The Field Of Critical Care

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The field of critical care is rapidly changing. It is important for anesthesiologists be knowledgeable of these changes for providing care to critically ill patients in the perioperative period. The purpose of this chapter is to provide update for clinicians on ICU issues relevant to clinical practice. Topics which will be discussed include: modes of mechanical ventilation, renal replacement therapy, antibiotic prophylaxis, nutritional support, sedation management, transport and transfer of care.
I. Modes of Mechanical Ventilation
Most patients undergoing general anesthesia for surgical procedures require mechanical ventilation. One of the biggest challenges facing clinicians providing mechanical ventilatory support today is managing the balance between providing adequate gas exchange and avoiding lung injury associated with positive pressure ventilation. Patients with respiratory failure need adequate tissue oxygenation and acid-base balance; however, the lungs are fragile structures that can be injured by over-distension, alveolar collapse and reopening, and high oxygen exposure. This challenge in providing “lung protective ventilation” is made more difficult by the fact that lung injury is often heterogeneous and thus what may benefit gas exchange in one region (e.g., higher pressure) may worsen injury in another.
Modern anesthesia ventilators are becoming increasingly sophisticated provide high performances in delivering accurately and
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