CURRENT Essentials of Critical Care.pdf

PrefaceOur goal in this book is to provide the reader with only the most crucialand important points for the variety of disorders likely to be encounteredin the adult intensive care unit, including the key first stepsin diagnosis, confirmation of diagnosis, and initial management strategies.In preparing the manuscript, we were struck by several insights.First was the importance of general supportive care of the patient regardlessof the primary diagnosis leading to admission to the ICU.Paying attention to prevention of aspiration pneumonia, reduction ofrisk for deep venous thrombosis, improving glycemic control, providingnutritional support, and reducing upper gastrointestinal bleedingshould be encouraged in all eligible patients. Second, we foundthat understanding the critically ill patient requires the knowledge andexperience of sound training. There can be no substitute for a strongbackground in basic science (physiology, pharmacology, microbiology,and pathology) combined with training in clinical medicine andskills in the critical analysis of the literature. Finally, we were challengedtremendously in making the decisions about what to includeand what to exclude in a book such as this. Thus, while this bookgives the reader only the key points, these points focus on what tolook for and what to do first in these critically ill patients.Much of what is done in the ICU has evolved from what seems tobe good common sense practice, and only recently has there beenevidence-based data supporting how we diagnose and manage criticallyill patients. Of course, there remains much to be studied and analyzed,and this reflects how difficult it is to perform valid clinicalstudies in these unstable and very sick patients. Nevertheless, there isnow evidence on adjusting tidal volume in ARDS, controlling glucosein postoperative patients, positioning patients to reduce the risk ofnosocomial pneumonia, and preventing complications in status asthmaticus.Those who take care of critically ill patients should look forwardto more and better investigations that will help us improve careand outcomes.Following in the footsteps of Essentials of Diagnosis and Treatment,we have tried to include a Clinical Pearl for each topic and toprovide one up-to-date reference to guide further reading. Providingthese was quite a challenge and we look forward to augmenting andupdating both of these features.xi