Editor
Mohan Gurjar MD PDCC FICCM
Additional Professor Department of Critical Care Medicine Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)
Lucknow, Uttar Pradesh, India
Forewords
Arvind Kumar Baronia
Jean-Louis Vincent
fm7Contributors
fm13Foreword
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Textbook of Ventilation, Fluids, Electrolytes and Blood Gases
First Edition: 2020
9789389188059
Printed at
fm6Dedicated to
Teachers who carry lamp of knowledge and spread it through their fellows to serve humanity
- A Sachdeva MBBS
- Director, Interventional Pulmonology
- Division of Pulmonary, Critical Care and Sleep Medicine
- University of Maryland School of Medicine
- Baltimore, MD, USA
- Aaron Lim MD
- Assistant Professor
- Department of Anesthesiology
- Virginia Commonwealth University Health System
- Richmond, Virginia, USA
- Abdul Wahab MD
- Resident Physician/Research Collaborator
- Department of Internal Medicine
- Unity Hospital
- Rochester, NY, USA
- METRIC Research Group
- Department of Pulmonary and Critical Care Medicine
- Mayo Clinic, Rochester, MN, USA
- Abhay Vakil MD
- Assistant Professor
- Department of Pulmonary Critical Care Medicine
- Corpus Christi Medical Center
- Corpus Christi, TX, USA
- Addy Yh Tan MBBS (S'pore) MMed Anesthesiology (S'pore) EDIC
- Senior Consultant and Assistant Professor
- Department of Anesthesia
- National University Health System
- Singapore
- Afzal Azim MD PDCC FICCM
- Professor
- Department of Critical Care Medicine
- Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS)
- Lucknow, Uttar Pradesh, India
- Alan D Kaye MD PhD
- Professor, Program Director, and Chairman
- Department of Anesthesiology
- The Louisiana State University Health Sciences Center
- New Orleans, LA, USA
- Professor, Department of Pharmacology
- The Louisiana State University Health Sciences Center
- New Orleans, Louisiana, LA, USA
- Albert Phan Nguyen MD
- Assistant Professor
- Department of Anesthesiology
- University of California San Diego
- San Diego, California, USA
- Alex Yartsev MBBS BApp Sci (MRS) FCICM
- Staff Specialist (Intensive Care Medicine)
- Department of Intensive Care
- Westmead Hospital
- Sydney, New South Wales, Australia
- András Lovas MD PhD EDIC EDAIC
- Consultant
- Department of Anesthesiology and Intensive Therapy
- Faculty of Medicine
- University of Szeged
- Szeged, Hungary
- Andrew Davenport MD FRCP
- Consultant Nephrologist and Professor of Dialysis and
- ICU Nephrology
- UCL Centre for Nephrology
- The Royal Free London NHS Foundation Trust
- London, NW3 2QG, UK
- Anjali Agarwal MBBS
- Research Trainee
- Department of Critical Care Medicine
- Mayo Clinic
- Florida, USA
- Antonio M Esquinas MD PhD FCCP
- International Fellow
- American Association for Respiratory Care
- Intensive Care Unit
- Hospital General Universitario Morales Meseguer
- Murcia, Spain
- Anumeha Bhagat MD DNB FAIMER Fellow
- Associate Professor and MEU Faculty
- Department of Physiology
- Government Medical College and Hospital
- Armin Ahmed MD PDCC
- Assistant Professor
- Department of Critical Care Medicine
- King George Medical University
- Lucknow, Uttar Pradesh, India
- Audrey De Jong MD PhD
- Associate Professor
- Department of Anesthesiology and Intensive Care
- Saint Eloi Teaching Hospital
- Centre Hospitalier Universitaire Montpellier
- Montpellier, France
- Banwari Agarwal MBBS MD FRCA FRCP EDIC FFICM
- Consultant (Critical Care Medicine) and Associate Professor
- Department of Intensive Care Unit
- The Royal Free London NHS Foundation Trust
- London, NW3 2QG, UK
- Bethany Menard MD
- Assistant Professor
- Department of Anesthesiology
- The Louisiana State University Health Sciences Center
- New Orleans, Louisiana, LA, USA
- Bhuvana Krishna MD IDCCM IFCCM
- Professor and Head
- Department of Critical Care Medicine
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Bogdan Tiru MD
- Assistant Professor of Medicine
- Tufts University School of Medicine
- Co-Director Medical ICU
- Division of Pulmonary and Critical Care Medicine
- Baystate Medical Center
- Springfield, MA, USA
- Bryan Anderson DO
- Clinical Fellow
- Department of Pulmonary Critical Care Medicine
- Corpus Christi Medical Center
- Corpus Christi, TX, USA
- Char Ogborn PhD
- Research Project Coordinator
- Department of Pediatrics
- McLane Children's Hospital
- Baylor Scott and White
- Texas A & M University
- Temple, Texas, USA
- Cody M Koress MD
- Research Associate and Senior Medical Student
- Department of Anesthesiology
- The Louisiana State University Health Sciences Center
- New Orleans, Louisiana, LA, USA
- Daniel Arellano Sepúlveda MSc
- Adjunct Professor
- Critical Care Unit
- Hospital Clínico Universidad de Chile
- Santiago of Chile
- Department of Physical Therapy
- Faculty of Medicine
- University of Chile
- Santiago, Chile
- Devang Sanghavi MBBS MD
- Senior Associate Consultant
- Department of Critical Care Medicine
- Mayo Clinic
- Florida, USA
- Dharmendra Bhadauria MD DM
- Additional Professor
- Department of Nephrology and Renal Transplant
- Sanjay Gandhi Postgraduate Institute of Medical Sciences
- Lucknow, Uttar Pradesh, India
- Dharshan Rangaswamy MD DM
- Associate Professor
- Department of Nephrology
- Kasturba Hospital and Medical College
- Manipal Academy of Higher Education
- Manipal, Karnataka, India
- Diego Luis Carrillo-Pérez MD
- Clinical Assistant Professor
- Department of Internal Medicine
- Instituto Nacional de Ciencias Médicas y Nutrición
- Salvador Zubirán
- Mexico City, Mexico
- Elena Spinelli MD
- Staff Physician
- Maggiore Policlinico Hospital
- Milan, Italy
- Department of Anesthesia, Critical Care and Emergency
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico
- Ewan C Goligher MD PhD
- Assistant Professor of Medicine
- Interdepartmental Division of Critical Care Medicine
- University of Toronto
- Scientist, Toronto General Hospital Research Institute
- Critical Care Medicine
- University Health Network
- Toronto General Hospital
- Toronto, Canada
- Fabrice Galia PhD
- Engineer
- Department of Anesthesiology and Intensive Care
- Saint Eloi Teaching Hospital
- Centre Hospitalier Universitaire Montpellier
- Montpellier, France
- Gerardo Gamba MD PhD
- Professor and Director of Research
- Instituto Nacional de Ciencias Médicas y Nutrición
- Salvador Zubirán
- Head, Molecular Physiology Unit
- Instituto de Investigaciones Biomédicas
- Universidad Nacional Autónoma de México
- Mexico City, Mexico
- Harsh Vardhan MD DM
- Associate Professor
- Department of Nephrology and Renal Transplant
- Indira Gandhi Institute of Medical Sciences
- Patna, Bihar, India
- Ivan Ramírez Venegas RT
- Kinesiólogo (Physical Therapist)
- Division of Critical Care Medicine
- Hospital Clinico Universidad de Chile, Santiago
- Faculty of Health Sciences
- Universidad de Los Andes
- Santiago, Chile
- Jacob George Pulinilkunnathil MD IDCCM EDIC FCCP
- Senior Resident
- Department of Anesthesia, Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Jan Van der Mullen MD
- Registrar Emergency Medicine
- Department of Emergency Medicine
- University Hospitals of Leuven
- Leuven, Belgium
- Jeroen Tahon MD
- Resident Internal Medicine
- Department of Intensive Care Medicine
- Ziekenhuis Netwerk Antwerpen Campus Stuivenberg
- Antwerp, Belgium
- John Botha
- MBChB MMed FCP (SA) FRACP FCICM Dip Neph (London) PG Dip Echo
- Director
- Department of Intensive Care Medicine
- Frankston Hospital
- Frankston, Victoria, Australia
- JV Divatia MD FICCM FCCM
- Professor and Head
- Department of Anesthesia, Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Past-President
- Indian Society of Critical Care Medicine
- Kapil Dev Soni MD
- Associate Professor
- Critical and Intensive Care
- JPN Apex Trauma Centre
- All India Institute of Medical Sciences
- New Delhi, India
- Kirtivardhan Vashistha MBBS
- Research Scholar
- Department of Infectious Disease
- Mayo Clinic, Rochester
- METRIC Research Team
- Mayo Clinic
- Rochester, MN, USA
- Louis Anzalone MD
- Resident Physician
- Department of Anesthesiology
- University of Pennsylvania
- Philadelphia, PA, USA
- Malvika Sagar MD FAAP
- Assistant Professor
- Department of Pediatrics
- McLane Children's Hospital
- Baylor Scott and White
- Texas A & M University
- Manu Malbrain MD PhD
- Head
- Department of Critical Care Medicine
- University Hospital Brussels (UZB)
- Brussels, Belgium
- Marco Albanese MD
- Resident
- Department of Anesthesia, Critical Care and Emergency
- Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico
- Milan, Italy
- Mark R Jones MD
- Senior Resident
- Department of Anesthesia, Critical Care and Pain Medicine
- Beth Israel Deaconess Medical Center
- Harvard Medical School
- Boston, MA, USA
- Mark W Motejunas MD
- Resident Physician
- Department of Anesthesiology
- The Louisiana State University Health Sciences Center
- New Orleans, Louisiana, LA, USA
- MG Allison MD
- Assistant Director, ICU
- Critical Care Medicine
- Saint Agnes Hospital Center
- Baltimore, MD, USA
- Nadia Corcione MD
- Staff Physician
- Pulmonary Medicine
- Maggiore Policlinico Hospital
- Milan, Italy
- Department of Anesthesia, Critical Care and Emergency
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
- Milan, Italy
- Nasirul J Ekbal PhD MRCP FFICM
- Consultant in Intensive Care and Renal Medicine
- Department of Intensive Care Medicine and Nephrology
- The Royal Free London NHS Foundation Trust
- London, NW3 2QG, UK
- Niels Van Regenmortel MD
- ICU Director
- Department of Intensive Care Medicine
- Ziekenhuis Netwerk Antwerpen Campus Stuivenberg
- Antwerp, Belgium
- Nilanchal Chakraborty MD PDCC EDIC
- Clinical Fellow
- Department of Critical Care Medicine
- Sunnybrook Health Sciences Centre
- University of Toronto
- Toronto, Ontario, Canada
- Nirvik Pal MBBS MD
- Assistant Professor
- Division of Cardiothoracic Anesthesiology
- Department of Anesthesiology
- Virginia Commonwealth University
- Richmond, VA, USA
- O Kalchiem-Dekel MD
- Fellow, Pulmonary Diseases and Critical Care Medicine
- Division of Pulmonary, Critical Care, and Sleep Medicine
- University of Maryland School of Medicine
- Baltimore, MD, USA
- Paolo Pelosi MD FERS
- Full Professor
- Anesthesiology and Intensive Care Medicine
- Department of Surgical Sciences and Integrated Diagnostics (DISC)
- San Martino Policlinico Hospital, IRCCS for Oncology and
- Neurosciences
- University of Genoa
- Genoa, Italy
- Patricia A Nicolato DO
- Assistant Professor
- Director of ECMO Program
- Division of Cardiothoracic Surgery
- Department of Surgery
- Virginia Commonwealth University
- Richmond, VA, USA
- Patricia RM Rocco MD PhD
- Full Professor
- Head, Laboratory of Pulmonary Investigation
- Carlos Chagas Filho Institute of Biophysics
- Federal University of Rio de Janeiro
- Rio de Janeiro, Brazil
- Pedro Leme Silva PhD
- Associate Professor of Physiology
- Laboratory of Pulmonary Investigation
- Carlos Chagas Filho Institute of Biophysics
- Federal University of Rio de Janeiro
- Pramod K Guru MBBS MD FASN
- Assistant Professor of Medicine
- Director, Adult ECMO Practice and Medical ICU
- Department of Critical Care Medicine
- Mayo Clinic
- Florida, USA
- Pranav Jetley MD DESA
- Clinical Fellow (Anesthesiology)
- West Middlesex University Hospital
- Chelsea and Westminster Hospital NHS Trust
- London, UK
- Rahul Kashyap MBBS MBA
- Assistant Professor
- Department of Anesthesiology and Perioperative Medicine
- Mayo Clinic, Rochester
- METRIC Research Team
- Mayo Clinic
- Rochester, MN, USA
- Rahul Nanchal MD MS
- Professor of Medicine
- Director, Medical Intensive Care Unit
- Director, Critical Care Fellowship Program
- Medical College of Wisconsin
- Milwaukee, WI, USA
- Ram Baalachandran MD
- Fellow Physician
- Division of Pulmonary and Critical Care
- University of Maryland
- Baltimore, Maryland, USA
- Ravindranath Tiruvoipati MBBS MS FRCSEd MCh MSc FCICM EDIC
- Director of Intensive Care Research
- Department of Intensive Care Medicine
- Frankston Hospital
- Frankston, Victoria, Australia
- Renata de Souza Mendes MD PhD
- Nephrologist
- Federal University of Rio de Janeiro
- Post-doc Laboratory of Pulmonary Investigation
- Carlos Chagas Filho Institute of Biophysics
- Federal University of Rio de Janeiro
- Rio de Janeiro, Brazil
- Robert Wise MBChB MMed FCA Cert Crit Care
- Clinical Fellow
- Discipline of Anesthesia and Critical Care
- Nelson Mandela School of Medicine
- University of KwaZulu-Natal
- Durban, South Africa
- Roop Kishen MBBS DA MD FRCA
- Consultant in Intensive Care Medicine and Anesthesia (Retd)
- Hope Hospital, Salford Royal NHS Foundation Trust
- Manchester, UK
- Honorary Lecture (Retd)
- Anesthesia, Translational Medicine and Clinical Neurosciences
- Victoria University of Manchester
- Manchester, UK
- Sai Saran PV MD DM IDCCM EDIC
- Assistant Professor
- Department of Critical Care Medicine
- Cancer Superspeciality Institute and Hospital
- Lucknow, Uttar Pradesh, India
- Salim Surani MD
- Adjunct Clinical Professor of Medicine
- Division of Pulmonary, Critical Care and Sleep Medicine
- Texas A&M University, Health Science Center
- Program Director, Pulmonary and Critical Care Fellowship Program
- Bay Area Medical Center
- Corpus Christi, TX, USA
- Samir Jaber MD PhD
- University Professor and Head
- Department of Anesthesiology and Intensive Care
- Saint Eloi Teaching Hospital
- Centre Hospitalier Universitaire Montpellier
- Montpellier, France
- Samir Samal MD IDCC
- Assistant Professor
- Department of Critical Care Medicine
- Institute of Medical Sciences and SUM Hospital
- Bhubaneswar, Odisha, India
- Sarah L Wachter MD
- Clinical Instructor in Anesthesiology
- R Adams Cowley Shock Trauma Center
- University of Maryland
- Baltimore, MD, USA
- Saurabh Saigal MD PDCC EDIC
- Associate Professor
- Critical Care Medicine
- All India Institute of Medical Sciences
- Bhopal, Madhya Pradesh, India
- Saurabh Vig MD DM
- Assistant Professor
- Department of Anesthesia
- Super Specialty Cancer Institute and Hospital
- Shakti Bedanta Mishra MD DM
- Associate Professor
- Department of Critical Care Medicine
- Institute of Medical Sciences and SUM Hospital
- Bhubaneswar, Odisha, India
- Shalini Donthi MD
- Research Trainee
- METRIC Research Group
- Department of Pulmonary and Critical Care Medicine
- Mayo Clinic
- Rochester, MN, USA
- Shekhar Ghamande MD FCCP FAASM
- Clinical Associate Professor
- Department of Internal Medicine
- Division of Pulmonary and Critical Care
- Baylor Scott and White
- Texas A & M University
- Temple, Texas, USA
- Snigdha Ipsita MD
- Senior Resident
- Department of Critical Care Medicine
- Institute of Medical Sciences and SUM Hospital
- Bhubaneswar, Odisha, India
- Sriram Sampath MD
- Professor
- Department of Critical Care Medicine
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Tom Carmeliet MD
- Cardiology Resident
- Department of Intensive Care (Cardiology)
- University Hospital Brussels (UZB)
- Brussels, Belgium
- Tom Schepens MD PhD
- PICU Staff Physician
- Department of Critical Care Medicine
- Antwerp University Hospital
- Antwerp, Belgium
- Tommaso Mauri MD
- Assistant Professor
- Department of Anesthesia, Critical Care and Emergency
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico
- Milan, Italy
- Department of Pathophysiology and Transplantation
- University of Milan
- Milan, Italy
- Ulrich H Schmidt MD PhD MBA
- Clinical Professor of Anesthesiology
- Vice Chair Critical Care Medicine
- Department of Anesthesiology
- University of California San Diego
- San Diego, California, USA
- Yugan Mudaliar
- MBChB FCP (SA) FANZCA FRACP FCICM ACPSEM AIP (Aus) IOP (UK)
- Clinical Associate Professor
- Senior Staff Specialist
- Department of Intensive Care
- Westmead Hospital
- Sydney, New South Wales, Australia
- Zbigniew Szkulmowski MD
- Specialist in Anesthesiology and Intensive Care
- Clinical Unit of Anesthesiology and Intensive Care
- University Hospital No. 1 in Bydgoszcz
- Collegium Medicum in Bydgoszcz
- Nicolaus Copernicus University in Toru ń
- Bydgoszcz, Poland
- Zsolt Molnár MD PhD EDAIC
- Head
- Department of Anesthesiology and Intensive Therapy
- Faculty of Medicine
- University of Szeged
- Szeged, Hungary
Foundation of the globally expanding specialty of Critical Care Medicine is constructed by the basic elements like ventilation, fluids, electrolytes, and blood gas. The Textbook of Ventilation, Fluids, Electrolytes and Blood Gases deals with these fundamental subjects in a very creative and enthusiastic manner. The intricately linked information flows seamlessly from one chapter to the other. The composition of the first edition of the book shall take its place as one of the most comprehensive textbooks on the basic clinical management practices of intensive care units (ICUs) and reminds me that in the era of digital information, the printed textbooks are still extremely valuable to the students and practitioners in the field of medicine.
Dr Mohan Gurjar has done a commendable job by maintaining the uniformity in the content and style of all the chapters. The book lays more emphasis on information than on existing guidelines. Keeping in the mind that the chapters of this book are written by outstanding specialist practitioners and researchers who are also internationally acclaimed authors from around the world including UK, European Union, Australia, and North America, this book comprehensively addresses pertinent clinical challenges in each chapter and provides a balanced view where differences do exist.
The book has an international standard character and, therefore, it is expected to serve immensely to the students, residents, fellows, and attending physicians who cover the ICUs or emergency medicine wards across the world. Having said that, I believe the book is getting introduced at a very crucial time in the developing countries like India, where the younger generation of intensivists includes an ever-increasing number of doctors who had only recently started enjoying fully structured training program with clinical rotations, courses, and well-designed exit examinations conducted under the watchful eyes of the medical regulatory boards and councils.
Arvind Kumar Baronia MD
Professor and Head
Department of Critical Care Medicine
Sanjay Gandhi Postgraduate Institute of Medical Sciences
fm15Foreword
I am delighted to have been asked to write the foreword for Textbook of Ventilation, Fluids, Electrolytes and Blood Gases, edited by Dr Mohan Gurjar. The topics covered in this comprehensive book are important not only in critical care medicine, but also for all specialists taking care of acutely ill patients. The book is divided into three key sections—“Ventilation”, “Fluids and Electrolytes”, and “Blood Gases”. Each section starts with chapters covering the essential physiology and pathophysiology of the field and then includes chapters on relevant practical considerations and subjects. Each chapter is clearly laid out, easy to read and understand, and supported by adequate and appropriate illustrations. A list of “salient points” at the end of each chapter provides a useful summary of the key points of each chapter. In a small fourth section “Miscellaneous”, chapters are included on other important associated issues, notably nutrition, transfusion, and organ donation. The textbook chapters are written by an international group of authors providing a wealth of experience and knowledge from around the world.
Textbooks provide an abundance of information in one easy-to-reference volume. As medicine advances, so new, up-to-date books such as this are needed to provide the very latest evidence and guidance. I am sure that this book will be of value both to medical students and to practicing clinicians, and congratulate Dr Mohan Gurjar on his excellent effort.
Jean-Louis Vincent MD PhD
Professor
Department of Intensive Care Medicine
Université Libre de Bruxelles
Bruxelles, Belgium
Consultant, Department of Intensive Care
Erasme University Hospital
fm17Preface
In managing critically ill patients, the understanding of pathophysiological abnormalities, monitoring of clinical variables, and timely intervention makes an impact on patient outcome. The Textbook of Ventilation, Fluids, Electrolytes and Blood Gases encompasses essential topics for which thorough education and training is a must for any clinician who manages these patients. This concept makes it a unique book, in a sense that readers will not need to go through various books or sources, despite easily available information on individual topic in current era.
This book has four sections, each for ventilation, fluids and electrolytes, blood gases, and miscellaneous. Each section starts with applied physiology and then covers routine as well as advance topics related to ventilation, fluids, and electrolytes in critically ill adult patients. Miscellaneous section covers enteral and parenteral nutrition, immunonutrition, blood product transfusion, and care of potential organ donor in the intensive care unit (ICU). Also, there are chapters based on common problems like approach to the patient having hypoxemia, hypercapnia, hypovolemia, electrolyte abnormalities, and acid–base disturbances. These chapters start with a case scenario, then structured description of the problem, and in the last again discussion about the index case, which makes better understanding of commonly encountered problems in critically ill patients.
The splendid chapters are written by experts from across the world, with their vast experience and knowledge. In the background of rapid changes in evidences in medicine and the advancement of technology, all authors tried their best to keep the content of the chapter up-to-date and as practical as possible. For better clarity on given topics, appropriate Figures, Tables, and Flowcharts have been used throughout the chapters. At the end of each chapter, there are a few salient points to emphasis on the important area of that particular topic.
I hope that the book will be useful for trainees as well as consultants of various clinical specialties who manage critically ill adult patients, including critical care medicine, emergency medicine, pulmonary medicine, and anesthesiology.
fm19Acknowledgments
The concept of having Textbook of Ventilation, Fluids, Electrolytes and Blood Gases is the result of feedback from trainees in critical care medicine about the need of such a book, which covers ventilation, fluids, electrolytes, and blood gases; as these topics are backbone in managing any critically ill patient.
I am very much thankful for supports from Professor Arvind Kumar Baronia (India), Dr Chithambaram Veerappan (United Kingdom), Dr Nirvik Pal (USA), Dr Vishal Kant Tiwari (USA), and Dr Tommaso Mauri (Italy) on various aspects during this project.
I am indebted to all contributors from various institutes across the world, without their contribution, the book was not possible. They kept patience with me while making changes in the chapter for improvement.
I would like to sincerely thank to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India and the production team members, especially Ms Chetna Malhotra Vohra (Associate Director—Content Strategy) and Dr Savleen Kaur (Development Editor), for their efforts to make the book in present form.
Throughout this project, I received much needed moral support from my colleagues, friends, staffs and students of my department, and Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
I owe for blessings from my parents, Dr Ganga Bishan Gurjar and Dr Gulab Gurjar, and also best wishes from my sister Divya Kasana.