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4 results

  • 1 - Shock

  • from Section 1 - General Critical Care
  • Edited by Kaushal Shah, Weill Cornell Medical Center, New York, Jarone Lee, Massachusetts General Hospital, Boston
  • Edited in association with Clark G. Owyang, Weill Cornell Medical Center, New York, Benjamin Christian Renne, Massachusetts General Hospital, Boston
  • Book:
    Practical Emergency Resuscitation and Critical Care
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 3-14

  • Summary

    Shock is a pathological state resulting from inadequate delivery, increased demand or poor utilization of metabolic substrates (i.e., oxygen and glucose), which leads to cellular dysfunction and cell death. This then leads to progressive acidosis, endothelial dysfunction and inflammatory cascade that results in end-organ injury. Early in the course of shock, compensatory mechanisms may attempt to augment cardiac output (CO) and/or systemic vascular resistance (SVR) in an effort to improve tissue perfusion. Without treatment, those compensatory mechanisms are overwhelmed, leading to decompensated shock, multiorgan failure (MOF) and death.

  • 32 - Assessment and management of coma

  • from Section 4 - Neurointensive care
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 488-497

  • Summary

    Specific aspects in the post-operative care of neurosurgical patients that will influence the decision to admit a neurosurgical patient to an intensive care unit (ICU) include the need for tight blood pressure control, delayed recovery and respiratory dysfunction. The indications for post-operative admission to an ICU, a high-dependency unit or a specialized neurosurgical ward will vary from institution to institution depending on local structures and characteristics of the available units. Besides frequent standardized neurological assessment and scoring, systemic and specific neuromonitoring are important tools to identify patients who are deteriorating post-operatively. Blood pressure derangements may be caused by central neurogenic effects on the heart, by changes in systemic vascular resistance due to circulating or local factors, or by dysfunction of brainstem pressor and depressor centres due to direct injury or neurohumoral stimulation. The suggested blood pressure management in selected post-operative complications is tabulated.

  • Chapter 18 - Principles of antibiotics use

  • from Section II: - Systemic disorders and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 124-129

  • Summary

    The failure of cardiovascular system to maintain adequate organ perfusion pressure causes inadequate oxygen delivery resulting in tissue hypoxia, lactic acidosis and end organ damage. Inotropes affect the force of myocardial contraction. A positive inotrope will increase myocardial contractility. Vasopressors cause vasoconstriction of blood vessels (most act by α1 receptor activation) and therefore increase mean arterial blood pressure (MAP) and systemic vascular resistance (SVR). Vasoactive drugs are used to support tissue perfusion and hence oxygenation. Vasoactive drugs act on various receptors in the body to produce their effects. Treatment with vasoactive drugs should be considered, if optimization of oxygenation, ventilation and adequate fluid resuscitation fail to restore cardiac output. Therapy may need to be started with minute-by-minute assessment of the patient's response. The response to vasoactive drugs is often unpredictable and dependent on the cause of shock and baseline circulation.