Critical care nephrology 3rd edition claudio ronco et al. (eds.) - The ebook in PDF and DOCX formats

Page 1


https://ebookmass.com/product/critical-care-nephrology-3rd-

Instant digital products (PDF, ePub, MOBI) ready for you

Download now and discover formats that fit your needs...

Anesthesiology 3rd Edition David Longnecker Et Al.

https://ebookmass.com/product/anesthesiology-3rd-edition-davidlongnecker-et-al/

ebookmass.com

Obstetric Imaging: Fetal Diagnosis and Care 2nd Edition Joshua A. Copel Et Al.

https://ebookmass.com/product/obstetric-imaging-fetal-diagnosis-andcare-2nd-edition-joshua-a-copel-et-al/

ebookmass.com

Critical Care Intravenous Infusion Drug Handbook 3rd Edition

https://ebookmass.com/product/critical-care-intravenous-infusion-drughandbook-3rd-edition/

ebookmass.com

Fallibilism : evidence and knowledge First Edition. Edition Brown

https://ebookmass.com/product/fallibilism-evidence-and-knowledgefirst-edition-edition-brown/

ebookmass.com

CRITICAL CARE NEPHROLOGY

Third Edition

CRITICAL CARE NEPHROLOGY

Claudio Ronco, MD

Director, Department of Nephrology, Dialysis and Transplantation and International Renal Research Institute (IRRIV)

San Bortolo Hospital Vicenza, Italy

Rinaldo Bellomo, MB BS (Hons), MD, FRACP, FCICM, FAAHMS

Department of Intensive Care

Austin Hospital and Royal Melbourne Hospital

Australian and New Zealand Intensive Care Research Centre

School of Public Health and Preventive Medicine

Monash University and School of Medicine

The University of Melbourne Melbourne, Victoria, Australia

John A. Kellum, MD, MCCM

Director, Center for Critical Care Nephrology

Professor and Vice Chair

Department of Critical Care Medicine

University of Pittsburgh Pittsburgh, Pennsylvania

Zaccaria Ricci, MD

Pediatric Cardiac Intensive Care Unit

Department of Pediatric Cardiac Surgery

Bambino Gesù Children’s Hospital, IRCCS Rome, Italy

1600 John F. Kennedy Blvd.

Ste 1800 Philadelphia, PA 19103-2899

Critical Care Nephrology, Third Edition

Copyright © 2019 by Elsevier, Inc. All rights reserved.

ISBN: 978-0-323-44942-7

No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein.

Previous editions copyrighted 2009 by Saunders, an imprint of Elsevier Inc.; 1998 by Claudio Ronco, MD, and Rinaldo Bellomo, MD

Library of Congress Cataloging-in-Publication Data

Names: Ronco, C. (Claudio), 1951- editor. | Bellomo, R. (Rinaldo), 1956-editor. | Kellum, John A., editor. | Ricci, Zaccaria, editor.

Title: Critical care nephrology / editors, Claudio Ronco, Rinaldo Bellomo, John A. Kellum, Zaccaria Ricci.

Other titles: Critical care nephrology (Ronco)

Description: Third edition. | Philadelphia, PA : Elsevier, Inc., [2018] | Includes bibliographical references and index.

Identifiers: LCCN 2017004974 | ISBN 9780323449427 (hardcover : alk. paper)

Subjects: | MESH: Kidney Diseases—therapy | Kidney Diseases—complications | Critical Care

Classification: LCC RC903 | NLM WJ 300 | DDC 616.6/1028—dc23 LC record available at https://lccn.loc.gov/2017004974

Content Strategist: Nancy Anastasi Duffy

Content Development Specialist: Janice Galliard

Publishing Services Manager: Patricia Tannian

Project Manager: Stephanie Turza

Design Direction: Margaret Reid Printed in the United States of America

To my wife, Paola, for her love, patience and support. To Federico, my dear son, now an esteemed colleague.

Claudio Ronco

To my wife, Debbie, for her patience, understanding, and support. To my daughter, Hilary, may she long continue to pursue excellence and wisdom. To both for giving my life meaning.

Rinaldo Bellomo

To my parents, John and Barbara, whose support and encouragement make all things seem possible; to my wonderful wife, Nita, who keeps my feet on the ground; and to my children, Brianna and Alston, who have given me the greatest joys I have ever known.

John A. Kellum

To my mentor, Claudio, the first who showed to me that it is more important to give than to take, in science and in life. To my coeditors, because I could collaborate with those who have previously taught me all of this. To Emanuela, Margherita, Alessandro e Matteo for the love they brought in my life.

Zaccaria Ricci

Francesco G. Casino, MD Nephrologist Dialysis Centre SM2 Potenza, Italy

Giuseppe Castellano, MD Nephrology, Dialysis, and Transplantation Unit Department of Emergency and Transplantation University of Bari Bari, Italy

Matteo Catania, MD Resident Department of Radiology University of Verona Verona, Italy

Kelly A. Cawcutt, MD, MS Assistant Professor of Medicine Department of Infectious Diseases University of Nebraska Medical Center Omaha, Nebraska

Jorge Cerda, MD Department of Medicine Albany Medical College Albany, New York

Elliot Charen, MD Assistant Professor of Medicine Department of Nephrology Icahn School of Medicine New York, New York

Lakhmir S. Chawla, MD Division of Intensive Care Medicine Division of Nephrology Department of Medicine Veterans Affairs Medical Center Washington, District of Columbia

Stefano Chiaramonte, MD Department of Nephrology Dialysis and Transplantation San Bortolo Hospital Vicenza, Italy

Horng-Ruey Chua, MBBS, MMed(Int Med), FRCP(Edin), FAMS, FASN Consultant Nephrologist Department of Medicine National University Hospital Singapore

Bruno Cianciaruso, MD (deceased) Division of Nephrology and Dialysis University of Naples Federico II Naples, Italy

Paola Ciceri, MD Renal Division Department of Health Sciences San Paolo Hospital University of Milan Milan, Italy

Jacek Cieslak, MD, FRCPC

Nephrology Resident Departments of Internal Medicine and Nephrology

University of British Columbia Vancouver, British Columbia, Canada

William R. Clark, MD Davidson School of Chemical Engineering

Purdue University West Lafayette, Indiana

Rolando Claure-Del Granado, MD, FASN

Universidad Mayor de San Simon School of Medicine–Hospital Obrero #2

Cochabamba, Bolivia

Anna Clementi, MD

Department of Nephrology and Dialysis

San Giovanni Di Dio Hospital Agrigento, Italy

International Renal Research Institute of Vicenza (IRRIV) Vicenza, Italy

Ivan N. Co, MD

Clinical Assistant Professor Department of Emergency Medicine and Internal Medicine

Division of Emergency Critical Care and Pulmonary Critical Care Medicine

University of Michigan Ann Arbor, Michigan

Fernanda Oliveira Coelho, MD, PhD

Sao Paulo State Cancer Institute University of Sao Paulo Sao Paulo, Brazil

Ferruccio Conte, MD

Renal Division Department of Health Sciences San Paolo Hospital University of Milan Milan, Italy

Howard E. Corey, MD

The Children’s Kidney Center of New Jersey

Goryeb Children’s Hospital Morristown, New Jersey

Laura Cosmai, MD

Onco-Nephrology Outpatient Clinic

San Carlo Borromeo Hospital, ASST Santi Paolo e Carlo Milan, Italy

Elerson Carlos Costalonga, MD

Sao Paulo State Cancer Institute

University of Sao Paulo Sao Paulo, Brazil

Andrea Costamagna, MD

Department of Anesthesia and Critical Care

AOU Città della Salute e della Scienza di Torino University of Turin Turin, Italy

Maria Rosa Costanzo, MD, FACC, FAHA

Advocate Medical Group

Midwest Heart Specialists Oak Brook, Illinois

Mario Cozzolino, MD

Renal Division

Department of Health Sciences

San Paolo Hospital University of Milan Milan, Italy

Carl H. Cramer II, MD

Mayo Eugenio Litta Children’s Hospital Mayo Clinic Rochester, Minnesota

Paolo Cravedi, MD, PhD Icahn School of Medicine at Mount Sinai New York, New York

Carlo Crepaldi, MD

Department of Nephrology

San Bortolo Hospital Vicenza, Italy

Jacques Creteur, MD, PhD

Department of Intensive Care

Erasme University Hospital Université Libre de Bruxelles Brussels, Belgium

R. John Crew, MD

Assistant Professor of Internal Medicine

Division of Nephrology

Columbia University Medical Center

New York, New York

Verônica Torres da Costa e Silva, MD, PhD

Sao Paulo State Cancer Institute

University of Sao Paulo

Sao Paulo, Brazil

Andrew Davenport, MD

Director, Dialysis Research Centre for Nephrology

Royal Free Hospital

University College London London, United Kingdom

Andrew R. Davies, MB, BS, FRACP

Deputy Director

Department of Intensive Care, Alfred Hospital Melbourne, Victoria, Australia

Dayong Gao, PhD

Department of Mechanical Engineering

University of Washington Seattle, Washington

Francesco Garzotto, MD

Department of Nephrology

Dialysis and Transplantation

International Renal Research Institute of Vincenza San Bartolo Hospital Vicenza, Italy

Giuseppe Gatta, MD

Department of Nephrology and Dialysis

Casa Sollievo della Sofferenza Research Hospital San Giovanni Rontondo, Italy

Kelly R. Genga, MD

Centre for Heart Lung Innovation

St. Paul’s Hospital

University of British Columbia Vancouver, British Columbia, Canada

Simonetta Genovesi, MD

Department of Medicine and Surgery University of Milan-Bicocca Nephrology Unit

San Gerardo Hospital Monza, Italy

Yuri S. Genyk, MD

Professor of Clinical Surgery

Surgical Director, Liver Transplant Program

Division of HepatoBiliary Surgery and Abdominal Organ Transplantation

Keck School of Medicine

University of Southern California Los Angeles, California

Christel Geradin, MD

Intensive Care Unit

Marc Jacquet Hospital Melun, France

Loreto Gesualdo, MD, FERA

Nephrology, Dialysis, and Transplantation Unit

Department of Emergency and Organ Transplantation

University of Bari Bari, Italy

Davide Giavarina, MD

Director of Clinical Laboratory

San Bortolo Hospital Venice, Italy

Anna Giuliani, MD

Department of Nephrology Dialysis and Transplantation

San Bortolo Hospital Vicenza, Italy

Ilya G. Glezerman, MD

Associate Attending Physician

Renal Service

Department of Medicine

Memorial Sloan Kettering Cancer Center

Associate Professor of Clinical Medicine

Department of Medicine

Weill Cornell Medical College

New York, New York

Stuart L. Goldstein, MD

Clark D. West Endowed Chair Director, Center for Acute Care Nephrology

Cincinnati Children’s Hospital Medical Center Cincinnati, Ohio

Thomas A. Golper, MD, FACP, FASN

Professor of Medicine

Department of Nephrology

Vanderbilt University Medical Center Nashville, Tennessee

Hernando Gómez, MD

The Center for Critical Care Nephrology

The CRISMA Center

Department of Critical Care Medicine

University of Pittsburgh Pittsburgh, Pennsylvania

Antonio Granata, MD

Department of Nephrology

St. Giovanni Di Dio Hospital

Agrigento, Italy

Giuseppe Grandaliano, MD

Nephrology, Dialysis, and Transplantation Unit

Department of Medical and Surgical Sciences

University of Foggia Foggia, Italy

Giacomo Grasselli, MD

Dipartimento di Anestesia

Rianimazione ed Emergenza Urgenza Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico Milan, Italy

A.B. Johan Groeneveld, MD, PhD (deceased)

Department of Intensive Care

Erasmus Medical Center

Rotterdam, the Netherlands

Philippe Guerci, MD

Surgical Intensive Care Unit

Department of Anesthesiology and Intensive Care Medicine

University Hospital of Nancy Nancy, France

Kyle J. Gunnerson, MD, FCCM

Associate Professor Departments of Emergency Medicine, Anesthesiology, and Internal Medicine

Chief, Division of Emergency Critical Care

Medical Director, Massey Family Foundation Emergency Critical Center (EC3)

Michigan Center for Integrative Research in Critical Care (MCIRCC)

University of Michigan Health System

Ann Arbor, Michigan

Nikolas Harbord, MD

Assistant Professor of Medicine

Department of Nephrology

Icahn School of Medicine

New York, New York

Lyndsay A. Harshman, MD

University of Iowa Stead Family Department of Pediatrics

Division of Pediatric Nephrology, Dialysis, and Transplantation

Iowa City, Iowa

Anthony J. Hennessy, MB BCh, MRCPI

Senior Registrar

Anaesthesia and Intensive Care

Cork University Hospital Cork, Ireland

Graham L. Hill, MD, FRCS, FRACS, FACS (deceased)

Emeritus Professor of Surgery Faculty of Medical and Health Sciences

University of Auckland Auckland, New Zealand

Charles Hobson, MD, MHA Department of Health Services Research, Management, and Policy University of Florida

Gainesville, Florida

Bernd Hohenstein, MD

Nephrological Center

Villingen-Schwenningen Faculty of Medicine Carl Gustav Carus

Technische Universitat Dresden Dresden, Germany

Patrick M. Honoré, MD

Intensive Care Unit Department Universitair Ziekenhuis Brussel

Vrije Universiteit Brussel Brussels, Belgium

Edward Horwitz, MD

MetroHealth Medical Center

Assistant Professor of Medicine

Case Western Reserve University School of Medicine Cleveland, Ohio

Leila Hosseinian, MD Department of Anesthesiology Mount Sinai Hospital New York, New York

Eric A.J. Hoste, MD, PhD Department of Intensive Care Medicine

Ghent University Hospital Ghent, Belgium

Ghent University, Ghent, Belgium and Research Foundation–Flanders Brussels, Belgium

Andrew A. House, MD, MS, FRCPC, FASN

Professor of Medicine

Chair/Chief Division of Nephrology Schulich School of Medicine & Dentistry

London Health Sciences Centre

University Hospital London, Ontario, Canada

H. David Humes, MD

Professor of Medicine Division of Nephrology Department of Internal Medicine University of Michigan School of Medicine

Ann Arbor, Michigan

Faeq Husain-Syed, MD Department of Internal Medicine II Division of Pulmonology, Nephrology, and Critical Care Medicine

University Clinic Giessen and Marburg (UKGM) Campus Giessen Giessen, Germany

Can Ince, PhD

Professor Department of Intensive Care Erasmus Medical Center Erasmus University of Rotterdam Rotterdam, the Netherlands

Professor Department of Translational Physiology

Academic Medical Center

University of Amsterdam Amsterdam, the Netherlands

Todd S. Ing, MD Department of Medicine

Stritch School of Medicine

Loyola University Chicago Maywood, Illinois

Rita Jacobs, MD

Intensive Care Unit Department Universitair Ziekenhuis Brussel

Vrije Universiteit Brussel Brussels, Belgium

Dharmvir Jaswal, MD

National Institutes of Health Rockville, Maryland

Arun Jeyabalan, MD

Associate Professor Department of Obstetrics, Gynecology, and Reproductive Sciences

University of Pittsburgh Pittsburgh, Pennsylvania

Olivier Joannes-Boyau, MD Department of Anesthesiology and Intensive Care II

University of Bordeaux Bordeaux, France

Michael Joannidis, MD Professor of Medicine

Division of Intensive Care and Emergency Medicine Department of Internal Medicine Medical University Innsbruck Innsbruck, Austria

Emily Joyce, MD

Center for Critical Care Nephrology Department of Pediatrics University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania

Sandra L. Kane-Gill, PharmD, MSc

Associate Professor of Medicine Department of Pharmacy and Therapeutics

Department of Critical Care Medicine

University of Pittsburgh Pittsburgh, Pennsylvania

Lewis J. Kaplan, MD, FACS, FCCM Associate Professor of Surgery Perelman School of Medicine, University of Pennsylvania

Division of Trauma, Surgical Critical Care, and Emergency Surgery

Section Chief, Surgical Critical Care

Corporal Michael J. Crescenz VA Medical Center Philadelphia, Pennsylvania

Kianoush Kashani, MD

Division of Nephrology and Hypertension

Division of Pulmonary and Critical Care Medicine

Department of Medicine

Mayo Clinic Rochester, Minnesota

Nevin Katz, MD

Division of Cardiac Surgery

Johns Hopkins University Baltimore, Maryland

John A. Kellum, MD, MCCM

Director, Center for Critical Care Nephrology

Professor and Vice Chair

Department of Critical Care Medicine

University of Pittsburgh Pittsburgh, Pennsylvania

Ramesh Khanna, MD

Karl D. Nolph, MD Chair in Nephrology

Professor of Medicine

Director

Division of Nephrology

University of Missouri-Columbia, Columbia, Missouri

Nahmah Kim-Campbell, MD

Assistant Professor of Critical Care Medicine

Department of Critical Care Medicine

Children’s Hospital of Pittsburgh of UPMC

University of Pittsburgh Pittsburgh, Pennsylvania

Joshua D. King, MD Division of Nephrology

University of Virginia Health System Charlottesville, Virginia

Christopher J. Kirwan, MD

William Harvey Institute

Barts and the London School of Medicine and Dentistry

Queen Mary University of London

Adult Critical Care Unit and Department of Renal Medicine and Transplantation

The Royal London Hospital

Barts Health NHS Trust London, United Kingdom

Joseph E. Kiss, MD Professor of Medicine

University of Pittsburgh Pittsburgh, Pennsylvania

David Klein, MD, MBA

Staff Physician

Department of Critical Care

St. Michael’s Hospital

Assistant Professor of Medicine and Public Health

University of Toronto

Scientist

Li Ka Shing Knowledge Institute Toronto, Ontario, Canada

xvi Contributors

Devika Nair, MD

Chief Nephrology Fellow

Vanderbilt University Medical Center Nashville, Tennessee

Federico Nalesso, MD, PhD Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV) Vicenza, Italy

Mauro Neri, MD Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital Department of Management and Engineering University of Padova Vicenza, Italy

Trung C. Nguyen, MD Associate Professor of Pediatrics

Baylor College of Medicine

Texas Children’s Hospital Houston, Texas

Zhaohui Ni, MD Department of Nephrology

Ren Ji Hospital School of Medicine

Shanghai Jiao Tong University Shanghai, China

Marina Noris, PhD

IRCCS–Istituto di Ricerche Farmacologiche Mario Negri Clinical Research Center for Rare Diseases Aldo e Cele Daccò Bergamo, Italy

Tessa Novick, MD Nephrology Fellow Division of Nephrology

Johns Hopkins University School of Medicine Baltimore, Maryland

John C. O’Horo, MD, MPH

Senior Associate Consultant Assistant Professor of Medicine Divisions of Infectious Diseases and Pulmonary and Critical Care Medicine

Mayo Clinic College of Medicine Rochester, Minnesota

Mark Douglas Okusa, MD Division of Nephrology and Center of Immunity and Regenerative Medicine

University of Virginia Charlottesville, Virginia

Steven M. Opal, MD

Professor of Medicine

Infectious Disease Division

Rhode Island Hospital

Alpert Medical School of Brown University Providence, Rhode Island

Helen Ingrid Opdam, FRACP, FCICM

The Austin Hospital Heidelberg, Victoria, Australia

Marlies Ostermann, PhD, MD, FRCP Consultant in Critical Care and Nephrology

King’s College London Department of Critical Care Medicine

Guy’s and St. Thomas’ Foundation Hospital

London, United Kingdom

Emerenziana Ottaviano, MD

Renal Division

Department of Health Sciences

San Paolo Hospital University of Milan Milan, Italy

Heleen M. Oudemans-van Straaten, MD, PhD

Department of Adult Intensive Care

VU University Medical Centre

Amsterdam, the Netherlands

Christian Overgaard-Steensen, MD, PhD

Department of Intensive Care

Rigshospitalet

Copenhagen, Denmark

Massimo A. Padalino, MD, PhD

Assistant Professor of Cardiac Surgery

Unit of Pediatric and Congenital Cardiovascular Surgery

Department of Cardiac, Thoracic, and Vascular Sciences

University of Padova

Padova, Italy

Vincenzo Panichi, MD

Nephrology and Dialysis Unit

USL Toscana Nord Ovest

Versilia Hospital

Lido di Camaiore, Italy

Priyanka Parameswaran, BS

Research Associate

Nephrology and Hypertension

Cincinnati Children’s Hospital Medical Center

Cincinnati, Ohio

Samir S. Patel, MD

The Veterans Affairs Medical Center

George Washington University Medical Center

Washington, District of Columbia

Didier Payen, MD, PhD

Professor of Anesthesiology and Critical Care

Groupe Hospitalier Lariboisère Saint-Louis

Paris, France

Federico Pea, MD

Institute of Clinical Pharmacology

Santa Maria della Misericordia University Hospital

ASUIUD

Department of Medicine

University of Udine

Udine, Italy

W. Frank Peacock, MD

Department of Emergency Medicine

Baylor College of Medicine

Houston, Texas

Sandrica Young Peart, MBBS, DM Paeds

Pediatric Nephrology Fellow

Montreal Children’s Hospital

McGill University Health Centre

Montréal, Québec, Canada

Sadudee Peerapornratana, MD

Division of Nephrology Department of Medicine

Faculty of Medicine

Chulalongkorn University

King Chulalongkorn Memorial Hospital Bangkok, Thailand

Paolo Pelosi, MD

IRCCS AOU San Martino–IST Department of Surgical Sciences and Integrated Diagnostics

University of Genoa

Genoa, Italy

Zhi-Yong Peng, MD, PhD Department of Critical Care Medicine

Zhongnan Hospital

Wuhan University School of Medicine

Wuhan, China

Norberto Perico, MD

IRCCS–Istituto di Ricerche

Farmacologiche Mario Negri

Clinical Research Center for Rare

Diseases Aldo e Cele Daccò Bergamo, Italy

Licia Peruzzi, MD

Nephrology, Dialysis and Transplantation Unit

Regina Margherita Children’s Hospital Turin, Italy

Francesco Pesce, MD, PhD

Nephrology, Dialysis and Transplantation Unit Department of Emergency and Organ Transplantation University of Bari Bari, Italy

Antonio Pesenti, MD

Dipartimento di Anestesia

Rianimazione ed Emergenza Urgenza

Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico Dipartimento di Fisiopatologia

Medico-Chirurgica e dei Trapianti

Università degli Studi di Milano Milan, Italy

Ilaria Petrucci, MD, PhD

Temporary Research Fellow Department of Nephrology

Sant’Anna School of Advanced Studies Pisa, Italy

Phuong-Chi Pham, MD, FASN

Chief, Division of Nephrology and Hypertension

Nephrology Fellowship Training Program Director

Olive View-UCLA Medical Center Clinical Professor of Medicine

David Geffen School of Medicine at UCLA Sylmar, California

Phuong-Thu Pham, MD, FASN

Clinical Professor of Medicine Director of Outpatient Services Kidney Transplant Program Department of Medicine, Nephrology Division

David Geffen School of Medicine at UCLA Los Angeles, California

Richard K.S. Phoon, FRACP Centre for Transplantation and Research University of Sydney Department of Renal Medicine Westmead, Australia

Salvatore Piano, MD Unit of Internal Medicine and Hepatology Department of Medicine University of Padova Padova, Italy

Michael R. Pinsky, MD Professor of Critical Care Medicine University of Pittsburgh Pittsburgh, Pennsylvania

Lise Piquilloud, MD

Département de Réanimation Médicale et de Médecine Hyperbare Centre Hospitalier Universitaire d’Angers Angers, France

Valentina Pistolesi, MD, PhD Hemodialysis Unit

Department of Nephrology and Urology

Umberto I Hospital, Sapienza University of Rome Rome, Italy

Lindsay D. Plank, DPhil, MSc

Associate Professor Department of Surgery Faculty of Medical and Health Sciences

University of Auckland Auckland, New Zealand

Frans B. Plötz, MD, PhD Department of Pediatrics Tergooi Hospital Blaricum, the Netherlands

Manuel Alfredo Podestá, MD Resident in Nephrology University of Milan Milan, Italy

ASST Papa Giovanni XXIII Bergamo, Italy

Camillo Porta, MD Medical Oncology

IRCCS San Matteo University Hospital Foundation Pavia, Italy

Marco Pozzato, MD AKI Team Leader

Nephrology and Dialysis Unit San Giovanni Bosco Hospital Torino, Italy

Michele Prencipe, MD Department of Nephrology and Dialysis

Casa Sollievo della Sofferenza Research Hospital San Giovanni Rontondo, Italy

John R. Prowle, MD

William Harvey Institute

Barts and the London School of Medicine and Dentistry

Queen Mary University of London

Adult Critical Care Unit and Department of Renal Medicine and Transplantation

The Royal London Hospital

Barts Health NHS Trust London, United Kingdom

Zudin A. Puthucheary, MD Critical Care Consultant

Royal Brompton Hospital London, United Kingdom

Lirong Qu, MD, PhD Associate Professor of Pathology University of Pittsburgh Pittsburgh, Pennsylvania

Jean-Sebastien Rachoin, MD, FASN Department of Medicine

Cooper Medical School of Rowan University Camden, New Jersey

Jai Radhakrishnan, MD Professor of Medicine

Division of Nephrology Department of Medicine

Columbia University Medical Center

Associate Division Chief for Clinical Affairs

Division of Nephrology

New York Presbyterian Hospital

New York, New York

V. Marco Ranieri, MD Department of Anesthesia and Critical Care

Ospedale Policlinico Umberto I Sapienza University of Rome Rome, Italy

Ranistha Ratanarat, MD Fellow

Department of Nephrology, Dialysis and Transplantation

San Bortolo Hospital Vicenza, Italy

Instructor

Department of Medicine

Faculty of Medicine Siriraj Hospital

Mahidol University

Bangkok, Thailand

xviii Contributors

Giuseppe Remuzzi, MD

IRCCS–Istituto di Ricerche Farmacologiche Mario Negri

Clinical Research Center for Rare Diseases Aldo e Cele Daccò

Ranica, Bergamo, Italy

Unit of Nephrology and Dialysis

Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII Bergamo, Italy

Shelby Resnick, MD

Perelman School of Medicine, University of Pennsylvania Division of Trauma, Surgical Critical Care and Emergency Surgery Philadelphia, Pennsylvania

Oleksa G. Rewa, MD

Critical Care Medicine

Faculty of Medicine and Dentistry University of Alberta Edmonton, Alberta, Canada

Zaccaria Ricci, MD

Department of Cardiology and Cardiac Surgery

Pediatric Cardiac Intensive Care Unit

Bambino Gesù Children’s Hospital, IRCCS Rome, Italy

Christophe Ridel, MD

Service de Nephrologie et d’Aphérèse

AURA Plaisance Paris, France

Kinan Rifai, MD

Department of Gastroenterology Städtisches Klinikum Wolfenbüttel Wolfenbüttel, Germany

Troels Ring, MD

Department of Nephrology Aalborg Hospital Aalborg, Denmark

Lilia M. Rizo-Topete, MD

Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital Vicenza, Italy; Department of Nephrology

University Hospital–José Eleuterio González Monterrey, Mexico

Eric Roessler, MD

Assistant Professor

Nephrology Department

Pontificia Universidad Católica de Chile Medical School

Chief, Acute Dialysis Unit

Clinical Hospital

Pontificia Universidad Católica de Chile

Santiago, Chile

Paola Romagnani, MD

Excellence Centre for Research Transfer and High Education for the Development of DE NOVO Therapies (DENOTHE)

Department of Clinical and Experimental Biomedical Sciences University of Florence

Nephrology Unit

Meyer’s Children’s University Hospital Florence, Italy

Stefano Romagnoli, MD

Department of Cardiac and Vascular Anesthesia and Post-Surgical Intensive Care Unit

Careggi Hospital Florence, Italy

Claudio Ronco, MD

Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital Vicenza, Italy

Federico Ronco, MD

Interventional Cardiology Cardiothoracic and Vascular Department

AULSS-3 Serenissima Venezia and Mestre, Italy

Mitchell H. Rosner, MD Division of Nephrology University of Virginia Health System Charlottesville, Virginia

Emanuele Rossetti, MD Pediatric Intensive Care Unit Department of Emergency, Anesthesia and Intensive Care (DEA-ARCO)

Bambino Gesú Children’s Hospital, IRCCS Rome, Italy

James A. Russell, MD

Principal Investigator Centre for Heart Lung Innovation Division of Critical Care Medicine

St. Paul’s Hospital University of British Columbia Vancouver, British Columbia, Canada

Georges Saab, MD

MetroHealth Medical Center

Associate Professor of Medicine

Case Western Reserve University School of Medicine Cleveland, Ohio

Alice Sabatino, MD, MSc

Renal Intensive Care Unit

Parma University Hospital Parma, Italy

Sonali S. Saboo, DMRD, DNB Director

Nephron Kidney Care

Consultant Radiologist

United Ciigma Hospital Aurangabad, India

Sara Samoni, MD

Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital Vicenza, Italy; Institute of Life Sciences

Sant’Anna School of Advanced Studies Pisa, Italy

Penny Lynn Sappington, MD

Associate Professor

Department of Critical Care Medicine

University of Pittsburgh Pittsburgh, Pennsylvania

Marco Sartori, PharmD, PhD Pharmacology Section

International Renal Research Institute of Vicenza (IRRIV) Vicenza, Italy; Department of Pharmaceutical and Pharmacological Science University of Padua Padua, Italy

Judy Savige, MD Department of Medicine

Royal Melbourne Hospital University of Melbourne Melbourne, Australia

Francesco Paolo Schena, MD

Emeritus Professor of Nephrology University of Bari Bari, Italy

Antoine Guillaume Schneider, MD, PhD

Adult Intensive Care Unit

Centre Hospitalier et Universitaire Vaudois (CHUV) Lausanne, Switzerland

Isaac Teitelbaum, MD Professor of Medicine University of Colorado School of Medicine Denver, Colorado

Ciro Tetta, MD Unicyte AG Oberdorf, Switzerland

Charuhas V. Thakar, MD Professor of Medicine Director, Division of Nephrology, Kidney C.A.R.E. Program University of Cincinnati Chief, Section of Nephrology Cincinnati VA Medical Center Cincinnati, Ohio

Marta Tonon, MD Unit of Internal Medicine and Hepatology Department of Medicine University of Padova Padova, Italy

Francesco Trepiccione, MD, PhD Department of Nephrology University of Campania–Luigi Vanvitelli Naples, Italy

Darrell Triulzi, MD Professor of Pathology University of Pittsburgh Pittsburgh, Pennsylvania

Chopra Tushar, MD Division of Nephrology and Center of Immunity and Regenerative Medicine University of Virginia Charlottesville, Virginia

Shigehiko Uchino, MD Associate Professor Department of Anesthesiology Staff Specialist Intensive Care Unit

Jikei University school of Medicine Tokyo, Japan

Ali Valika, MD, FACC Advocate Medical Group—Midwest Heart Specialists Oak Brook, Illinois

Wim Van Biesen, MD, PhD Renal Division

Ghent University Hospital Ghent, Belgium

Wim Vandenberghe, MD Department of Intensive Care Medicine

Ghent University Hospital Ghent, Belgium

Raymond Vanholder, MD, PhD

Renal Division

Ghent University Hospital Ghent, Belgium

Jill Vanmassenhove, MD, PhD

Renal Division

Ghent University Hospital Ghent, Belgium

Anton Verbine, MD Department of Nephrology Conemaugh Health System Johnstown, Pennsylvania

Marco Vergano, MD Department of Anesthesia and Intensive Care

S. Giovanni Bosco Hospital Torino, Italy

Gianluca Villa, MD

Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV)

San Bortolo Hospital

Vicenza, Italy; Department of Health Science

Section of Anesthesiology and Intensive Care

University of Florence Department of Anesthesiology and Intensive Care

Azienda Ospedaliero Universitaria Careggi Florence, Italy

Pierre-Marc Villeneuve, MD Department of Critical Care Medicine

Faculty of Medicine and Dentistry University of Alberta Edmonton, Alberta, Canada

Jean-Louis Vincent, MD, PhD Department of Intensive Care

Erasme University Hospital Université Libre de Bruxelles Brussels, Belgium

Christophe Vinsonneau, MD, MSc Intensive Care Unit

Marc Jacquet Hospital Melun, France

Grazia Maria Virzì, Bsc Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV)

San Bortolo Hospital Vicenza, Italy

Federico Visconti, MD

Department of Anesthesiology and Critical Care

San Bartolo Hospital

Vicenza, Italy

Ravindran Visvanathan MBBS, FRCP (Edin)

Consultant Nephrologist

Hospital Kuala Lumpur

Kuala Lumpur, Malaysia

Li Van Vong, MD

Intensive Care Unit

Marc Jacquet Hospital Melun, France

Hans-Dieter Walmrath, MD

Department of Internal Medicine II Division of Pulmonology, Nephrology, and Critical Care Medicine

University Clinic Giessen and Marburg (UKGM) Campus Giessen Giessen, Germany

Peter A. Ward, MD Department of Pathology University of Michigan Medical School

Ann Arbor, Michigan

Matthew A. Weir, MD Department of Medicine

Schulich School of Medicine and Dentistry

Western University London, Ontario, Canada

Xiaoyan Wen, MD

Center for Critical Care Nephrology

The CRISMA Center University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania

Julia Wendon, MD

Liver Intensive Care Unit

Institute of Liver Studies

King College Hospital London, United Kingdom

James Frank Winchester, MD Professor of Medicine

Department of Nephrology

Icahn School of Medicine

New York, New York

Adrian Wong, PharmD, MPH

Fellow, Outcomes Research and Pharmacy Informatics

Division of General Internal Medicine and Primary Care

Brigham and Women’s Hospital

Boston, Massachusetts

Elke L. Woodhouse, MBBS

Centre for Transplantation and Renal Research

University of Sydney Department of Renal Medicine Westmead Hospital Westmead, Australia

Jun Xue, MD

Department of Nephrology Huashan Hospital Fudan University Shanghai, China

Anju Yadav, MD

Assistant Professor, Nephrology Thomas Jefferson University Philadelphia, Pennsylvania

Preethi Yerram, MD

Associate Professor of Clinical Medicine

University of Missouri–Columbia Columbia, Missouri

Lenar Yessayan, MD

Clinical Associate Professor of Medicine

Division of Nephrology Department of Internal Medicine University of Michigan Ann Arbor, Michigan

Jane Y. Yeun, MD

Staff Nephrologist

Sacramento Veterans Administration Medical Center

Mather, California

Health Sciences Professor of Medicine

Department of Internal Medicine Division of Nephrology

University of California, Davis School of Medicine Sacramento, California

Alex W. Yu, MD

Honorary Clinical Professor Department of Medicine and Therapeutics

Chinese University of Hong Kong Chief-of-Service and Consultant Physician

Department of Medicine

Alice Ho Miu Ling Nethersole Hospital Hong Kong, China

Marta Zaccaria, MD

Department of Nephrology, Dialysis and Transplantation

International Renal Research Institute of Vicenza (IRRIV) San Bortolo Hospital Vicenza, Italy

Miriam Zacchia, MD, PhD Department of Nephrology University of Campania–Luigi Vanvitelli Naples, Italy

Teena P. Zachariah, MD

Division of Nephrology

Columbia University Medical Center

New York, New York

Nereo Zamperetti, MD

Pain Therapy Unit Vicenza, Italy

Fernando G. Zampieri, MD Research Institute, HCor–Hospital do Coração Intensive Care Unit

Hospital Alemão Oswaldo Cruz São Paulo, Brazil

Pierluigi Zanco, MD Director

Department of Nuclear Medicine Ospedale San Bortolo–ULSS 8 Berica Vicenza, Italy

Alberto Zanella, MD

Dipartimento di Anestesia Rianimazione ed Emergenza Urgenza Fondazione IRCCS Ca’ Granda–Ospedale Maggiore Policlinico

Dipartimento di Fisiopatologia

Medico-Chirurgica e dei Trapianti Università degli Studi di Milano Milan, Italy

Luca Zanoli, MD, PhD Department of Internal Medicine University of Catania Catania, Italy

Michael Zappitelli, MD

Pediatric Nephrologist

Associate Professor

Montreal Children’s Hospital

McGill University Health Centre

Montréal, Québec, Canada

Jose J. Zaragoza, MD

Intensive Care Unit

Hospital Español

Mexico City, Mexico

Alexander Zarbock

Departments of Anesthesiology, Intensive Care, and Pain Medicine

University Hospital Münster Münster, Germany

Marta Zaroccolo, MD

Nuclear Medicine Physician

Department of Nuclear Medicine

Ospedale San Bortolo Vicenza, Italy

Han Zhang, MD

Attending Physician

Department of Nephrology

Zhongshan Hospital Fudan University Shanghai, China

Andrea Zimmer, MD Assistant Professor Division of Infectious Diseases

University of Nebraska Medical Center Omaha, Nebraska

Principles of Critical Care

CHAPTER 1

The Critically Ill Patient

OBJECTIVES

This chapter will:

1. Identify the key indicators of organ dysfunction used to characterize “critically ill patients.”

2. Discuss key principles of management for critically ill patients using the VIP rule.

3. Highlight the need for individualized therapy guided by appropriate monitoring.

4. Describe critical illness as one part of a continuum of healthcare.

We often hear the term “critically ill,” but exactly how can we define the critically ill patient? What characteristics make a patient “critically ill”? Synonyms of the word critically include dangerously, severely, gravely, profoundly, and desperately. Although these all stress the serious nature of this condition, they do not really help define it. In fact, the key feature that makes a patient critically ill is essentially the presence (or imminent risk) of acute organ dysfunction. Importantly, although many critically ill patients have a “life-threatening” condition, this term, although widely used in the context of critical illness, is not an essential component of its definition. For example, patients at risk of developing acute renal failure may be critically ill, but they do not necessarily have a life-threatening condition because, with appropriate support, it is possible to survive with no renal function.

The critically ill patient may have a single or multiple disease processes, and the state of critical illness is therefore difficult to define. For example, some complex patients with mild acute respiratory distress syndrome (ARDS) associated with septic shock resulting from peritonitis also have secondary renal failure and several comorbidities, e.g., complicated diabetes and chronic obstructive pulmonary disease (COPD). Critically ill patients therefore are characterized usually by the types and severities of their organ dysfunction(s), which are different in each patient and influence treatments and outcomes. In the following section we will consider the key indicators of organ dysfunction used to characterize critically ill patients before briefly discussing some of the general aspects of management and

monitoring that are typically used in these patients and thus form part of their “critical illness” identity.

ORGAN DYSFUNCTION

Cardiovascular

A patient with cardiovascular dysfunction has insufficient oxygen available to meet tissue requirements, thus leading to dysfunction of other organ systems. Circulatory failure or shock can be classified according to the four key pathophysiologic mechanisms: hypovolemic, cardiogenic, obstructive, or distributive.1 Shock is recognized clinically by the presence of hypotension (although this is sometimes subtle, especially in patients with a history of hypertension) and typically requires vasopressor therapy. Importantly, however, shock is not just hypotension, and the tissue perfusion must be evaluated. This can be accomplished by using the three “windows” to look inside the body: skin perfusion, urine output, and mental status (typically obtundation, disorientation, confusion). An increase in blood lactate concentration above 2 mEq/L (or mmol/L) provides important confirmation of abnormal cellular oxygen metabolism.

Arrhythmias are no longer considered such an important sign of cardiovascular dysfunction in the critically ill patient, because the excessive treatment of arrhythmias in the past was accompanied by more complications than benefits. Tachycardia does remain an important sign, but patients should be evaluated carefully using an algorithm to determine the underlying cause. Tachycardia is usually present to compensate for a low stroke volume (in the presence of hypovolemia, cardiac pump issues, or an obstruction in the cardiovascular system) or to generate a supranormal cardiac output (in sepsis or other inflammatory conditions or in anemia or hypoxemia).

Respiratory

There are two types of respiratory failure: hypercapnic (typically related to chronic lung disease or central hypoventilation) and hypoxemic (e.g., in pneumonia or ARDS). In

resuscitation and correction of shock. As such, a rapid fluid bolus should be given and interventions to treat any obvious underlying cause and support failing organs initiated. In the optimization phase, the patient remains hemodynamically unstable but is no longer in immediate danger of hypovolemia. The important target during this phase is to optimize and maintain adequate tissue perfusion and oxygenation to prevent and limit (further) organ damage. Fluids and vasoactive agents should be administered according to individual needs, reassessed on a regular basis. The patient must be monitored carefully during this optimization phase (see the following section). In the stabilization phase, fluids are administered to replace ongoing losses and often vasopressor agents can be weaned. In the deescalation phase, the aim is to remove any excess fluid by spontaneous diuresis if possible or using ultrafiltration or diuretics if necessary.

MONITORING SYSTEMS

Many large clinical trials have demonstrated that simple, pragmatic protocols do not work in critically ill patients. Targeting a higher or a lower arterial pressure, a supranormal cardiac output or a central venous oxygen saturation (ScvO2) above a given value does not improve outcomes. Rather, treatment should be individualized according to each patient’s needs and clinical response. However, this approach requires some form of monitoring. Although all critically ill patients therefore have some form of monitoring in situ, the type and nature of such monitoring will depend, of course, on the individual patient’s underlying disease process(es) and clinical status and will vary during the course of the ICU stay as the patient’s condition evolves. Local availability and physician preferences also affect the types of monitoring used.

Use of the pulmonary artery catheter has decreased considerably in recent years, primarily because of the development of echocardiographic techniques, but invasive monitoring is still used. Arterial catheters are needed for accurate, continuous arterial pressure monitoring and central venous catheters for monitoring of central venous pressure to evaluate the response to therapy and the ScvO2 in complex cases. In the future, we are likely to see more patients with microcirculatory monitoring to assess ongoing tissue oxygenation and perfusion.

THE ICU STAY AS PART OF A TRAJECTORY

In the past, the ICU stay was a separate, detached event, with patients being admitted when critically ill and discharged when intensive care was no longer necessary. Little attention was paid to pre- or post-ICU care. More recently, the approach to critical illness has changed, and it is seen much more as just one portion of the ongoing disease trajectory. ICU teams now are encouraged to leave the ICU to evaluate patients on the floor before they deteriorate to such an extent that ICU admission becomes a necessity and also to follow up with patients after their ICU stay to ensure their condition continues to improve. Revalidation

with early mobilization also is initiated much earlier than before, as soon as is practical on the ICU, to limit ICUacquired weakness; this is facilitated by the much less widespread use of sedation. Patients may even be taken outside the hospital with their respirators.

CONCLUSION

Critically ill patients can be of any size, shape, age, and background, but all have a serious degree (or risk) of acute organ dysfunction and require admission to an ICU for monitoring and treatment. Their underlying conditions may be varied, but the resulting critical illness conditions (e.g., sepsis, acute respiratory failure, acute renal failure) are similar, and all such patients should be cared for by experienced intensivists. ICUs have changed considerably over the years and are no longer the frightening places they once were, to be avoided at all costs, but rather just one period of many in a patient’s disease trajectory. Today, patients often prefer (more often a wish expressed by their families) to stay in the ICU, knowing they are under close surveillance with appropriate staff to prevent complications and provide rapid appropriate treatment. Evaluation of the critically ill patient is based primarily on the type and severity of organ dysfunction, but treatment clearly is not limited to organ support. Rather, patient management should be based on a clear understanding of underlying pathophysiologic alterations so that a rational, individualized approach to therapy can be established.

Key Points

1. A critically ill patient can be defined by the presence of acute organ dysfunction and the need for intensive monitoring and management.

2. The pattern and severity of dysfunction of six organ systems—cardiovascular, respiratory, neurologic, hematologic, renal, and hepatic—are used to characterize critically ill patients.

3. Initial resuscitation for all critically ill patients can be guided by the VIP (ventilator, infusion, pump) mnemonic, with adequate oxygenation, fluid therapy, and vasoactive support.

4. Management should be adapted according to the patient’s phase of illness—salvage, optimization, stabilization, de-escalation (SOSD)—and guided by monitoring equipment adjusted to individual needs and status.

5. Early awareness of deteriorating patient condition in the general floor, enabling rapid intervention and greater attention to the long-term complications of critical illness, helps optimize outcomes.

A complete reference list can be found online at ExpertConsult.com

Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.
Critical care nephrology 3rd edition claudio ronco et al. (eds.) - The ebook in PDF and DOCX formats by Education Libraries - Issuu