvres  20–1 red cell transfusion  276–9 red man syndrome  240 refeeding syndrome  186–7 rehabilitation 409 relative adrenal insufficiency  149 remifentanil 192t renal replacement therapy  121–7 access 122 acute kidney injury  118 anticoagulation 125–6 components 121 continuous 123–4 discontinuation 126 haemodiafiltration 122 haemodialysis 121–2 haemofiltration 121 indications 122–3 intermittent haemodialysis  124 membranes 122 modalities 123–5 peritoneal dialysis  123 poisoning 330 slow continuous ultrafiltration  125 slow low efficiency dialysis  125 reperfusion therapy  99, 209–10 reservoir bag mask  14 respiratory monitoring  12–13 respiratory pathophysiology  1–11 respiratory support  14–27 resuscitation decisions  416–17 rewarming 325 rhabdomyolysis 116 Richmond Agitation–Sedation Score (RASS)  190 RIFLE criteria  111, 112f right-sided heart failure  103 rise time  15t risk prediction  424–5 road transport  402t Rockall Score  167 R on T phenomenon  91 rotational thromboelastrometry (ROTEM®)  290, 291t Royal College of Surgeons’ clinical criteria for major gastrointestinal and vascular surgery 424 rule of nines  315 S salbutamol 47t, 50t salicylate poisoning  333 saline, hypertonic  203t SAPS 394 scoring systems  391–8 admission 392–4 disease-specific 395–6 ICU performance  396–7 nursing workload  395 organ-specific 395–6 severity of illness  394–5 462   Index secondary survey  299 second-degree heart block  91 sedation 189–92 adverse effects  189 holds 189–90 scoring systems  190 sedative agents  190–2 seizures  203–4, 206–9 selective digestive decontamination  273–4 selective oral decontamination  273–4 Sengstaken–Blakemore tube  171 senile emphysema  404 sensing threshold  97–8 sepsis 245–55 activated protein C  253–4 beta blockade  254 definitions 245–7 extracorporeal clearance therapy  254 fluid therapy  249–52 goal-directed therapy  249 heparin 254 intravenous immunoglobulin  255 liver transplantation  165 neutropaenic 294–5 pregnancy 362–3 severe  246, 247–8 statins 254 steroids 252–3 Surviving Sepsis Guidelines  247–8 target blood pressure  249 therapy 249–55 septic shock  246, 247–8 Sequential Organ Failure Assessment (SOFA) 394–5 serotonin syndrome  331t, 334–5, 336t severe sepsis  246, 247–8 severity of illness scores  394–5 shock 63–5 cardiogenic 65 distributive (vasodilatory)  65 hyperdynamic 65 hypodynamic 65 hypovolaemic 64 neurogenic 307 pulmonary embolus  58 septic  246, 247–8 spinal 305 short Synacthen test  149 shunt 2 sick euthyroid state  146 sickle cell disease  292–3 side rooms  386 Siggaard–Anderson approach  136–7 sigh breath  21 Simplified Acute Physiology Score (SAPS)  394 single parameter track and trigger systems  389 16s test  230 slow continuous ultrafiltration  125 slow low efficiency dialysis  125 small bowel GI haemorrhage  173–4 SMARTCOP 54f sniff test  75 sodium (corrected)  142 sodium nitroprusside  102t sodium thiosulphate  338 SOFA 394–5 somatic death  372 speech and language therapists  388 spinal clearance  312 spinal cord injury  302–14 airway  306–7, 310–11 autonomic dysreflexia  308 classification 304–5 clearing the spine  312 imaging 311–12 longer term care  314 management 310–14 medical therapy  313 neurological level  305–6 non-traumatic 302–3 paralytic ileus  308–9 pathophysiology 305–10 spinal protection  312–13 surgical interventions  313 transportation 310 traumatic 303–4 spinal drain  437 spinal protection  312–13 spinal shock  305 spontaneous breathing trial  34, 35b staffing 386–8 stagnant hypoxia  standard base excess  136 standardized mortality ratio  396–7 Staphylococcus aureus, methicillin-resistant  267 Starling curve  75f static compliance  10 statins 43t, 254 status epilepticus  206–8 ST elevation myocardial infarction  99 Stenotrophomonas maltophila 268 steroids ARDS 43t asthma 47t CIRCI 149–50 COPD 50t critical illness  150 meningitis 227 pneumonia 55 sepsis 252–3 Stewart approach  137–8 Stewart–Hamilton equation  71 Index   463 straight leg raise  75 stress response  148–9 stress ulceration  168–9 stridor, post-extubation  36–7 stroke 209–10 strong ion difference  138 subarachnoid haemorrhage  212–16 surfactant 43t surgical clipping  214t surgical risk prediction  424–5 Surviving Sepsis Guidelines  247–8 sustained inflation  21 Swiss Staging System  324 sympathomimetic toxidrome  331t syndrome of inappropriate antidiuretic hormone secretion 128 systemic inflammatory response syndrome (SIRS)  245–6, 430 T tachyarrhythmia  92, 94t tamponade  430, 431, 434t tandem heart  88t targeted temperature management  106–8 teicoplanin 240 temperature control  320 temporary pacing  97–8 Tensilon test  217 terbutaline 47t terlipressin  160, 171 tertiary survey  299 tetanus 262–3 tetracyclines 363 theophylline 47t therapeutic hypothermia  106–8 Therapeutic Intervention Scoring System (TISS) 395 thermodilution method  71 thermoregulation 320 thiopental 191t third-degree heart block  91 thoracic aortic aneurysm repair  435 three-column theory  313 thrombocytopenia 282–7 thromboelastrograph (TEG)  290, 291f, 291t thrombolysis contraindications 99t pulmonary embolus  58 thrombotic thrombocytopenic purpura  284–5 thyroid axis  145–8 thyroid storm  146–7 tidal volume  15t time constants  11 TIPSS 172 TISS 395 tissue donation  354, 379–80 tissue plasminogen activator  209 tobramycin 237 tocolysis 351 topical oropharyngeal antiseptic agents  273 torsades-de-pointes 91 toxic megacolon  175 toxidromes 330–1t toxin-producing bacteria  264–5 Toxoplasmosis gondii 261 tracheostomy 37–9 track and trigger  389 tranexamic acid  282 trans-cranial Doppler  204 transcutaneous pacing  96t transfer of patients  398–403 transfusion massive 281 plasma components  288 platelets  283, 284t red cell  276–9 transfusion associated cardiac overload (TACO) 278 transfusion-related acute lung injury (TRALI)  278 transjugular intrahepatic porto-systemic shunt (TIPSS) 172 transplantation, liver  163–5 emergency  155, 156t transport modes  401–2 trans-pulmonary dilution monitors  71–2 transudates 59–60 trans-urethral resection of prostate (TURP) syndrome 344–5 transvenous pacing  96t trauma major 297–301 pregnancy 365–6 spinal cord  303–4 traumatic brain injury  195–206 classification 195 general management  199–200 mechanisms and physiology  196–9 neurological monitoring  204–5 neuro-protective strategy  200t neurosurgical referral  200b outcome prediction  205 polyuria 205–6 prevention of secondary injury  200–4 primary 196 secondary 196 seizures 203–4 triazoles 243 tricyclic anti-depressant poisoning  333–4 trimethoprim 363 Trojan horse hypothesis  153 tumour lysis syndrome  116, 295 TURP syndrome  344–5 464   Index U ultrasound major trauma  301 oesophageal Doppler  72–3 renal tract  118 trans-cranial Doppler  204 unfractionated heparin  58, 125 upper gastrointestinal haemorrhage non-variceal  165–8, 173t stress ulceration  168–9 variceal  170–2, 173t uraemia 286 V valgancyclovir 242 vancomycin 240 vancomycin-resistant Enterococcus 267 variceal haemorrhage  170–2, 173t vasodilatory shock  65 vasopressin 84t vasopressors 79–85 vasospasm 214–15 Vaughn–Williams classification  94, 95t venous-arterial extracorporeal membrane oxygenation 88t venous oxygen saturation  66 ventilation 6 alveolar 6–7 mechanics of  10–11 minute  7, 8f, 9f volumes  6, 7f see also mechanical ventilation ventilation/perfusion (V/Q) mismatch  ventilator-associated pneumonia  51–2, 271–4 ventilator-induced lung injury  17 Vigileo 72 vitamin B12a  338 volume assist  17t volume controlled ventilation  16t Von Willebrand’s disease  286 voriconazole 243 W Warkentin 4T score  284, 285t warm ischaemia time  375 weakness 216–17 weaning 32–6 West Haven grade  154t whole bowel irrigation  329 whole lung compliance  11 Wolff–Parkinson–White syndrome  91 World Federation of Neurosurgeons, SAH grading 213t written consent  413 Z zanamivir 242 .. .Revision Notes in Intensive Care Medicine Revision Notes in Intensive Care Medicine Stuart Gillon Specialty Registrar in Intensive Care Medicine, Guy’s and St Thomas’... Consultant in Intensive Care Medicine, Queen Elizabeth University Hospital, Glasgow, UK Cameron Knott Consultant in Intensive Care Medicine & Medical Donation Specialist, Austin Hospital & Austin Clinical... IAP intra-abdominal pressure ICM intensive care medicine ICP intracranial pressure ICU intensive care unit IMCA independent mental capacity advocate INR international normalized ratio ISS injury