Annual Update in Intensive Care and Emergency Medicine 2011

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270 C.Y. Goh and C. Ronco VII receptor abnormalities may help to prevent progression of CKD and may help limit cardiovascular complications. Special measures, such as use of biocompatible materials, convective therapy and ultrapure dialysate, can also be implemented to reduce the incidence of cardiovascular complications in hemodialysis patients leading to reduced rates of type 4 cardio-renal syndrome. Finally, in patients with cardio-renal syndrome type 5, treatment of the primary illness (diabetes mellitus, amyloidosis, sepsis, rhabdomyolysis, hemorrhagic shock, etc) generally improves both heart and kidney function. Conclusion The new definition and classification system for cardio-renal syndromes seems to represent an important advance and spur new interest in a collaborative nephrological-cardiological effort. The complexity of cardio-renal syndromes and the specificity of care necessary to offer best therapy to these patients demand a multidisciplinary approach, combining the expertise of cardiology, nephrology, and critical care medicine. This multidisciplinary effort should facilitate a better appreciation of the interaction between heart and kidneys during dysfunction of each or both organs with significant practical clinical implications. Epidemiological studies in different settings could be carried out classifying patients according to specific disorders or cardio-renal syndrome subtypes. Investigators can identify aspects of each single syndrome subtype that carry clear priorities for further research. It is true that patients may move from one subtype to another but this should not discourage categorization of a patient in a specific timeframe of his/ her medical history. It may be difficult to distinguish between type 2 and type 4 cardio-renal syndrome in some cases but careful discussion about prevention and therapeutic priorities should anyway be made collegially between nephrologists and cardiologists. Hopefully, all these efforts will contribute to an increased awareness and physiological understanding leading to some innovative therapeutic approaches and possibly to improved clinical outcomes. References 1. Ronco C (2008) Cardiorenal and renocardiac syndromes: clinical disorders in search of a systematic definition. Int J Artif Organs 31: 1–2 2. Ronco C, House AA, Haapio M (2008) Cardiorenal syndrome: refining the definition of a complex symbiosis gone wrong. Intensive Care Med 34: 957–962 3. Ronco C, Haapio M, House AA, Anavekar N, Bellomo R (2008) Cardiorenal syndrome. J Am Coll Cardiol 52: 1527–1539 4. Ronco C, McCullough P, Anker SD, et al (2010) Cardio-renal syndromes: report from the consensus conference of the acute dialysis quality initiative. Eur Heart J 31: 703–711 5. Adams KF Jr, Fonarow GC, Emerman CL, et al (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149: 209–216 6. Liang KV, Williams AW, Greene EL, Redfield MM (2008) Acute decompensated heart failure and the cardiorenal syndrome. Crit Care Med 36 (Suppl 1): S75–88 7. Gottlieb SS, Abraham W, Butler J, et al (2002) The prognostic importance of different definitions of worsening renal function in congestive heart failure. J Card Fail 8: 136–141 8. Newsome BB, Warnock DG, McClellan WM, et al (2008) Long-term risk of mortality and end-stage renal disease among the elderly after small increases in serum creatinine level during hospitalization for acute myocardial infarction. Arch Intern Med 168: 609–616
Cardio-renal Syndromes: A Complex Series of Combined Heart/Kidney Disorders 271 9. Goldberg A, Hammerman H, Petcherski S, et al (2005) Inhospital and 1-year mortality of patients who develop worsening renal function following acute ST-elevation myocardial infarction. Am Heart J 150: 330–337 10. Cao Z, Cooper ME (2001) Role of angiotensin II in tubulointerstitial injury. Semin Nephrol 21: 554–562 11. Hillege HL, Nitsch D, Pfeffer MA, et al (2006) Renal function as a predictor of outcome in a broad spectrum of patients with heart failure. Circulation 113: 671–678 12. Heywood JT, Fonarow GC, Costanzo MR, et al (2007) High prevalence of renal dysfunction and its impact on outcome in 118,465 patients hospitalized with acute decompensated heart failure: a report from the ADHERE database. J Card Fail 13: 422–430 13. Meyer TW, Hostetter TH (2007) Uremia. N Engl J Med 357: 1316–1325 14. Kelly KJ (2006) Acute renal failure: much more than a kidney disease. Semin Nephrol 26: 105–113 15. McCullough PA, Jurkovitz CT, Pergola PE, et al (2007) Independent components of chronic kidney disease as a cardiovascular risk state: results from the Kidney Early Evaluation Program (KEEP). Arch Intern Med 167: 1122–1129 16. Go AS, Chertow GM, Fan D, et al (2004) Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 351: 1296–1305 17. Gross ML, Ritz E (2008) Hypertrophy and fibrosis in the cardiomyopathy of uremia-beyond coronary heart disease. Semin Dial 21: 308–318 18. Remppis A, Ritz E (2008) Cardiac problems in the dialysis patient: beyond coronary disease. Semin Dial 21: 319–325 19.CunninghamPN,DyanovHM,ParkP,WangJ,NewellKA,QuiggRJ(2002)Acuterenal failure in endotoxemia is caused by TNF acting directly on TNF receptor-1 in kidney. J Immunol 168: 5817–5823 20. Kumar A, Paladugu B, Mensing J, et al (2007) Nitric oxide-dependent and -independent mechanisms are involved in TNF-alpha -induced depression of cardiac myocyte contractility. Am J Physiol Regul Integr Comp Physiol 292: R1900–1906 21. Parikh SV, de Lemos JA (2006) Biomarkers in cardiovascular disease: integrating pathophysiology into clinical practice. Am J Med Sci 332: 186–197 22. Carr SJ, Bavanandan S, Fentum B, et al (2005) Prognostic potential of brain natriuretic peptide (BNP) in predialysis chronic kidney disease patients. Clin Sci (Lond) 109: 75–82 23. Howie-Esquivel J, White M (2008) Biomarkers in acute cardiovascular disease. J Cardiovasc Nurs 23: 124–131 24. Needham DM, Shufelt KA, Tomlinson G, Scholey JW, Newton GE (2004) Troponin I and T levels in renal failure patients without acute coronary syndrome: a systematic review of the literature. Can J Cardiol 20: 1212–1218 25. Cameron SJ, Sokoll LJ, Laterza OF, Shah S, Greene GB (2007) A multi-marker approach for the prediction of adverse events in patients with acute coronary syndromes. Clin Chim Acta 376: 168–173 26. Sommerer C, Beimler J, Schwenger V, et al (2007) Cardiac biomarkers and survival in haemodialysis patients. Eur J Clin Invest 37: 350–356 27. Austin WJ, Bhalla V, Hernandez-Arce I, et al (2006) Correlation and prognostic utility of B-type natriuretic peptide and its amino-terminal fragment in patients with chronic kidney disease. Am J Clin Pathol 126: 506–512 28. Hickman PE, McGill DA, Talaulikar G, et al (2009) Prognostic efficacy of cardiac biomarkers for mortality in dialysis patients. Intern Med J 39: 812–818 29. Hayashi T, Obi Y, Kimura T, et al (2008) Cardiac troponin T predicts occult coronary artery stenosis in patients with chronic kidney disease at the start of renal replacement therapy. Nephrol Dial Transplant 23: 2936–2942 30. Codognotto M, Piccoli A, Zaninotto M, et al (2010) Effect of a dialysis session on the prognostic values of NT-proBNP, troponins, endothelial damage and inflammation biomarkers. J Nephrol 23: 465–471 31. Wang AY, Lam CW, Yu CM, et al (2007) N-terminal pro-brain natriuretic peptide: an independent risk predictor of cardiovascular congestion, mortality, and adverse cardiovascular outcomes in chronic peritoneal dialysis patients. J Am Soc Nephrol 18: 321–330 VII
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Annual Update in Intensive Care and
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The series Annual Update in Intensi
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VI Table of Contents IV Endotrachea
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VIII Table of Contents XI Periopera
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List of Contributors Abroug F Inten
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Cecconi M Department of General Int
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Garcia X Department of Critical Car
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Jog S Department of Intensive Care
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Murias G Intensive Care Unit Clinic
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Reuter DA Department of Anesthesiol
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Sobol J Department of Anesthesiolog
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Wunsch H Department of Anesthesiolo
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Section I 1 I Mechanisms of Sepsis
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4 M.A.D. van Zoelen, A. Achouiti, a
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10 M.A.D. van Zoelen, A. Achouiti,
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16 I The Endocannabinoid System: A
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18 C. Lehmann, V. Cerny, and M. Mat
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26 I Remote Ischemic Conditioning a
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28 P. Meybohm and B. Bein I Remote
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30 P. Meybohm and B. Bein I other i
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32 P. Meybohm and B. Bein I determi
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34 P. Meybohm and B. Bein I to enco
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36 P. Meybohm and B. Bein I 39. Wal
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38 S.N. Heyman, S. Rosen, and C. Ro
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Section II 49 II Coagulation System
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52 X. Delabranche, F. Toti, and F.
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62 II The Inflammatory Potential of
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64 C. Jennewein, N. Tran, and K. Za
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70 II Iron Deficiency in Critically
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72 N.Heming,P.Montravers,andS.Lasoc
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80 II Heparin-induced Thrombocytope
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82 Y. Sakr II increase the risk of
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84 Y. Sakr II Thrombotic Complicati
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86 Y. Sakr II used. The agglutinati
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88 Y. Sakr II In30%ofpatientswhoare
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90 Y. Sakr II The Challenge of Diag
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92 Y. Sakr II tures of heparin-indu
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Section III 95 III Acute Respirator
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98 N.J. Meyer and J.D. Christie III
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100 N.J. Meyer and J.D. Christie II
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110 F. Dachraoui, L. Ouanes-Besbes,
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118 I. Galvin and N.D. Ferguson III
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Rapid Sequence Intubation: Overview
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Pre-hospital Rapid Sequence Intubat
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ecommend its use in the setting of
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Table 1. Hypnotic agents Agent Dose
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Conclusion Rapid sequence intubatio
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Alterations in Oral Microbial Ecolo
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pharynx is deemed to play an import
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Table 1. The BRUSHED Assessment Mod
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Research Priorities in Oral Care fo
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Conclusion Research Priorities in O
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Research Priorities in Oral Care fo
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Pros and Cons of Assisted Mechanica
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NoisyPSVhasanadvantageoverotherassi
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improvement in lung elastance, with
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controlled mechanical ventilation [
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References Pros and Cons of Assiste
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Can ’Permissive’ Hypercapnia Mo
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However, concerns persist, particul
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NAVA: Why, When, Who? 189 Restricte
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Table 1. Summary of recent human ph
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Essentially, neural (EAdi) monitori
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NAVA: Why, When, Who? 195 16. Girar
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Therapeutic Aerosols in Mechanicall
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a) Jet nebulizer b) Ultrasonic nebu
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References Therapeutic Aerosols in
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Section VI 207 VI Cardiac Crises VI
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210 S. Scolletta, B. Biagioli, and
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Page 233 and 234: 218 S. Scolletta, B. Biagioli, and
Page 235 and 236: 220 VI Evolving Rationale for Minim
Page 237 and 238: 222 J.G. Wigginton, A.H. Idris, and
Page 247 and 248: Hypoalbuminemia as a Risk Factor fo
Page 249 and 250: Microcirculation Possibly, at least
Page 257 and 258: Tubular Function Tubular concentrat
Page 259 and 260: injury, failure, need for renal rep
Page 261 and 262: Developing Biological Markers 247 a
Page 263 and 264: Conclusion The discovery of several
Page 265 and 266: Biomarkers of Acute Kidney Injury i
Page 267 and 268: and acute tubular necrosis is unpro
Page 269 and 270: utility (Breathing Not Properly stu
Page 271 and 272: NGAL, in various other complexes wi
Page 273 and 274: tantly, a positive association with
Page 275 and 276: References Biomarkers of Acute Kidn
Page 277 and 278: Cardio-renal Syndromes: A Complex S
Page 279 and 280: �� Cardio-renal Syndro
Page 281 and 282: Cardio-renal Syndromes: A Complex S
Page 283: Cardio-renal Syndromes: A Complex S
Page 287 and 288: Blood Purification in Sepsis and Ac
Page 299 and 300: The Lymphatic Vasculature as a Part
Page 301 and 302: FormationofLymph The Lymphatic Vasc
Page 309 and 310: The Interstitium and Lymphatics hav
Page 319 and 320: Fluid is a Drug that can be Overdos
Page 321 and 322: Table 1. Fluid overload and outcome
Page 323 and 324: Conclusion The studies discussed ab
Page 325 and 326: Crystalloid or Colloid Fluids: A Ma
Page 327 and 328: More Saline than Colloid Needed? Cr
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The Cyclic Effects of Mechanical Ve
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PracticalUseofPPVinPatientswithARDS
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Meaning of Pulse Pressure Variation
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References Meaning of Pulse Pressur
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Meaning of Pulse Pressure Variation
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however, an overall assessment of t
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Fig. 2. Varying response to stoke v
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Table 1. An example of a safety pro
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References The Fluid Challenge 339
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Facing the Challenge: A Rational St
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Section IX 353 IX The Microcirculat
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356 M.A. Puskarich and A.E. Jones I
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366 IX How Can We Use Tissue Carbon
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368 E. Futier, J.-L. Teboul, and B.
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376 X.Garcia,F.X.Guyette,andM.R.Pin
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378 X.Garcia,F.X.Guyette,andM.R.Pin
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380 IX The Microcirculation of the
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382 A.P.C. Top, R.C. Tasker, and C.
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384 A.P.C.Top,R.C.Tasker,andC.Ince
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Heart Rate as Prognostic Marker and
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Fig. 3. Effects of baseline heart r
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heart rate 140 120 100 80 60 40 20
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in conjunction with cardiogenic sho
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Table 1. Summary of different hemod
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Hemodynamic Monitoring in Cardiogen
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variations of the left sided time-v
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Non-Invasive Estimation of Left Ven
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Fig. 1. Original theory by Otto Fra
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Hemodynamics from the Periphery 427
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Totally Non-invasive Continuous Car
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There are some limitations to the u
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Cardiac Output Monitoring: An Integ
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occurring signal variation with dif
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Table 2. (continued) Additional var
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Fig. 2. Integrative concept for the
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Section XI 457 XI Perioperative Med
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460 N. Brienza, L. Dalfino, and M.T
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472 S.G. De Hert and P.F. Wouters X
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A New Approach to Ventilator-associ
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Underlying Diseases A New Approach
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organisms in acute respiratory infe
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Selective Decontamination of the Di
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SDD/SOD and Antibiotic Resistance A
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study the effects of SDD and SOD on
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Selective Decontamination of the Di
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New Treatment Options against Gram-
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Table 1. Classification schemes for
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are currently no antibacterials in
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activity of BAL 30376 against vario
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Panipenem/betamipron New Treatment
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References New Treatment Options ag
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The ‘Bug’ In order to ensure ou
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tum [38].Allthreecompoundsarefungic
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Antifungal Therapy in The ICU: The
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Renal Dysfunction Antifungal Therap
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For fusariosis, voriconazole, posac
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Mycobacterial Sepsis and Multiorgan
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Other Systems Seeding of every orga
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mediuminthepresenceandabsenceofanti
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Table 1. Suggested treatment regime
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Pentraxin 3 (PTX3): Possible Role i
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patients, anti-PTX3 antibodies are
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Fig. 2. Pentraxin 3 (PTX3) in septi
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Pentraxin3(PTX3):PossibleRoleinCrit
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The Role of IgM- and IgA-enriched I
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Spontaneous Bacterial Peritonitis i
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of the splanchnic sympathetic nervo
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concomitant malignancy or traumatic
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These criteria seem to be very sens
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Prognosis When SBP was initially de
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significant effect on the probabili
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Fig. 1. The ‘critical mass’ con
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Acute-on-chronic Liver Failure: An
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Fig. 4. Representative scheme of th
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Survival benefit with MARS in patie
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Section XIV 589 XIV Trauma and Emer
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XIV 592 J.E. Hollander and A.M. Cha
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XIV 600 C. Hommers and J. Nolan sys
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XIV 602 C. Hommers and J. Nolan 97-
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XIV 604 C. Hommers and J. Nolan exp
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XIV 606 C. Hommers and J. Nolan per
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XIV 608 C. Hommers and J. Nolan 4.
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XIV 610 C. Hommers and J. Nolan 49.
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XIV 612 H. Schoechl, W. Voelckel, a
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XIV 620 H.Schoechl,W.Voelckel,andC.
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Section XV 629 XV Neurological Aspe
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632 S. Legriel, F. Pico, and E. Azo
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654 XV Prediction of Neurological O
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656 C. Sandroni, F. Cavallaro, and
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664 XV Neuroprotection in Sepsis by
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666 F. Esen XV leading to further n
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668 F. Esen XV can activate complem
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670 F. Esen XV tested the neuroprot
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672 F. Esen XV In sepsis, the use o
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674 F. Esen XV 41. Mocco J, Mack WJ
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676 A. Demertzi, S. Laureys, and M.
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Metformin and Lactic Acidosis S. Ve
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note, lactic acidosis may develop e
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unexplained lactic acidosis and hav
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17 ± 5 mmol/l. In one fatal case,
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Metformin and Lactic Acidosis 693 2
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Determination of Energy Goals Indir
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acy rates (defined as < 15 % error
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Energy Goals in the Critically Ill
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ing. Hence, while a brief period of
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lipogenesis, hepatic steatosis, inc
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educed metabolic demands of adipose
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Energy Goals in the Critically Ill
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Frailty: A New Conceptual Framework
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Although the concept of frailty has
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tion in the development of acquired
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digm that includes those processes
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Frailty: A New Conceptual Framework
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In the last decade, the UK reduced
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Access Block and Emergency Departme
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Potential Solutions Access Block an
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Access Block and Emergency Departme
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Triage of High-risk Surgical Patien
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is another system calculated from s
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ICU Admission Guidelines Triage of
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Transportation of the Critically Il
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sum of several smaller - seemingly
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shown that intra-hospital transport
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is stationary, the external ventric
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Should We Still Order Chest X-rays
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Table 1. Item wording of the Delphi
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on-demand approach, such as increas
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Fig. 2. Assessment of intragastricp
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Fig. 4. Assessment of lung sliding
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Conclusion We have convincingly sho
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Should We Still Order Chest X-rays
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tor cells of rods (low-level light)
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Box 1. Examples of immune effects a
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The Effect of Light on Critical Ill
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Box 2. Some beneficial health effec
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still many nebulous aspects, and wi
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Context Information in Critical Car
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Fig. 2. Alternative medical problem
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of intensivist specialty expertise
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Fig. 3. XML file for context inform
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Context Information in Critical Car
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Ambient Intelligence in the Intensi
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cognitive networks, likely without
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Conclusion The application of rules
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Simulation in Critical Care Medicin
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Engineering a Better Simulation Exp
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skills development before any patie
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decade has to be about reaching out
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seriously we take the safety of our
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Intensive Care Medicine: Where We A
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direction and orientation of a prim
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Subject Index Abdominal compartment
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C-reactive protein (CRP) 57, 268, 5
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Information 781 Injury severity sco
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Phenytoin 648 Phorbol myristate ace
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Vagal activity 398 - stimulation 74
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