Textbook of Critical Care

Low systemic arterial blood pressure

Introduction Assessment of hemodynamics is an important skill in the critical care setting. The goal of hemodynamic monitoring in a critically ill patient is to ensure adequate tissue oxygen delivery and end-organ perfusion. Low systemic arterial blood pressures are commonly…

Very high systemic arterial blood pressure

Hypertensive emergency (HE) is a severe elevation in systemic blood pressure combined with new or progressive end-organ damage most frequently in the cardiac, renal, and central nervous systems. HE is an infrequent clinical presentation of acute hypertension that requires immediate,…

Fever and hyperthermia

“Humanity has but three great enemies: fever, famine and war; of these by far the greatest, by far the most terrible, is fever.” William Osler, from his address to the 47th annual meeting of the American Medical Association, 1896 Fever…

Management of acute pain in the intensive care unit

Introduction Pain management in the critically ill patient is complex. Each patient brings a unique set of sociodemographic, pharmacokinetic, and pharmacogenomic variables that are coupled with underlying psychosocial and medical comorbidities. These not only influence a patient’s response to painful…

Agitation and delirium

Agitation and delirium are commonly encountered in the intensive care unit (ICU). Although frequently underrecognized, delirium is present in up to 80% of critically ill adults on mechanical ventilation when routinely assessed. Delirium and agitation are more than just an…

Sudden deterioration in neurologic status

Patients admitted to the intensive care unit (ICU) with critical illness or injury are at risk for neurologic complications. A sudden or unexpected change in the neurologic condition of a critically ill patient often heralds a complication that may cause…