ISCCM Manual of RRT and ECMO in ICU: A Reference Book for Practicing Intensivists Poonam Malhotra Kapoor, Rajesh Chandra Mishra, Kanwalpreet Sodhi, KC Prakash
INDEX
Page numbers followed by b refer to box, f refer to figure, fc refer to flowchart, and t refer to table
A
Abdominal compartment syndrome 186
Acid-base 83
abnormalities 114
balance 95
restoration of 86
status 96, 108, 109
Acidemia 36
metabolic 67
Acidosis 40, 369
metabolic 19, 41, 152
Aconite 363
Acrylonitrile, copolymer of 176
Activated clotting time 63, 74, 261, 266, 268-271, 276, 313, 318, 357
Activated coagulation time 276, 412, 414
Activated partial thromboplastin time 63, 69, 72, 74, 75, 200, 267-269, 271, 277, 312, 375, 412
Acute cardiac arrest 342
Acute clot 320
formation 320
Acute coronary syndrome 233
Acute kidney injury 2, 3, 7, 12, 19, 27, 36, 39, 40, 45, 47, 83, 93, 104, 114, 119, 121, 133, 135, 136, 166, 180, 182, 182b, 203, 368
causes of 16, 39
classification of 14, 180
determination 369
etiology of 14, 15t
hospital-acquired 16
incidence of 12
male-female ratio of 13
management of 14
network 136
septic 111
treatment of 36
Acute renal failure 19, 90, 92, 113
causes of 14
trials network 53, 70, 107
study 14
Acute respiratory distress syndrome 1, 90, 108, 208, 256, 310, 316, 333, 407, 409
Acyclovir 137
Additives 71
Adenosine
diphosphate 265
triphosphate 309
Adjuvant therapy 171, 175
for sepsis 169, 170f
indication of 174f
patient selection for 173b
Adsorbents
biocompatibility of 160
natural 159
synthetic 159
types of 159
utilization of 160
Adult capillary leak syndrome 316
Advisory alarms 101
Air
detection alarm 148
causes 148
troubleshooting 149
embolism 258, 339, 355, 358, 376, 380
thromboembolism 355
Airway 358
Akin classification 12
Alarm 143
sensors 141f
systems 101
Albumin 165, 188
serum 120
Alcohols 115
Aldosterone levels 112
Alkalemia, metabolic 79
Alkalosis, metabolic 79
Alpha-1-acid glycoprotein 131
Aluminum
phosphate poisoning 366
phosphide 1, 363, 366
poisoning, management of acute severe 360
American Association of Blood Banks 310
Transfusion Guidelines 310
American Heart Association 342
Guidelines 350
American Society for Parenteral and Enteral Nutrition 389
Amikacin 138
Amino acids 122, 183
essential 88
nonessential 88
Aminocaproic acid 269
Aminoglycosides 126, 131, 133-135
Aminophylline 157
Amnesia 304
Amphotericin B 130, 132
Ampicillin 137
Analgesia 302, 303
Anaphylaxis, acute 233
Anesthesia
general 152
local 152
Anesthetists, cardiac 3
Aneurysm 339
Angiotensin
converting enzyme 15
receptor blocker 15
Anion gap 97
Anthropometry 120
Antiarrhythmic agents 363
Antibiotic 37, 165
concentration-dependent 137
hydrophilic 126
lipophilic 126
prophylaxis 394
therapy
optimum 125
standard principles of 397
Anticoagulant 74t
agents 265
alternative 267
coated circuits 268
Anticoagulation 26, 63, 73, 98, 165, 176, 187, 339, 411
drugs 269t
heparin for 278fc
management 329
monitoring of 270
regional 77, 78, 80, 268
systemic 74, 77
type of 9
Anticonvulsants 157
Antiendotoxin neutralization therapy 170
Antiepileptics 363
Antifibrinolytics 269
Antifungals 132
Anti-inflammatory mediators 172
Antimalarial agents 363
Antimicrobial dosing, assessment of 125
Antimicrobial drug doses 137t, 138t
Antineutrophil cytoplasmic antibodies 166
Antiplatelet drugs 269
Antistreptolysin-O antibody 182
Antithrombin 266, 268, 269, 271
deficiency 75
III replacement, role of 266
Antithrombotic activity 276
Antivirals 132
Anuria 19
Anxiolysis 304
Aorta 198, 209
Aortic dissection 355
Aortic root 198, 209
Aprotinin 269, 271
Arachidonic acid 265
Argatroban 76, 267, 269
Arrhythmias 362
cardiac 258, 360
refractory 409
Arterial cannula 252f, 410, 239, 245, 411
Arterial pressure monitor 60
Arteriovenous carbon dioxide removal 331, 336, 337f
Arteriovenous system 334
Artery 210
axillary 202
drainage, pulmonary 356
femoral 198, 202, 209, 255, 257f, 317
pulmonary 97, 220
right femoral 208
subclavian 255f
Artificial kidney failure 140
common cause for 140
Aspiration pneumonia 407, 409
Atrial natriuretic peptide hormone 369
Atrial pressure, left 409
Atrium
left 416
right 198, 208, 218, 354, 416
Azithromycin 130
Azole antimycotics 132
Azotemia, prerenal 14
Aztreonam 137
B
Backflow cannula 346
Barbiturates 41, 157
Basal metabolic rate 213
Benzodiazepines 303, 304
Beta-blockers 183, 363
Beta-lactam 126, 130, 133
antibiotics 129
Bicarbonate 61, 62
buffer 25
Bilirubin 172
Bioelectrical impedance analysis 97
Bioimpedance vector analysis 97
Bispectral index 304
Bivalirudin 76, 267, 268t, 269, 280
Biventricular assist device 404
Bladder perforation 185
Blalock-Taussig shunt, modified 416
Bleeding 185, 201, 203, 318, 339, 355, 357, 380
bundle, role of 270
intracranial 207, 319
retroperitoneal 317
risk of 113
severe 355
uncontrolled 408
Blender 249, 250f
Blood 188, 329
ammonia level 89
conservation strategy 312
flow 49, 375
citrate complexes 79
gastrointestinal 386
low 334
measurement 283
rate 30, 50, 68, 99, 143, 187
turbulent 73
gas 106, 329
arterial 67, 69, 72, 285, 330
monitoring 284, 297
leak alarm 149
causes 149
troubleshooting 149
leak detector 59
loss 79
pressure 51, 220, 221, 234
priming 259
products 329
pump 142
rheological properties 166
rheology 147
stasis of 73
stream infections 393
transfusion 80, 309
restricted use of 231
trauma 258
urea nitrogen 96, 369
vessels 346
accidental puncture of 152
volume 242
intravascular 68
Body
mass index 120, 259
surface area 153, 259
weight, adjusted 390
Bone marrow transplantation 180
Bowel
ischemia 403
perforation 185
Brain 418
death 319
natriuretic peptide 97
Breathing 358
Brittle circulation 83
Bupropion 363
C
Calcium 62
acetate 183
carbonate 183
channel blockers 183, 363
free solutions 62
infusion 71
serum ionized 95
Calorie protein requirements 385
Canadian Critical Care Trial Group 311
Candida albicans 394
Cannula 329, 334
selection 251
size 248t, 251, 382, 411t
Cannulation 215, 251
complications of 258
sites 252
Carbamates 363
Carbamazepine 363
Carbapenems 134
Carbohydrate requirement 122
Carbon dioxide 206, 245, 331
partial pressure of 203
transfer 216
Carbon monoxide 363, 366
Cardiac arrest 199, 342, 358, 360
in-hospital 409
out-of-hospital 343, 347
refractory 234
witnessed 343
Cardiac disease 16
Cardiac failure
congestive 37
management of 353
Cardiac index 97, 415
Cardiac output 15, 283, 286, 415
adequate 183
Cardiac resynchronization therapy 327
Cardiac support, connections for 371
Cardiac trauma, isolated 233
Cardiomyopathy 409
nonischemic 199
sepsis induced 199
Cardiopulmonary bypass 37, 199, 218, 235, 275, 308, 353, 361, 408
after cardiac surgery 409
history of 180
Cardiopulmonary function 87
Cardiothoracic surgeon 228
Cardiotoxic drugs 362
Cardiotoxic toxins 363
Cardiovascular diseases 14, 17
Cardiovascular toxicity 362
Carotid artery 198, 202, 209
right superior 198, 209
Catabolism, prevention of 183
Catheter
blockage 153
dislodgement 339
insertion 338
site
bleeding 338
infection 338
troubleshooting 100
Cefepime 138
Ceftazidime 138
Ceftriaxone 130, 138
Cellular cascade 169
Cellulose 25
Celphos 1
Centers for Disease Control and Prevention criteria 396
Central cannulation
advantages of 410
disadvantages of 410
Central nervous system 158
Central venous pressure 97, 106
Centrifugal pump 207, 238, 241f, 242, 336f, 412
Cephalosporin 41, 135
Cerebral
cardiopulmonary resuscitation 343
edema 87
hypoxemia 208
hypoxia 202
near-infrared spectroscopy 289
perfusion pressure 113
Chelating agent 77
Chest
compressions 346
X-ray 207, 416f
Chloramphenicol 126
Chloride 62, 115
Chloroquine 363
Chromosomal disorder 408
Chronic circulatory support system 359
Cilley test 328
Ciprofloxacin 131, 138
Circuit 240
components 371
filter life 11
integrity 93
monitoring of 96
management 394
pressures 100
priming 260
suspected infection of 321
tubing rupture 355
Citrate 62, 94, 268
accumulation 79
management of 79
anticoagulation 95
protocol 64t
based solutions 61
infusion, rate of 78
regional anticoagulation 69
titration of 78
use
contraindication of 380
indication of 380
Clindamycin 126, 130
Clogging 147
causes 147
circuit 101
troubleshooting 147
Clot formation 339
Clotting 144, 147
circuit 101
tests 63
Coagulase-negative staphylococci 394
Coagulation
factors, removal of 165
system 265
test 412
Coagulopathy 318
acquired 339
device induced 321
dilutional 318
Cocaine 363
Colchicine 363
Colistin 53, 131, 134, 138
methanesulfonate 131
Colloidal dispersion 132
Commercial hemoperfusion adsorbents 159t
Communication unit 57
Compartmental syndrome 339, 403
Compensatory anti-inflammatory response syndrome 170, 171
Complete blood count 69, 72, 270
Complex phenomenon 137
Computed tomography 288
Confusion assessment method 305
Continuous ambulatory peritoneal dialysis 134, 153
Continuous peripheral capillary oxygen saturation 285
Continuous renal replacement therapy 2, 7, 14, 20, 29, 34, 36, 37, 42, 43, 47, 49, 56, 58t, 61t, 64t, 66, 67t, 69, 71t, 72, 73, 74t, 83, 84, 84t, 88, 89, 90, 92, 93, 95, 97, 97t, 102, 104-106, 111-116, 119, 125-127, 127t, 136, 140, 151, 170, 172, 184, 188, 368, 371, 372, 372f, 373, 373f, 375, 375, 375f, 376, 377f-379f, 381
basic components of 57f
circuit 371
duration of 381
goals 83, 86-89
implications of 380, 381t
indications for 369
line 376-378
machine 57, 57b
modality of 66t, 381
modes of 84
position of 382
prescription 188
process 57f
separate 374
termination of 104
types of 58t
Convective therapy 127
Conventional extracorporeal therapies 161
Cooler machine 242
Copper 123
Countercurrent flows 31f
Coupled plasma filtration adsorption 29, 160, 161, 169, 176
C-reactive protein 174, 182, 321, 390, 397
high sensitivity 69
Creatine phosphokinase 182
Creatinine 19, 85, 106, 150, 181
serum 180, 369
Critical care unit 29
Crystalloid 165
priming 259
solution 20
Cyanide 363
Cytokine 73, 169, 172
removal 41
storm 168, 171
Cytosorb technology 176
D
Dacron T-graft 200
Danaparoid 76
Danger-associated molecular pattern 171
D-dimer 273
Deaeration chamber 59
Decannulation 327, 329
Decarboxylation 206, 207
Deep vein thrombosis 252
Depression, cardiac 233
Desipramine 363
Desmopressin 269
Determine fluid balance 96
Device failure 339
Dexmedetomidine 303
Diabetes mellitus 155
Diabetic nephropathy 155
Dialysate
composition 51
flow 49
flow rate 30, 50, 187
kinds of 62t
type of 121
Dialysis
catheters 64t
circuit 140, 157
continuous 371
dose/adequacy 51
duration of 187
filter fiber's clotting 147
fluid 374
method of clearance during 84t
modalities 42t
solution, temperature of 62
technicians 3
Dialyzers 60, 187
types of 61t, 187, 187t
Diastolic dysfunction 325
Diazepam 25
Diethylenetriamine pentaacetic acid 182
Different arterial cannulation techniques 202t
Diffusion 20, 30f
Digitalis compounds 157
Digoxin 363
specific antibody fragments 364
Direct thrombin inhibitors 76, 267, 269, 280
Disconnection alarm 148
causes 148
troubleshooting 148
Disposable pressure transducers 283
Disseminated intravascular coagulation 15
Distal perfusion catheter 317
Diuretics 183
role of 104
Dopamine 363
Downstream resistance 242
Doxycycline 130
Drug 363
charge 127
dosing considerations 128, 135, 135t, 136
general principles 128
limitations 129
loading dose 128
maintenance dose 128
factors 126
lipophilic 157
molecule, size of 26
overdose/toxicity 233
protein 126
removal 127t
sequestration of 302
site-specific nephrotoxicity of 16f
toxicity 88
toxins 365
Dual-lumen cannula 222f, 247f
advantages of 205t
disadvantages of 205t
Dual-lumen jugular catheters 2
Dynamic outflow tract obstruction 325
Dysnatremia 40
E
Ebola virus disease, severe 177
Echinocandins 132
Echocardiography 182, 207, 285, 325, 326
transthoracic 357f
Edema
peripheral 51
pulmonary 40, 41, 112, 152, 203, 256, 356
Effluent bag 146
Ejection fraction 324
Electrical impedance tomography 297
Electrolyte 83, 88, 106, 181
balance 114
imbalance 9, 79, 369
management 183
testing 67
Electronic
intensive care unit 227
medical record 97
Embolism, pulmonary 233
Endogenous toxins, removal of 115
Endotoxin 172, 176
activity assay 173
effects of 171
filtration 176
removing 175, 176
Energy 389, 390
calculation of 389
doses of 390t
Enteral nutrition 88
route of 388
Enzymes 165
Ertapenem 53
Estimated glomerular filtration rate 136
Ethylene glycol 37, 41, 157
European Medicine Agency 136
European Resuscitation Council Guidelines 350
Excessive pump suction 206
Exogenous toxins, removal of 115
Extracorporeal carbon dioxide 333, 336
removal
characteristics of 334
mechanism of 334
system 333-335
Extracorporeal cardiopulmonary resuscitation 197, 233, 254, 308, 342, 345, 348-350, 368, 393, 407
Extracorporeal circuit 48, 140, 141, 172, 188, 268
Extracorporeal immunomodulation 67
Extracorporeal life support 1, 231, 238, 241, 266, 275, 276, 291, 292, 360, 361, 406
organization 226, 235, 283, 294, 304, 309, 319, 342, 360, 367, 407
guidelines 295, 385
registry 353
physiology of 212
system 342
Extracorporeal lung assist, pumpless 336, 337f
Extracorporeal membrane oxygenation 7, 67, 83, 195, 197, 202t, 209, 212, 218f, 223f, 226, 227, 229, 231, 233-235, 238, 240, 242, 251, 264, 265f, 270, 275, 276, 282, 286t, 287, 291, 294, 295, 297, 301, 302, 302fc, 305, 306, 308, 311-313, 316, 321, 324, 327fc, 330fc, 333, 345, 353-355, 358-361, 363, 368-372, 372f-374f, 377f-379f, 381, 382, 385, 393, 396, 397, 403, 406-409, 412, 414t, 415, 415t, 417, 417t, 418
arteriovenous 355
cannula size 375
cannulation 409
carbon dioxide removal 333
cardiac issues in 353
catheter insertion 247f
circuit 215, 238, 240, 260f, 370, 370f, 372, 373f, 375, 375f, 376, 377f, 380, 381t, 382, 388
component 217
independent of 374
physiology 218
pressure monitoring 283
priming of 259
complications of 3, 316, 355t
console 238, 243f
operator 346
contraindications of 355t
controversies of 381
coordinator 228
devices, portable 345
director 228
disposables 248f
flow 414
hybrid 197, 208, 208t, 209f
indications of 231, 282, 408
induced hypertension 321
initiation safety checklist 262
machine 238
management 224
neurological
complications of 319
monitoring during 288
oxygenation 223
pediatric 407t, 414, 419
physiology of 282
pumps, hydrodynamic characteristics of 242t
sedation algorithm 305fc
sepsis 3
setup, typical 337
specialist 228
support 212, 285
stages of 287t
system 239f
system monitoring 283, 284
team 226
components of 226
formation of 227f
mobile 229
therapy 306
titration of sedation in 304
transfusion therapy during 308
treatment of infections on 397
types of 197, 353, 354t, 370
ventilation strategies on 416
ventilator settings during 293fc
weaning 324
Extracorporeal therapy 2, 151, 158b, 168-170
future of 175
role of 3, 170f
Extracorporeal treatment 151
F
Feeding
enteral 121
gut 173
Femoral vein, left 208
Fibrinogen 270, 271, 273
Fibrosis, retroperitoneal 16
Fick's law 20
Filters 24, 25, 142
adsorption 24
and circuit parameters 100
biocompatibility 24
clotting 148
flux 24
pressure 142
drop 142
extremely positive 146
surface area 25
thickness 24
Filtration fraction 70, 102, 375
First-generation devices 404
Fistula, severe bronchopleural 232
Flow
control unit 59
sensor 240f
Fluconazole 138
Fluid
administration, predilution 94
balance 96
achieving 85
alarm 149
errors 99
negative 22
containing alkali 94
control unit 60
effluent 374
homeostasis 83
management 93, 100, 182
precision 94
prescription, stepwise 95
principles of 95
overload 19, 67, 369
removal 40, 49, 68, 88
transfusion, restricted use of 231
urea nitrogen 96
volume of 185
Fluoroquinolones 126, 131, 133, 137
Folate 123
Fontan procedure 417
Food and Drug Administration 136
Fraction inspired oxygen 203, 284
Fresh frozen plasma 278, 357
Furosemide 182
stress test 105
G
Gamma-aminobutyric acid 304
Gas exchange 219, 221, 292
catheter 337
pathophysiology of 292
Gastrointestinal complication 355
Gastrointestinal tract 318, 395
Gentamicin 135, 138
Gestational age 344
Glenn procedure, bidirectional 417
Glenn surgery, bidirectional 417, 418f
Glomerular
basement membrane 15
filtration rate 25, 183, 369
Glomerulonephritis
acute 16
chronic 155
infection-related 15
rapidly progressive 15, 166
Glucose 62, 391
Glycopeptides 126
Glycosaminoglycan 177
Glycosides, cardiac 363
Graft dysfunction, primary 400
Gram-negative bacteria 171, 175
Gram-positive bacteria 186
Guillain-Barré syndrome 165
H
Harlequin syndrome 202, 256, 357
Harris-Benedict's equation 389
Head
injury, acute 83
ultrasound 288
Heart 346
disease
congenital 199
ischemic 155
failure 87
acute decompensated 87
congestive 112
decompensated 112
right 199
rate 51
transplant 400, 401
Heat exchanger 238, 249, 249f, 355
malfunction 339
Heater machine 242
Heavy sedation 386
Hematoma 203, 339
retroperitoneal 258
Hemoconcentration 73
Hemodiafiltration 21, 170
continuous 371
arteriovenous 42
venoarterial 371
venovenous 20, 24, 24f, 27, 29, 34, 42, 57, 66, 72, 90, 125, 137t, 138, 371
Hemodialysis 20, 21f, 127, 151, 159, 184, 187, 271, 301
continuous
arteriovenous 42
venoarterial 371
venovenous 20, 29, 34, 42, 57, 61, 66, 89, 90, 125, 137t, 138, 371
conventional intermittent 47
intermittent 7, 14, 22, 33, 42, 43, 49, 106, 109, 114, 119, 126, 127, 127t, 132, 138, 186, 379
pediatric 187t
vascular catheters for 186t
urgent-start 151
Hemodynamic 173, 218, 221
compromise 199
criteria 234
instability 67, 125, 331, 386
monitoring 285, 286t
stability 329
tolerance 52
Hemofiltration 20, 21f, 170, 371
bags 148
combination of 47
continuous 22, 371
arteriovenous 20, 42
venoarterial 371
venovenous 20, 24, 24f, 27, 29, 34, 42, 57, 66, 89, 90, 112, 125, 137t, 138, 142, 159, 255, 371
convective 22
goals 375
high volume 29, 169, 176, 375
Hemolung 337, 338f
Hemolysis 203, 258, 272, 319, 339
Hemolytic uremic syndrome 15, 183
Hemoperfusion 157, 157b, 158, 158b, 159fc, 160, 161
adverse effects of 160
circuit, components of 158
consideration of 157
hemodialysis 161
Hemorrhage 258
diffuse alveolar 165, 166
intracranial 403
intraventricular 408
major 403
pulmonary 356
uncontrolled 344
vessel perforation with 207
Hemostatic
adjuncts 269
derangements 264
impairement 265f
Hemothorax 258
Henoch-Schönlein purpura 15
Heparan sulfate 177
Heparin 74, 267, 269, 275, 318
anticoagulation action of 318
bolus 51
coated circuit 268
free method 63
infusion 329
method 63
protocol 63t
resistance 266
systemic 68
therapy 63
Heparinase thromboelastogram 266
Hepatic failure, fulminant 83, 106, 114
Hepatorenal syndrome 15, 114
Hernia, congenital diaphragmatic 407, 409
Heterogeneous syndrome 17
High cutoff membranes 112, 172
High filter pressure 146
troubleshooting 146
High parasitic index 166
High positive end-expiratory pressure 291
High return pressure alarm 144
troubleshooting 144
High volume plasma 165
exchange 164, 166
Hospital cardiac arrest 347
Human albumin 172
Human cells 177
Hybrid 47
therapies 20, 34, 43, 67
Hydrophilicity 126, 158
Hydrophobic membrane 371
Hydrostatic pressure 20, 32, 33f
Hyperbilirubinemia 16, 272
Hypercalcemia, management of 79
Hypercapnia 331
Hypercatabolic state 152
Hypercytokinemia 171
Hyperfibrinolysis 318
Hyperkalemia 19, 40, 41, 67, 152, 183
Hypermagnesemia 40
Hypernatremia, management of 79
Hyperparasitemia 166
Hyperphosphatemia 67, 123, 183
Hyperplasia, benign prostatic 15
Hypersensitivity 133
Hypertension 155, 181, 183, 321
chronic systemic venous 418
persistent pulmonary 408
primary pulmonary 407, 409
pulmonary 199, 325, 408
severe pulmonary 409
venous 252
Hypertensive emergency 183
Hyperthermia 37, 38
Hypertrophy, left ventricular 402
Hypervolemia, worsen 88
Hypoalbuminemia 16
Hypocalcemia 79, 160, 165
Hyponatremia 67
symptomatic 183
Hypoperfusion 418
Hypophosphatemia 160
Hypoplastic left heart syndrome, Norwood stage I procedure for 418f
Hypotension 362
Hypothermia 37, 271, 358
accidental 343
management of 79
Hypovolemia 15, 16, 325
Hypoxemia 203, 205, 207, 331, 356
severe 409
worsening 339
Hypoxia 319, 331, 357
I
Imipenem 130, 138
Imipramine 363
Immune
absorption 166, 164
complexes 163
dysfunction, lesser 175
restoration inflammatory syndrome 16
Immunoglobulin 163, 165
G, intravenous 165
Immunohomeostasis 170
Immunological dysfunction 168
Inadequate systemic perfusion 418
Inadvertent arterial insertion 339
Induction trainings 9
Indwelling catheter 99
Infection 200, 201, 203, 207, 258, 321, 403
Infectious diseases 16
Inflammatory mediators 177
Inflow pressure 141
Influence adsorptive capacity 160
Infusion pump 374
Inspired oxygen fraction 364
Intensive care delirium screening checklist 306
Intensive care unit 1, 7, 13, 19, 36, 39, 47, 67, 140, 151, 152, 181, 228, 282, 303, 305, 306, 308, 385, 393
complications 153
nurse 228
Intermittent heparin bolus method 63
Intermittent renal replacement
therapy 29
treatment 34
International Extracorporeal Life Support Organization 406
Intoxication, acute 362
Intra-aortic balloon pump 353, 361
Intracranial pressure, high 106
Intrinsic coagulation system 73
Ionized calcium levels 259
Ischemia
distal limb 256, 339
left ventricular 356
renal 15
Ischuria renalis 12
Isotonic solution 182
Itraconazole 132
J
Job orientation program 9
Jugular carotid access 220
Jugular vein, internal 239, 354
K
Ketamine 303
Kidney 183
disease 107, 135t
acute 89, 135t, 180
chronic 9, 12, 36, 107, 129, 135, 135t, 136, 158, 180
end-stage 181
Improving Global Outcomes Group 2, 12
function 19
failure of 181
loss of 181
reduction in 19
injury, oxidative stress-related 370
reabsorption in 132
L
Lactate 25, 115
dehydrogenase 182
Large volume resuscitation, impact of 387
Lectin protein 177
Left ventricle 213, 286
Left ventricular 203, 287, 354, 414
assist device 199, 234, 401, 403, 404
implantation 199
distension 356
ejection fraction 325, 327
end-diastolic
pressure 409
volume 409
failure 325
rupture 356
thrombus formation 356
Lepirudin 76, 267
Leukocytapheresis 164
Leukocytes 163
Leukocytosis 321
Leukopenia 160
Levofloxacin 53, 131, 138
Limb
ischemia 200, 201, 203, 317, 355, 403
perfusion 256
Linezolid 53, 130, 131
Lipemia 272
Lipophilicity 126, 158
Lipopolysaccharides, removal of 171
Lipoprotein, low density 166
Liposomal dispersion 132
Lithium 37, 41, 115
Liver
disease 114
disorders 87
dysfunction 68
failure 79, 166
function 125
support 37
Lorazepam 304
Loss pulsatile flow 319
Low access pressure alarm 143, 143f
Low cardiac output, presence of 418
Low efficiency daily dialysis 7, 34, 53t
Low molecular weight
heparin 74, 75, 267, 279
therapy 277
solute 22
Lower tidal volume ventilation 339
Lung
artificial 292
injury
acute 165
ventilator-induced 231, 291, 333
recovery, parameters of 328t
rest 291, 295, 334
transplant 199
Lymph circulation 171
M
Machine 49
basic outlook of 56f
parts of 58f
Macrolides 126
Magnesium 62
Magnetic resonance imaging 288
Malaria 166
Malignancy 207
urogenital 16
Malnutrition
high risk of 119
inflammation score 120
risk, screening of 119
Mean arterial pressure 106, 286, 409
Mechanical ventilation 106, 180, 291
conventional 291
Meconium aspiration syndrome 407, 409
Membrane
lung 217f, 335, 335f
oxygenator 238, 320
shunt 380
permeability 26
pore size 127
Meprobamate 363
Meropenem 53, 130, 138
Metabolic abnormalities 119
control of 183
Metabolic derangements 369
Metabolic monitoring 288
Metabolism
anaerobic 214
inborn errors of 41, 89
Metformin 37
Methanol 37, 41, 157
Methicillin-resistant staphylococcus aureus, treatment of 133
Metronidazole 130
Microangiopathy, thrombotic 166
Microcirculatory flow 166
Mid-arm circumference 120
Midazolam 304
Mixed venous oxygen
consumption 220, 221
saturation 203
Molecular absorbent recirculating systems 7, 67
Molecular weight 127, 158
Monitor anticoagulation, tests to 271t
Monmouth junction 176
Morphine 303
6-glucuronide 303
Mortality 53
Moxifloxacin 53, 131, 134, 138
Multifiltrate machine, pediatric filters for 188t
Multiorgan dysfunction syndrome 39
Multiorgan failure 73, 111, 355
nonpulmonary 207
Multiorgan support therapy 168
Multiple extracorporeal techniques 168, 172
Multiport venous cannula 252f
Myocardial dysfunction, severe 409
Myocardial infarction 15, 198, 199, 234, 400
Myocarditis 233, 235, 409
fulminant 198, 199
N
Nafamostat 77, 268
National Institutes of Health 291
National Kidney Foundation Kidney Disease Outcomes Quality Initiative 120
Near-infrared spectroscopy 200, 317, 414
Neonatal respiratory extracorporeal membrane oxygenation 408
Nephritis
acute interstitial 15
chronic interstitial 155
Nephropathy, HIV-associated 16
Nephrotoxic drugs, omission of 183
Nephrotoxicity, drug induced 15
Neurological disorders 86
Neurological injury, acute 113
Neuropathy, peripheral 133
Neutrophil gelatinase-associated lipocalin 106
New monitoring systems 297
Nitric oxide 268, 272
N-methyl-D-aspartate 303
Nonsteroidal anti-inflammatory drugs 15
Norepinephrine uptake inhibitors 363
North South syndrome 256
Novalung interventional lung assist 337f
N-terminal pro-brain natriuretic peptide 113, 325
Nutrition 37, 88, 99, 119-121, 181, 183, 385, 395
adequate 183
assessment of 120, 120t
monitoring adequacy of 390
parenteral 88, 121
support 37, 40
total parenteral 99
type of 119
Nutritional requirements, estimation of 121
Nutritional support, adequate 88
O
Observational studies 295
Obstetrical diseases 16
Oliguria 19, 41
Oozing 152
Opioids 303, 363
intravenous 303
Oral nutritional supplementation 121
Organ
dysfunction
life-threatening 168
multiple 168
sharing, network for 402
transplantation 343
Organophosphates 363
Orthotopic liver transplantation 114
Osmotic pressure 33, 33f, 34
Outflow cannula 245
Overanticoagulation 318
OXiris hemofilter 176
Oxygen
analyzers 284
blender 238
consumption 213f, 214f, 220, 221, 288
delivery 214, 214f, 309, 310
index 408
saturation 203, 220, 221
transfer 216
Oxygenation 173, 245
delivery 220, 221
failure 321
indices 169
membrane shunt 376
Oxygenator 242, 355, 411
failure 339
first sign of 411
P
Packed red blood cells 308, 309
Pain
abdominal 186
acute 302
management 301
Paired filtration dialysis 160, 161
Pancreatitis 231
Paraplegia 319
Pediatric intensive care unit 181
Pediatric renal angina 180
criteria 181t
Penicillin 41, 135
Perfusionists handling dialysis 3
Pericardial tamponade 325
Peripheral cannulation 197, 254
Peripheral vascular disease 155
severe 355
Peripheral vascular resistance 220, 221
Peristaltic pumps 242
Peritoneal dialysis 14, 34, 36, 42, 43, 126, 134, 135, 152, 154, 155, 184, 186, 372, 373
advantages of 155
automated 153
catheters, types of 184f
continuous cyclic 134
current status of 151
disadvantages of 155
emergent-start 152
fluid 153
in intensive care unit 151, 153
nocturnal intermittent 134
prescription
complications 185
modifications 185
monitoring 185
types of 134t
urgent-start 151
use of 45
Peritoneal pleural connections 45
Peritonitis 186
Pesticides 363
Pharmacokinetic parameters 125
Phenytoin 25, 363
Phosphate 62, 115
binders 183
Piperacillin 53, 130, 138
Plant toxins 363
Plasma 163, 165
composition 93, 96
adjusting 86
concentrations 113
electrolyte 94
exchange 163, 167, 168
anticoagulant for 165
filter 164, 165
protein binding 126
capacity 126
refilling rate 68
remove from 23
renin activity 321
Plasmapheresis 7, 163
double-filtration 164-166
Platelet 264, 268, 271, 273
aggregation
defect 133
inhibitors 76
count, monitoring of 75
Pneumonia 256
bacterial 407, 409
ventilator-associated 393, 403
viral 407, 409
Pneumothorax 258
Point-of-care
devices 277
test 276
Poisoning 1, 88
acute 360, 361
treatment of 157, 161
Poly-4-methyl pentene 335
Polyacrylonitrile 60
high permeability 112
membranes 77
Polycarbonate 60
Polycyclic antidepressants 363
Polycystic kidney disease, autosomal dominant 155
Polymethylpentene 242
Polymyxin
B 132, 138
immobilized fiber 175
direct hemoperfusion 171
Polyneuropathy
acute inflammatory demyelinating 166
chronic inflammatory demyelinating 166
Polysulfone 60, 76
Polyvinylchloride 240, 302
Poor single ventricle function 418
Positive access pressure implies arterial cannulation 144
Positive end-expiratory pressure 291, 294, 296, 330, 364
Positive pressure ventilation, low frequency 335
Postantibiotic effect 131, 133
Postcardiac surgery, support 199
Postcardiotomy 409
Postfilter 94
advantages 94
disadvantages 94
Post-heart 199
Post-weaning 326
Potassium 23, 62, 122, 150
serum 52
Prealbumin 120
Preblood pump 72
Prefilter 94
advantages 94
disadvantage 94
Pressure
alarm
high access 145f
low return 145
management of 380
effluent 142
intracranial 86, 288
monitor 141, 240
venous 60
Priming, types of 259
PrismaFlex machines, pediatric filters for 188t
Procalcitonin 173, 174, 321
Pro-inflammatory forces 171
Propofol 304
Propranolol 25
Prostacyclin 76, 77, 273
Prostaglandin 76
Protein 390
binding 25, 127, 158
bound 27, 32
doses of 390t
energy wasting 119
provision, optimal 88
targets, calculation of 389
Proteinuria 17
long-term 14
Prothrombin time 270
Prune Belly syndrome 186
Pseudoaneurysm formation 317, 339
Pseudomonas 394
aeruginosa 130, 131
Pulsed high-volume hemofiltration 29
Pump 215, 241, 335, 411
console 242
failure 339, 355
speed 242
type of 412t
Pyridoxine 123
Q
QT interval prolongation 133
Quadrox extracorporeal membrane oxygenation oxygenator 243f, 244f
Quality improvement programs, development of 10
Quality-adjusted life year 348
Quinine 363
Quinolones 133, 134
R
Randomized clinical trials 166
Randomized controlled trial 295, 309
Rated flow, concept of 216f
Recirculation 205, 207, 252, 339, 376, 380
fraction 263
Red blood cell 163, 164, 166
exchange 164, 166
storage life of 309
transfusion 77
perioperative 310
Regional citrate 68
anticoagulation 68, 77, 78, 78f, 79
advantages 78
complications 79
method 63
principle and mechanism of action 77
technique 78
Regional heparin protamine anticoagulation 77
Regurgitation, mitral 325
Renal disease
end-stage 9, 14, 151
evidence of 180
intrinsic 14
preexisting 180
Renal dysfunction 362
classification, pediatric risk of 180
criteria, pediatric risk of 181t
pediatric risk of 136, 181
risk of 180
Renal elimination, degree of 127
Renal failure 125
acute-onset chronic 14
intrinsic 182
treatment of 36
Renal function
derangement 132
normal 180
Renal intensive care unit 153
Renal recovery 25, 53, 83
assessment of 105
terms of 44
Renal replacement 66
method 132
Renal replacement therapy 1, 5, 7, 11, 13, 19, 23t, 25, 29, 33, 36, 39, 40, 44, 49t, 90t, 113, 119, 120t, 121, 125, 127, 151, 172, 180, 181, 183, 184, 364, 368, 381
aims of 40
circuit 141f
complications of 45
dose of 26, 44
hardware regulation 9
hybrid 29
indications for 19, 36, 40
initiation of 36t, 39
modalities of 42, 47, 48, 70
mode of 26, 371
nonrenal indications for 37t
prescription of 26
principles of 29, 30
programs 11
timing of 26, 41
troubleshooting in 140
types of 3, 19, 29, 372
Renal support 37, 66, 176
Renal vasoconstriction 15
Replacement fluid 25, 62, 62t, 66, 165, 374
bags 69
type of 26
Respiratory 98
acidosis 336
depression 362
dialysis 337, 331
syndrome 231, 407, 409
embarrassment 186
extracorporeal membrane oxygenation
for neonates 408
indications for 409t
failure 407t, 409
severe 45, 295
function, monitoring 287
monitoring 287
rate 296
therapist 228
Resuscitation
cardiopulmonary 199, 264, 358, 401, 409
continuous cardiopulmonary 361
conventional cardiopulmonary 348, 349
Retrograde reperfusion 239
Rhabdomyolysis 16
Richmond agitation-sedation scale 304, 305
Rifampicin 126, 130
Right internal jugular vein 198, 208, 209, 253f-255f, 258f
Right ventricle 199, 208, 213, 286
Right ventricular
assist device 404
failure 325
Rigid peritoneal dialysis catheter 185f
Ringer's lactate 182
Rodenticides 363
Roller pump 412
S
Salicylate 37, 41, 115
Saline 165
normal 182
Second-generation devices 404
Sedation 301, 304
agitation scale 304
Seizures 362
Seldinger technique 203, 251
Selenium 123
Sepsis 37, 73, 87, 111, 152, 168, 169, 169fc, 172, 198, 207, 231, 355, 358, 393, 407, 409
intra-abdominal 112
mediators, pleiotropia of 169
pathobiology of 168
pathogenesis of 168
severity of 173, 175
with profound cardiac depression 233
Septic shock 41, 236
abdominal 176
trial, transfusion requirements in 311
Septostomy, atrial 356
Sequential organ failure assessment 321, 401
Serum electrolytes 369
monitor 96
Serum glutamic
oxaloacetic transaminase 182
pyruvic transaminase 182
Shock 231
cardiogenic 15, 199, 233, 234, 360
lung syndrome 316
postcardiotomy 235
refractory cardiogenic 325
septic 41, 236
Shunt 207
Sickle cell disease 166
Sieving coefficient 127
Silicone
and hallow fiber 411
rubber membrane 242
Single lumen cannula
advantages of 205t
disadvantages of 205t
Skin fold thickness 120
Slow continuous ultrafiltration 20, 29, 34, 42, 57, 66, 88, 112, 371
Slow low efficiency dialysis 47, 49, 119
advantages of 47
disadvantages of 48
use of 48
Society of Critical Care Medicine 389
Sodium 62, 122
fractional excretion of 369
methalylsulfonate 176
profiling 49
Solid organ transplant 167
Sorbent application, modes of 161t
Spinal cord infarct 319
Spontaneous awakening trials 305
Spontaneous breathing trials 305
Standard operating procedures 8
Staphylococcus
aureus 186, 394
epidermidis 186
Steroids, use of 386
Stroke 403
ischemic 403
Stuivenberg hospital acute renal failure 53
Substitution fluid, part of 78
Sustained low efficiency dialysis 23, 43, 106, 126, 133, 138
Swan-Ganz catheter 285
Sweep flow 215
Systemic infections, prevention of 395
Systemic inflammatory response syndrome 60, 161, 171, 331, 368
Systemic vascular resistance 220, 221, 286
T
Taxus 363
Tazobactam 53, 130
Teicoplanin 126, 127, 131
Tenckhoff catheter 152
insertion 151
Tenckhoff type 184f
Tendon rupture 133
Tetracycline 126
Thebesian veins 254
Theophylline 37, 157
Theranostic circuit devices 175
Therapeutic apheresis 163
guidelines for 167
Therapeutic drug monitoring 129, 137
Therapeutic plasma exchange 29, 57, 159, 163, 164, 166
Therapy, timing of 174
Thiamine 123
Third-generation devices 404
Threshold modulation theory 171
Thrombelastography 412, 413
Thrombocytapheresis 164
Thrombocytopenia 160, 264, 318
heparin induced 75, 266, 269, 278, 339, 396
thrombotic 318
Thromboelastogram 270-272, 277
Thromboelastography 277
Thromboelastometry 272
rotational 271, 277, 278, 412
Thromboembolism 357
Thrombosis 203, 355, 380
cardiac 202, 356
Thrombotic thrombocytopenic purpura 165, 166
Tidal volume 294
setting of 295
Tigecycline 130
Tissue
binding 158
factor pathway inhibitor 318
hypoperfusion 15
absence of 15
signs of 234
plasminogen activator 318
Tobramycin 135, 175
Toxic accumulation 183
Toxins 37, 38
amenable 157b
removal, determinants of 158
with cardiotoxic potential 363t
Trace element 88, 123
Tranexamic acid 269
Tranquillizers 157
Transcatheter aortic valve implantation 236
Transcranial Doppler 288
Transfusion 201
indication threshold reduction 311
Transmembrane pressure 61, 70, 101, 142, 146
alarm 146
troubleshooting 146
Transplantation, cardiac 199, 358, 359
Trauma 231
concomitant major 344
Traumatic brain injury 106
Triglycerides 389
Triple cannulation 257
Trisodium citrate 78
Tubular drug handling 137
U
Ulinastatin 171
Ultra high-volume hemofiltration 29
Ultrafiltration 187, 338
isolated 33
rate 50
Ultrasonic flow probes 283
Ultrasonography 414
Unfractionated heparin 26, 72, 74, 80, 265, 271, 275, 411, 412
actions of 276fc
advantages of 265
dose of 276
therapeutic monitoring of 276
Urea 51, 85, 150
clearance 70
fractional excretion of 105
reduction rate 51
Uremia, symptomatic 19
Uremic
complications 36, 40
solutes 84t
symptoms 151
Urinary tract infection, catheter associated 393, 403
Urine
optimum 105
output 105, 106, 369
total suppression of 12
V
Valproic acid 37
Vancomycin 53, 127, 130, 133, 138
Vascular access 49, 63
functioning of 141
site complications 403
Vascular cannulas 245
Vascular catheter 143, 144, 238
obstructed 144
Vascular injury 317
Vascular structure, laceration of 258
Vasodilatation, systemic 15
Vasopressor support 386
Vein 210
femoral 198, 253f, 255f, 258f, 354
hepatic 258
right femoral 208
Vena cava
inferior 97, 108, 204, 208, 221, 330, 417
superior 204, 208, 221, 417
Venoarterial extracorporeal membrane oxygenation 197, 198f, 201t, 202, 209, 218, 220, 221f, 232, 239, 251, 254, 255f, 257, 257f, 258f, 286, 287, 327, 342, 353, 354, 354f, 355, 358, 416
central 256, 416f
complications of 203b
indications for 98, 199b, 204b, 409
physiology of 283
potential complications of 200, 205, 207b
weaning 324
Venous cannula 207, 239, 245, 410, 411
compressing artery 258
Venovenous extracorporeal membrane oxygenation 203, 204f, 205, 205t, 207, 207b, 208, 209, 220, 221, 222f, 227, 231, 239f, 251, 252, 253f, 257, 257f, 258f, 287, 292, 294, 327, 330, 354, 355, 361, 385
physiology of 282
system functions 231
Ventilation 3, 37, 186
ultraprotective 295
Ventricular assist device 83, 199, 232, 308, 319, 400, 403
Ventricular ejection fraction 366
Vitamin 123
A 123
B complex 123
C 123
D 123
water-soluble 88, 183
Volume exchange transfusions 271
von Willebrand
factor 269, 319
syndrome, acquired 318, 319, 339
Voriconazole 130, 132
W
Warning alarms 101
Waste products, removal of 84
Watershed phenomenon 254, 256
Weaning 207, 326, 327
assessment of 328
criteria for 324
failure of 331
predictors of 325
procedure of 326
process of 328
Wegener's granulomatosis 165
replacement fluid 165
Weight loss 120
White blood cell 164, 331
Wire reinforced cannulas 252f
Y
Yellow phosphorus 363
Z
Zinc 123
phosphide 363
×
Chapter Notes

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Introduction to Extracorporeal Life SupportCHAPTER 1

Rajesh Chandra Mishra,
Kanwalpreet Sodhi,
Vishwa Bharatkumar Patel
In recent times, critical care medicine is one of the most rapidly evolving medical specialties. Over last two decades or so, there have been enormous advances in technology, diagnostics, treatment, and our deeper understanding of the pathophysiology of disease processes affecting critically ill patients. Extracorporeal life support (ECLS) is being routinely promoted as a “rescue therapy” rather than supportive treatment for a large number of diseases in day-to-day intensive care practice. The term “extracorporeal” literally means “outside the body”. Extracorporeal therapy (ECT) refers to any mechanical assistance to perform physiologic functions of the body, may be respiratory or cardiac through extracorporeal membrane oxygenation (ECMO) or supporting kidney function through renal replacement therapy (RRT) in different forms. ECMO is used in critically ill patients presenting as acute cardiac and/or pulmonary dysfunctions, who are at high risk of developing acute kidney injury and fluid overload. RRT is commonly used in ICU to provide renal replacement, electrolyte, and fluid management. Beyond these routine indications of ECT, the therapies are further extending their roles into toxicology and sepsis.
The use of RRT and ECMO is no longer limited to the remit of nephrologists and cardiac surgeons, or anesthetists, respectively. They have become a routine therapy in varying clinical conditions in intensive care unit (ICU) on daily basis. The nephrologists or dialysis technicians are not expected to leave their dialysis units and manage ICU patients on bedside RRT. So, an in-depth knowledge of RRT—its indications, contraindications, how and when to begin, troubleshooting, and recent applications in non-renal conditions like poisonings, sepsis, etc.—is mandatory for a hardcore intensivist. Similarly, ECMO is being routinely employed for noncardiac indications in ICU patients, including acute respiratory distress syndrome (ARDS), for extracorporeal carbon dioxide removal (ECCO2R) and for cardiac support in poisonings like in aluminum phosphide (Celphos). So, ECMO has come out of the cardiac surgeon's domain and entered into the intensivists’ arena. This too mandates the accustomization of critical care physician with the practical aspects of ECMO, its applications, and the complications. The main incentive to launch this book dedicated to ECT is the sense of crisis acknowledged by the society regarding the current status of RRT and ECMO in 2Indian ICUs. The aim of this book is to provide concise and pragmatic practical guidelines to clinicians managing patients on ECT in varying clinical conditions at the bedside in ICU.
To broadly assess the knowledge and practices of ECT among intensivists in Indian ICUs, we conducted an online survey including questions on types of ICUs and the practices of RRT and ECMO therein. A total of 320 intensivists responded to the survey through an online portal. According to the survey, only 20% of participating Indian ICUs were closed and 83% of open ICUs are managed by a full-timer intensivist. 94% of participating ICUs have bedside RRT facility available. RRT in 50% ICUs is still managed by the nephrologist, while in only 28% ICUs, RRT is intensivists’ domain. Around one-third of ICUs do not have continuous renal replacement therapy (CRRT) facility. Overall there was no major difference in most common indications for RRT in different ICUs across the country, metabolic acidosis being the most common indication for starting RRT in ICU, followed by rising creatinine and hyperkalemia (64%, 32%, 30%, respectively). The intensivists across the ICUs in the country did not have differences in initiating triggers for commencing RRT. Commonly used triggers were early septic shock with acute kidney injury by 43% intensivists and early Kidney Disease Improving Global Outcomes (KDIGO) stage 3 by 31%. Looking at the nonconventional uses of ECT, 44% of responders had never used RRT for poisonings and only 21% of intensivists were practicing ECMO for resuscitation (eCPR). One-fourth of intensivists are either not modifying or sometimes modifying drug doses for patients undergoing ECT.
The survey highlighted that only 9% Indian ICUs are in public domain, against 50% being in corporate sector and 41% being private setups and there was a statistically significant difference in ICU beds in different sectors (p = 0.000). Availability of ECMO was also significantly different according to the type of setup (p < 0.05). More than half of public sector and private setups do not have ECMO facility as compared to 74% corporate settings having ECMO. There was also a significant difference in intensivists’ preference of RRT modality in hemodynamically unstable patients (p = 0.007). 63% of intensivists from corporate setups preferred CRRT for such patients while only 55% of those working in public sector ICUs and 40% in private setups used CRRT. This might be because of limited availability of resources: 80% of corporate setups and 66% of public and private setups had CRRT facility, but this difference was not statistically significant (p = 0.023). Financial consideration was another major reason while deciding the choice of RRT. 54% intensivists considered high cost as sole reason for not considering CRRT. A major difference in practice among public and private/corporate sector intensivists was the preferred dialysis access (p = 0.000). Femoral access was preferred by public sector (41%) while corporate and private sector physicians (81%, 71%) preferred double-lumen jugular catheters. A significant difference was also observed in use of RRT for poisonings. This indication was used for RRT mostly by corporate sector (40%) while less commonly used by public (24%) or private sector (23%) (p = 0.005). There was a significant difference in intensivist being ECMO team leader in corporate setups (61%) while in public setups (38%) and 54% in private setups (p = 0.017).
Of the total Indian ICUs, 66% have been running teaching programs. On comparison of teaching versus nonteaching ICU, there was a significant difference in availability of both extracorporeal therapies (RRT and ECMO) in teaching versus nonteaching institutes. Only 37% 3of nonteaching institutes had ECMO facility as compared to 72% in teaching hospitals (p = 0.000). 54% of nonteaching ICUs had CRRT facility versus 82% of teaching institutes (p = 0.000). When ECT practices were compared, very few nonsignificant differences were observed.
Keeping in mind the results of survey, the practical aspects of ECT have been vastly covered in the book. The book is divided into two sections: Section 1 including 23 chapters widely covering theoretical and practical management of RRT including acute kidney injury (AKI) epidemiology, setting up of RRT in ICU, different types of RRT available, modality preference for specific ICU patients, how and when to initiate, prescription while starting CRRT, troubleshooting, weaning from RRT, and managing nutrition. Altering the doses of drugs during RRT should be a routine that needs to be inculcated into day-to-day practice. To practically help the intensivists, we have included a separate chapter on drug dosing during RRT. Recent uses of RRT like hemoperfusion in poisonings, therapeutic apheresis, and ECT for sepsis have been included as separate chapters in the book. Section 2 covers ECMO with 24 chapters including physiology of ECMO, indications and contraindications, hardware, cannulation and priming of circuit, how to initiate, anticoagulation, monitoring, sedation, ventilation during ECMO, weaning and complications of ECMO including ECMO sepsis. It also includes unconventional topics like ECMO for poisonings, cardiac issues on ECMO, nutrition during ECMO, and ECMO during cardiopulmonary resuscitation. Another technical aspect of patients on ECMO is how to initiate CRRT during ECMO. This has been included as a separate chapter. Both the sections have separate chapters focusing on pediatric differences in RRT and ECMO. At the end of each section, multiple-choice questions have been provided for the readers to self-assess their overall knowledge of the subject.
The role of ECT in the ICU is primarily to support specific organ dysfunction with multiorgan failure. The strategies to employ it are dynamic and evolving. The ultimate goal of this book is to further promote and practically help the critical care physicians handling bedside ECT in ICUs in their day-to-day management of sick patients requiring specific therapy and be a handy ready reckoner in times of trouble for them. The book will be a great help for critical care students, freshers joining ICUs, and can even at times be a troubleshooter for senior intensivists. It will provide insight into the ECT for general physicians, dialysis technicians, cardiac anesthetists, and perfusionists handling dialysis or ECMO machines. The society also wishes to promote research into AKI, RRT, and ECMO in critically ill patients, which is as of now lacking in Indian ICUs. A national registry database capturing the detailed information of ICU patients requiring RRT and ECMO can be the way forward to look into Indian ICU practices and aim for quality improvement. We sincerely hope that the book serves its purpose and is read by the intensivists not only in India but across the globe.
HAPPY and FRUITFUL READING!!4