domingo, 31 de octubre de 2010

NUEVAS GUIAS RCP 2010 [Archivo adjunto 1]

 
[Más abajo se incluyen archivos adjuntos de Edwin Villacorta]





--- El mar, 10/19/10, Jessica Bedoya <jessbeve@hotmail.com> escribió:

ULTIMO MINUTO..!!!!!!!!
NUEVAS GUIAS RCP 2010

 

Queridos Amig@s:

 

Hoy 18 de Octubre a las 00.00 horas dieron a conocer las NUEVAS GUIAS DE LA RESUCITACIÓN CARDIOPULMONAR VERSION 2010, por ello, El Comite Directivo del Consejo Peruano de Reanimacion, consciente de su mision, quiere hacer llegar de manera especial a todos sus visitantes, el contenido de las mismas incluyendo el texto completo version en ingles, lo pueden descargar gratuitamente visitando nuestra pag web: www.cpr.com.pe  y hacer sus comentarios.


            Asi mismo, agradecemos tengan a bien difundirlas, invitando nos visiten a nuestra web

 

             Jorge Vigo Ramos
Presidente del Consejo Peruano de Reanimacion

                www.cpr.com.pe

 

 


__._,_.___

Archivos adjuntos de Edwin Villacorta

Archivo 1 de 1

 

domingo, 24 de octubre de 2010

solicita libros



----------
 

  
Principles and Practice of Mechanical Ventilation, 2nd Edition
by: Martin J. Tobin
en
2008-03-23 18:41
 
  
Lung Biology in Health & Disease Volume 152 Long-Term Mechanical Ventilation
by: Hill
en | Dekker
2008-05-05 11:06
 
  
Noninvasive Mechanical Ventilation
by: John R. Bach MD
en | Hanley & Belfus
2010-05-18 09:36
 
  
Noninvasive Mechanical Ventilation: Theory, Equipment, and Clinical Applications
by: Antonio Matías Esquinas
en | Springer
2010-08-19 08:01
 
  
Clinics in Perinatology Vol 34 Issue 01 / 2007 Surfactant and Mechanical Ventilation
by: S. Donn, T. Wiswell,
en | Elsevier
2007-05-05 17:41
 
  
Mechanical Ventilation (Update in Intensive Care Medicine)
by: Arthur S. Slutsky (Editor), Laurent Brochard (Editor)
en
2006-10-12 20:05
 
  
Core Topics in Mechanical Ventilation
by: Iain Mackenzie
en
2008-12-09 10:51
 
  
Mechanical Ventilation: Clinical Applications and Pathophysiology
by: Peter J. Papadakos MD, B. Lachmann MD PhD
en | Saunders
2010-08-07 00:19
 
  
Fundamentals of Mechanical Ventilation: A Short Course on the Theory and Application of Mechanical Ventilators
by: Robert L. Chatburn
en
2008-06-08 21:47
 
  
Understanding Mechanical Ventilation: A Practical Handbook 2nd Edition
by: Ashfaq Hasan
en | Springer
2010-02-02 23:40
  
The Intensive Care Manual
by: Michael J. Apostolakas Peter J. Papadakos
en
2006-05-26 06:01
 
  
Acid-Base, Fluids, and Electrolytes Made Ridiculously Simple
by: Richard Arthur Preston
en | Medmaster
2006-07-10 10:34
 
  
Fluids and Electrolytes Demystified
by: Joyce Y. Johnson
en
2008-02-28 12:08
 
  
Fluid and Electrolytes in Pediatrics: A Comprehensive Handbook (Nutrition and Health)
by: Leonard G. Feld, Frederick J. Kaskel
en | Humana Press
2009-12-18 00:02
 
  
Lange Instant Access: Acid-Base, Fluids, and Electrolytes (Lange Instant Access)
by: Robert F. Reilly, Mark Perazella
en | McGraw-Hill Professional
2008-03-10 18:57
 
 
  
Clinical Physiology of Acid-Base and Electrolyte Disorders
by: Burton David Rose, Theodore Post, Burton Rose,
en | McGraw-Hill Professional
2007-06-12 08:22
 
 
 

 

         gorjussScaryCutiesRochy.gif picture by rochymauricio        

 

"There comes a point in your life when you realize who matters, who never did, who won't anymore, and who always will. So don't worry about people from your past, there's a reason they didn't make it to your future"

Amor no es encontrar a alguien con quien vivir, amor es encontrar a alguien que tu sientas no puedes vivir sin el..."


Tres artículos de interés

Stroke guidelines in Stroke (Free PDF) http://click.jwatch.org/cts/click?q=227%3B67458583%3BQi4MA%2BZ91v4DOp1OQGHboEZYH3TnxBmWZfkGEBitJGo%3D
Diabetes guidelines in Diabetes Care (Free PDF) http://click.jwatch.org/cts/click?q=227%3B67458583%3BQi4MA%2BZ91v4DOp1OQGHboCVgEa44yoqpZfkGEBitJGo%3D
Hypertension guidelines in JAMA (Free) http://click.jwatch.org/cts/click?q=227%3B67458583%3BQi4MA%2BZ91v4DOp1OQGHboJO6DDz1btWiZfkGEBitJGo%3D


Dr. Pedro Bardález Lindley
Medicina Interna e Intensiva
           CMP 18331
      RNE 16095 y 14511


--- El sáb, 10/23/10, Murillo Santucci Cesar de Assunção <murilloa@uol.com.br> escribió:

De: Murillo Santucci Cesar de Assunção <murilloa@uol.com.br>
Asunto: Re: [interno_residente_medico_PERU] ayuda [Archivo adjunto 1]
A: interno_residente_medico_PERU@yahoogroups.com
Fecha: sábado, 23 de octubre de 2010, 08:51 pm

Enjoy it!!



Em 23/10/2010, às 23:12, Julio Grados escreveu:

 

Un favor su ayuda con este articulo
 
In vitro conventional cytology: Historical strengths and current limitations
Mark Spitzer
pages 673-683

 Volume 29, Issue 4,(December 2002)

 

      Dr. Julio Grados

     Oncologo Medico

CMP 29835 RNE 19413





Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069










 

__._,_.___

6th International Symposium on Intensive Care and Emergency Medicine for Latin America





Assunto: 6th International Symposium on Intensive Care and Emergency Medicine for Latin America

[cid:C64C2DAE-D4EC-4D8E-94FA-E91300269317]<http://www.einstein.br/isicem>
Esta mensagem contém informação confidencial e/ou privilegiada. Se você não for o destinatário ou a pessoa autorizada a receber esta mensagem, não pode usar, copiar ou divulgar as informações nela contidas ou tomar qualquer ação baseada nessas informações. Se você recebeu esta mensagem por engano, por favor avise imediatamente o remetente, respondendo o e-mail e em seguida apague-o. Comunicações pela Internet não podem ser garantidas quanto à pontualidade, segurança ou inexistência de erros ou vírus. O remetente por esta razão não se responsabiliza por qualquer erro, omissão ou mesmo opiniões e declarações contidas no conteúdo desta mensagem.
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Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069










sábado, 23 de octubre de 2010

Critical Care Considerations of the Morbidly Obese



Infinitas Gracias Amigo César Murillo, era justo lo que buscaba ... Obesidad Mórbida en Críticos... Gracias !!!!!!!!!!!!!!!!
 !!!!!!!!!!!!!
 
LUIS A.B.F...



De: Murillo Santucci Cesar de Assunção <murilloa@uol.com.br>
Para: salud loreto <SALUD_LORETO@yahoogroups.com>; interno_residente_medico_PERU@yahoogroups.com
Enviado: jue,21 octubre, 2010 23:39
Asunto: [SALUD_LORETO] Critical Care Considerations of the Morbidly Obese



Critical Care Considerations of the Morbidly Obese

07490704_00260004_cov150h.gif 
Critical Care Clinics Volume 26, Issue 4, Pages e1-e10, 583-742 (October 2010)

Critical Care Considerations of the Morbidly Obese

        Contents  
5 The Obesity Paradox 
Dennis E. Amundson, Svetolik Djurkovic, Gregory N. Matwiyoff
Open Show preview  |   PDF (108 K)   |   Related articles  |  Related reference work articles
The term "obesity paradox" refers to the observation that, although obesity is a major risk factor in the development of cardiovascular and peripheral vascular disease, when acute cardiovascular decompensation occurs, for example, in myocardial infarction or congestive heart failure, obese patients may have a survival benefit. In addition, it has been suggested that obese patients tend to fare better after certain surgical procedures, such as coronary artery bypass surgery. Moreover, it appears that obese men with chronic hypertensive heart disease live longer than men of normal weight. Mounting evidence shows that obesity alone may confer a survival benefit independent of age, medical care, or therapy. Perhaps the definition of obesity needs to be revisited, and it is also possible that all fat is not equal.
Effects of Obesity by System and Critical Care Considerations

6         Pulmonary System and Obesity
Doyle D. Ashburn, Angela DeAntonio, Mary Jane Reed
Open Show preview  |   PDF (67 K)   |   Related articles  |  Related reference work articles
There are several challenges in the management of respiratory failure in the obese population. Pulmonary physiology is significantly altered leading to reduced lung volumes, decreased compliance, abnormal ventilation and perfusion relationships, and respiratory muscle inefficiency. These complications can lead to a prolonged requirement for mechanical ventilation and increased intensive-care-unit length of stay.

7 Cardiovascular Considerations in Critically Ill Obese Patients
Mitchell K. Craft, Mary Jane Reed
Open Show preview  |   PDF (42 K)   |   Related articles  |  Related reference work articles
With a growing obese population, preventative and therapeutic strategies need to be developed to combat the complex cardiac pathophysiology related to obesity. This is paramount in the management of critically ill obese patients. This article highlights these strategies.

8 Acute Kidney Injury in the Critically Ill, Morbidly Obese Patient: Diagnostic and Therapeutic Challenges in a Unique Patient Population 
Ion D. Bucaloiu, Robert M. Perkins, William DiFilippo, Taher Yahya, Evan Norfolk
Open Show preview  |   PDF (148 K)   |   Related articles  |  Related reference work articles
The growing burden of morbid obesity (body mass index >40 kg/m2) on critical care resources translates to a significant incidence of acute kidney injury (AKI) in morbidly obese (MO), critically ill patients. This article examines the literature pertinent to AKI in critically ill MO patients. After a concise review of the available epidemiologic data regarding the incidence of acute renal injury in MO individuals, the authors review the limitations and available tools for estimation of renal function in the MO population (with emphasis on the critical illness). Also described are several specific types of renal injury previously described in this population that are applicable to the critical care setting. Lastly, the authors review some of the challenges and limitations in providing renal support to critically ill MO individuals, and identify potential areas for future research in this population.

9         Gastrointestinal System and Obesity
Pages 625-627
Doyle D. Ashburn, Mary Jane Reed
Open Show preview  |   PDF (44 K)   |   Related articles  |  Related reference work articles
Several significant changes occur in the gastrointestinal system with obesity that can effect management in critical illness. This population is at risk for gastroesophageal reflux disease (GERD), abdominal compartment syndrome, nonalcoholic fatty liver disease (NAFLD), and an increased incidence of cholelithiasis. It is important for critical care providers to be aware of these potential complicating factors.

10        Immunologic Changes in Obesity
Pages 629-631
Mitchell K. Craft, Mary Jane Reed
Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
A growing body of literature suggests multifaceted alterations to the immune function in obese patients compared with a lean cohort. Although treatment in the intensive care unit has an associated risk of infectious complications, which, if any, of these immunologic alterations are causal is unclear. Obesity clearly causes abundant alterations to the immune system. Overall, the aggregate effect seems to be chronic activation of inflammatory mediators.

11        Endocrine System and Obesity
Pages 633-636
Doyle D. Ashburn, Mary Jane Reed
Open Show preview  |   PDF (50 K)   |   Related articles  |  Related reference work articles
Obesity is associated with significant alterations in endocrine function. An association with type 2 diabetes mellitus and dyslipidemia has been well documented. This article highlights the complexities of treating endocrine system disorders in obese patients.

12        Venous Thromboembolic Disease and Hematologic Considerations in Obesity
Mitchell K. Craft, Mary Jane Reed
Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
Venous thromboembolic disease continues to be a major source of morbidity and mortality, with obese patients who are critically ill presenting some of the most at-risk patients. As the literature evolves, it has become clear that there is a complex relationship between obesity and thrombosis and atherogenesis. It is true that many of these conditions are reversible with weight loss; however, obesity remains on the rise. Management of obese patients must incorporate and consider these intricate changes in an attempt to improve patient outcomes.

13         Airway Management in the Obese Patient
William A. Loder
Open Show preview  |   PDF (409 K)   |   Related articles  |  Related reference work articles
Any patient can have a difficult airway, but obese patients have anatomic and physiologic features that can make airway management particularly challenging. Obesity does not seem to be an independent risk factor for difficult intubation but is one of the several factors that need to be considered as part of an airway evaluation. To effectively manage airways in obese patients, health care providers working in the intensive care unit setting must be proficient in airway evaluation and management in all types of patients. This article discusses the risk factors for a difficult airway and the methods of managing the airway.

Procedures in the Morbidly Obese Critically Ill

14         Vascular Procedures in the Critically Ill Obese Patient
Omar Rahman, Laurel Willis
Open Show preview  |   PDF (109 K)   |   Related articles  |  Related reference work articles
The increasing societal prevalence of obesity is consequential to the increasing number of critically ill obese patients. Vascular procedures are an essential aspect of care in these patients. This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed.

15         Ultrasound-Assisted Lumbar Puncture in Obese Patients
Robert Strony
Open Show preview  |   PDF (442 K)   |   Related articles  |  Related reference work articles
The use of ultrasound to mark landmarks for diagnostic lumbar puncture has been described in emergency medicine as well as in the anesthesia literature. One of the most difficult scenarios arises when obese patients with a body mass index (BMI) of greater than 30 present to an acute care setting, such as the emergency department or intensive care unit and require diagnostic LP. This article discusses lumbar puncture in patients with a high BMI.

16         Bedside and Radiologic Procedures in the Critically Ill Obese Patient
Michelle Olson, Chris Pohl
Open Show preview  |   PDF (43 K)   |   Related articles  |  Related reference work articles
Performance of procedures upon the obese critically ill patient in the ICU or in the radiology suite, require certain considerations. Additional staff, equipment and proper ergonomics are often necessary to perform these procedures safely for both patient and staff.

17         Tracheostomy in Critical Ill Morbidly Obese
Michael Clark, Scott Greene, Mary Jane Reed
Open Show preview  |   PDF (125 K)   |   Related articles  |  Related reference work articles

18         Nutrition in Critically Ill Obese Patients
Naeem Raza, Peter N. Benotti, Christopher D. Still
Open Show preview  |   PDF (68 K)   |   Related articles  |  Related reference work articles
Critically ill obese patients require timely nutrition in the intensive care unit. Hypocaloric, high protein nutritional feeding might have a role in critically ill obese patients. Although critically ill obese patients need special medical and nutritional care as do nonobese patients in the ICU, there are some differences in the literature about the initiation, routes, and nature of nutritional support. This article reviews the norms of nutritional care among critically ill obese patients and the differences between these patients and those with a normal BMI.

19         Pharmacotherapy in the Critically Ill Obese Patient
Charles J. Medico, Patrick Walsh
Open Show preview  |   PDF (90 K)   |   Related articles  |  Related reference work articles
Despite the growing epidemic of obesity in the United States, dosing medications in such patients remains poorly studied and understood. Most recommendations are based on small independent studies, case reports, and expert opinion. Applying manufacturer kinetics and dosing recommendations in the obese patient may result in toxicity or treatment failure, leading to increased morbidity, mortality, and hospital length of stay.

Special Populations

20         Trauma in Obese Patients
Christine C. Toevs
Open Show preview  |   PDF (50 K)   |   Related articles  |  Related reference work articles
As the American population grows larger in terms of weight and body mass index each year, a greater percentage of patients admitted to the trauma service are overweight or obese. Obese patients do not have the same injury patterns or outcomes of normal-weight patients. This article reviews some of the latest data regarding the injury patterns, outcomes, and areas of further studies in the obese trauma population.

21         Bariatric Surgery Patients in the ICU
Mary Jane Reed, Jon Gabrielsen
Open Show preview  |   PDF (187 K)   |   Related articles  |  Related reference work articles
As the incidence of bariatric surgery continues to increase, the medical community should be aware of the most common procedures, resultant anatomy, and possible complications to be better prepared to care for these patients in all situations.

22         Special Considerations in the Critically Ill Morbidly Obese Child
Karen Allison Bailey
Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specific concern and require special consideration when the morbidly obese child becomes critically ill.

23         Critical Care of the Morbidly Obese in Disaster
James Geiling
Open Show preview  |   PDF (89 K)   |   Related articles  |  Related reference work articles
The prevalence of obesity in the United States is increasing, with extreme morbid obesity of body mass index greater than 40 increasing twice as fast as obesity in general. With the increased weight comes an increased risk of comorbidities, including type 2 diabetes mellitus, cardiovascular disease, respiratory problems such as obstructive sleep apnea or restrictive lung disease, skin disorders such as intertrigo and cellulitis, and urinary incontinence. Thus, patients exposed to a variety of disasters not only are increasingly overweight but also have an associated number of coexistent medical conditions that require increased support with medical devices and medications. This article focuses on management of the morbidly obese patients during disasters.

24         Special Populations Critical Care Considerations of the Morbidly Obese Pregnant Patient
Marie R. Baldisseri, Margaret D. Larkins-Pettigrew
Open Show preview  |   PDF (123 K)   |   Related articles  |  Related reference work articles
The critically ill pregnant patient poses a unique challenge to the clinician, requiring a thorough understanding of normal and abnormal maternal and fetal physiology associated with pregnancy. The morbidly obese patient presents even greater challenges to the clinician, and morbidity and mortality are proportionately increased. Because increased numbers of obese pregnant women are now admitted to intensive care units, practitioners must be aware of the physiology associated with both pregnancy and obesity. A multidisciplinary approach is imperative to prevent both maternal and fetal morbidity and mortality for these very complex patients, especially when they are admitted to the ICU with critical illness.

25         Afterword: Sensitivity in Caring for the Obese Patient  
Page 733
Michele Chamberlain
Open Show preview  |   PDF (27 K)   |   Related articles  |  Related reference work articles

26         Index  
Open Show preview  |   PDF (44 K)   |   Related articles  |  Related reference work articles

27         Indirect Calorimetry Measurements in the Ventilated Critically Ill Patient: Facts and Controversies—The Heat is On  
Shaul Lev, Jonathan Cohen, Pierre Singer
Open Show preview  |   PDF (84 K)   |   Related articles  |  Related reference work articles
The provision of nutrition to critically ill patients in the ICU often receives lower priority compared with hemodynamic and ventilation control. This frequently results in a significant calorie deficit. Overestimation of daily energy expenditure may also result in adverse outcomes. In many centers, nutritional decision making is based on predictive formulas, which have been shown to underestimate true energy requirements. Such estimations are ideally performed using indirect calorimetry. Nevertheless, the use of indirect calorimetry has been limited owing to costs and technical difficulties. Controversies about its actual clinical benefits are the focus of recent clinical studies and recommendations. The aim of this review was to describe the advantages of measuring indirect calorimetry within the concept of energy–protein goal-oriented therapy.

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Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069










Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069











jueves, 21 de octubre de 2010

Critical Care Considerations of the Morbidly Obese

Critical Care Considerations of the Morbidly Obese

07490704_00260004_cov150h.gif 
Critical Care Clinics Volume 26, Issue 4, Pages e1-e10, 583-742 (October 2010)

Critical Care Considerations of the Morbidly Obese

        Contents  
5 The Obesity Paradox 
Dennis E. Amundson, Svetolik Djurkovic, Gregory N. Matwiyoff
Open Show preview  |   PDF (108 K)   |   Related articles  |  Related reference work articles
The term "obesity paradox" refers to the observation that, although obesity is a major risk factor in the development of cardiovascular and peripheral vascular disease, when acute cardiovascular decompensation occurs, for example, in myocardial infarction or congestive heart failure, obese patients may have a survival benefit. In addition, it has been suggested that obese patients tend to fare better after certain surgical procedures, such as coronary artery bypass surgery. Moreover, it appears that obese men with chronic hypertensive heart disease live longer than men of normal weight. Mounting evidence shows that obesity alone may confer a survival benefit independent of age, medical care, or therapy. Perhaps the definition of obesity needs to be revisited, and it is also possible that all fat is not equal.
Effects of Obesity by System and Critical Care Considerations

6         Pulmonary System and Obesity
Doyle D. Ashburn, Angela DeAntonio, Mary Jane Reed
Open Show preview  |   PDF (67 K)   |   Related articles  |  Related reference work articles
There are several challenges in the management of respiratory failure in the obese population. Pulmonary physiology is significantly altered leading to reduced lung volumes, decreased compliance, abnormal ventilation and perfusion relationships, and respiratory muscle inefficiency. These complications can lead to a prolonged requirement for mechanical ventilation and increased intensive-care-unit length of stay.

7 Cardiovascular Considerations in Critically Ill Obese Patients
Mitchell K. Craft, Mary Jane Reed
Open Show preview  |   PDF (42 K)   |   Related articles  |  Related reference work articles
With a growing obese population, preventative and therapeutic strategies need to be developed to combat the complex cardiac pathophysiology related to obesity. This is paramount in the management of critically ill obese patients. This article highlights these strategies.

8 Acute Kidney Injury in the Critically Ill, Morbidly Obese Patient: Diagnostic and Therapeutic Challenges in a Unique Patient Population 
Ion D. Bucaloiu, Robert M. Perkins, William DiFilippo, Taher Yahya, Evan Norfolk
Open Show preview  |   PDF (148 K)   |   Related articles  |  Related reference work articles
The growing burden of morbid obesity (body mass index >40 kg/m2) on critical care resources translates to a significant incidence of acute kidney injury (AKI) in morbidly obese (MO), critically ill patients. This article examines the literature pertinent to AKI in critically ill MO patients. After a concise review of the available epidemiologic data regarding the incidence of acute renal injury in MO individuals, the authors review the limitations and available tools for estimation of renal function in the MO population (with emphasis on the critical illness). Also described are several specific types of renal injury previously described in this population that are applicable to the critical care setting. Lastly, the authors review some of the challenges and limitations in providing renal support to critically ill MO individuals, and identify potential areas for future research in this population.

9         Gastrointestinal System and Obesity
Pages 625-627
Doyle D. Ashburn, Mary Jane Reed
Open Show preview  |   PDF (44 K)   |   Related articles  |  Related reference work articles
Several significant changes occur in the gastrointestinal system with obesity that can effect management in critical illness. This population is at risk for gastroesophageal reflux disease (GERD), abdominal compartment syndrome, nonalcoholic fatty liver disease (NAFLD), and an increased incidence of cholelithiasis. It is important for critical care providers to be aware of these potential complicating factors.

10        Immunologic Changes in Obesity
Pages 629-631
Mitchell K. Craft, Mary Jane Reed
Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
A growing body of literature suggests multifaceted alterations to the immune function in obese patients compared with a lean cohort. Although treatment in the intensive care unit has an associated risk of infectious complications, which, if any, of these immunologic alterations are causal is unclear. Obesity clearly causes abundant alterations to the immune system. Overall, the aggregate effect seems to be chronic activation of inflammatory mediators.

11        Endocrine System and Obesity
Pages 633-636
Doyle D. Ashburn, Mary Jane Reed
Open Show preview  |   PDF (50 K)   |   Related articles  |  Related reference work articles
Obesity is associated with significant alterations in endocrine function. An association with type 2 diabetes mellitus and dyslipidemia has been well documented. This article highlights the complexities of treating endocrine system disorders in obese patients.

12        Venous Thromboembolic Disease and Hematologic Considerations in Obesity
Mitchell K. Craft, Mary Jane Reed
Open Show preview  |   PDF (46 K)   |   Related articles  |  Related reference work articles
Venous thromboembolic disease continues to be a major source of morbidity and mortality, with obese patients who are critically ill presenting some of the most at-risk patients. As the literature evolves, it has become clear that there is a complex relationship between obesity and thrombosis and atherogenesis. It is true that many of these conditions are reversible with weight loss; however, obesity remains on the rise. Management of obese patients must incorporate and consider these intricate changes in an attempt to improve patient outcomes.

13         Airway Management in the Obese Patient
William A. Loder
Open Show preview  |   PDF (409 K)   |   Related articles  |  Related reference work articles
Any patient can have a difficult airway, but obese patients have anatomic and physiologic features that can make airway management particularly challenging. Obesity does not seem to be an independent risk factor for difficult intubation but is one of the several factors that need to be considered as part of an airway evaluation. To effectively manage airways in obese patients, health care providers working in the intensive care unit setting must be proficient in airway evaluation and management in all types of patients. This article discusses the risk factors for a difficult airway and the methods of managing the airway.

Procedures in the Morbidly Obese Critically Ill

14         Vascular Procedures in the Critically Ill Obese Patient
Omar Rahman, Laurel Willis
Open Show preview  |   PDF (109 K)   |   Related articles  |  Related reference work articles
The increasing societal prevalence of obesity is consequential to the increasing number of critically ill obese patients. Vascular procedures are an essential aspect of care in these patients. This article reviews the general, anatomic, and physiologic considerations pertaining to vascular procedures in critically ill obese patients. In addition, the use of ultrasonography for these procedures is discussed.

15         Ultrasound-Assisted Lumbar Puncture in Obese Patients
Robert Strony
Open Show preview  |   PDF (442 K)   |   Related articles  |  Related reference work articles
The use of ultrasound to mark landmarks for diagnostic lumbar puncture has been described in emergency medicine as well as in the anesthesia literature. One of the most difficult scenarios arises when obese patients with a body mass index (BMI) of greater than 30 present to an acute care setting, such as the emergency department or intensive care unit and require diagnostic LP. This article discusses lumbar puncture in patients with a high BMI.

16         Bedside and Radiologic Procedures in the Critically Ill Obese Patient
Michelle Olson, Chris Pohl
Open Show preview  |   PDF (43 K)   |   Related articles  |  Related reference work articles
Performance of procedures upon the obese critically ill patient in the ICU or in the radiology suite, require certain considerations. Additional staff, equipment and proper ergonomics are often necessary to perform these procedures safely for both patient and staff.

17         Tracheostomy in Critical Ill Morbidly Obese
Michael Clark, Scott Greene, Mary Jane Reed
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18         Nutrition in Critically Ill Obese Patients
Naeem Raza, Peter N. Benotti, Christopher D. Still
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Critically ill obese patients require timely nutrition in the intensive care unit. Hypocaloric, high protein nutritional feeding might have a role in critically ill obese patients. Although critically ill obese patients need special medical and nutritional care as do nonobese patients in the ICU, there are some differences in the literature about the initiation, routes, and nature of nutritional support. This article reviews the norms of nutritional care among critically ill obese patients and the differences between these patients and those with a normal BMI.

19         Pharmacotherapy in the Critically Ill Obese Patient
Charles J. Medico, Patrick Walsh
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Despite the growing epidemic of obesity in the United States, dosing medications in such patients remains poorly studied and understood. Most recommendations are based on small independent studies, case reports, and expert opinion. Applying manufacturer kinetics and dosing recommendations in the obese patient may result in toxicity or treatment failure, leading to increased morbidity, mortality, and hospital length of stay.

Special Populations

20         Trauma in Obese Patients
Christine C. Toevs
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As the American population grows larger in terms of weight and body mass index each year, a greater percentage of patients admitted to the trauma service are overweight or obese. Obese patients do not have the same injury patterns or outcomes of normal-weight patients. This article reviews some of the latest data regarding the injury patterns, outcomes, and areas of further studies in the obese trauma population.

21         Bariatric Surgery Patients in the ICU
Mary Jane Reed, Jon Gabrielsen
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As the incidence of bariatric surgery continues to increase, the medical community should be aware of the most common procedures, resultant anatomy, and possible complications to be better prepared to care for these patients in all situations.

22         Special Considerations in the Critically Ill Morbidly Obese Child
Karen Allison Bailey
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Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specific concern and require special consideration when the morbidly obese child becomes critically ill.

23         Critical Care of the Morbidly Obese in Disaster
James Geiling
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The prevalence of obesity in the United States is increasing, with extreme morbid obesity of body mass index greater than 40 increasing twice as fast as obesity in general. With the increased weight comes an increased risk of comorbidities, including type 2 diabetes mellitus, cardiovascular disease, respiratory problems such as obstructive sleep apnea or restrictive lung disease, skin disorders such as intertrigo and cellulitis, and urinary incontinence. Thus, patients exposed to a variety of disasters not only are increasingly overweight but also have an associated number of coexistent medical conditions that require increased support with medical devices and medications. This article focuses on management of the morbidly obese patients during disasters.

24         Special Populations Critical Care Considerations of the Morbidly Obese Pregnant Patient
Marie R. Baldisseri, Margaret D. Larkins-Pettigrew
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The critically ill pregnant patient poses a unique challenge to the clinician, requiring a thorough understanding of normal and abnormal maternal and fetal physiology associated with pregnancy. The morbidly obese patient presents even greater challenges to the clinician, and morbidity and mortality are proportionately increased. Because increased numbers of obese pregnant women are now admitted to intensive care units, practitioners must be aware of the physiology associated with both pregnancy and obesity. A multidisciplinary approach is imperative to prevent both maternal and fetal morbidity and mortality for these very complex patients, especially when they are admitted to the ICU with critical illness.

25         Afterword: Sensitivity in Caring for the Obese Patient  
Page 733
Michele Chamberlain
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26         Index  
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27         Indirect Calorimetry Measurements in the Ventilated Critically Ill Patient: Facts and Controversies—The Heat is On  
Shaul Lev, Jonathan Cohen, Pierre Singer
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The provision of nutrition to critically ill patients in the ICU often receives lower priority compared with hemodynamic and ventilation control. This frequently results in a significant calorie deficit. Overestimation of daily energy expenditure may also result in adverse outcomes. In many centers, nutritional decision making is based on predictive formulas, which have been shown to underestimate true energy requirements. Such estimations are ideally performed using indirect calorimetry. Nevertheless, the use of indirect calorimetry has been limited owing to costs and technical difficulties. Controversies about its actual clinical benefits are the focus of recent clinical studies and recommendations. The aim of this review was to describe the advantages of measuring indirect calorimetry within the concept of energy–protein goal-oriented therapy.

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Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069










Murillo Santucci Cesar de Assunção
Unidade de Terapia Intensiva adulto
Disciplina de Anestesiologia, Dor e Terapia Intensiva
Escola Paulista de Medicina
Rua Napoleão de Barros,715
Vila Clementino - São Paulo - CEP: 04024-002
Tel/Fax: +55-11-55757768
Tel/Fax: +55-11- 55764069