In recent years, many clinical interventions in intensive care medicine have been based on clear scientific evidence. However, at least as many clinical interventions still remain the subject of controversy, either due to a lack of rigorous data or due to the existence of conflicting data. In this book, these controversies are discussed by experts of international renown in their respective fields. The goal is twofold: To provide us with a balanced and unbiased presentation of the subject, explaining the different 'schools of thought' relevant to the controversy; To summarise the data with a clinically useful and valid recommendation for our practice. Virtually all fields of intensive care medicine are covered in more than 50 chapters dealing with controversies over treatment options in acute illness states, organising and providing care for acutely ill patients, as well as how to answer ethical questions arising in critical care medicine every day.

with contributions from: MG Abate, L Abrahão Hajjar, S Afonso, F Álvarez-Lerma, P Amado, PJD Andrews, D Annane, D De Backer, J Bakker, O Barbosa da Silva, G Bellingan, K Bendjelid, A Biasi Cavalcanti, L Blanch, SI Blot, M Borelli, J Brokmann, C Bruel, C Brun-Buisson, J Carlet, J Chastre, BP Cholley, G Citerio, G Colin, A Combes, RC Costa Filho, C Cozowicz, BH Cuthbertson, D Crippen, J Cruz, R Dembinski, P Devos, J-M Domínguez-Roldán, G Ferreyra, S Finfer, H Flaatten, MJ Garcia Monge, E Gayat, T Geeraerts, FRB Gomes Galas, RD Griffiths, ABJ Groeneveld, O Grottke, O Hamzaoui, GT Henriques Filho, M Hiesmayr, M Imhoff, TC Jansen, AL Jardim, M Jonas, C Jones, JA Kellum, R Kitzberger, E Knobel, M Knobel, L Kramer, K Kranzer, S Kreyer, R Kuhlen, M Leone, A Liolios, T Lisboa, B Lortat Jacob, U Lucangelo, C-E Luyt, MR Macleod, R Maio, C Martin, FO Martins, V Maxime, A Mebazaa, DK Menon, TM Merz, B Misset, I Morales, RP Moreno, T Muders, AP Neves, P Olaechea, G Ospina-Tascon, HM Oudemans-van Straaten, M Palomar, AE Pesaro, F Philippart, J Poelaert, KH Polderman, LF Poli-de-Figueiredo, J-C Preiser, RJ Price, C Putensen, VM Ranieri, J Rello, A Rhodes, JL da Rocha Paranhos, A Rodriguez, J-A Romand, R Rossaint, HU Rothen, D Schmidlin, K Singbartl, JMA Sousa, CL Sprung, M Tavares, JF Teixeira, J-L Trouillet, RJ Trof, V Umbrain, A Valentin, DM Vandijck, J-L Vincent, C Waldmann, J Wernerman, J Woods, H Wrigge

1;Cover;1 2;Impressum;5 3;Preface;6 4;Content;8 5;A. Acute respiratory failure;14 5.1;Noninvasive ventilation in hypoxemic respiratory insufficiency;16 5.2;Weaning: Protocols vs. clinically driven;24 5.3;Pressure-volume curves: Useful in clinical practice;32 5.4;Replacing or restricting fluids: Timing, dosing and choosing the type of fluid in patients with or at risk for ALI/ARDS;42 5.5;Spontaneous versus mechanical ventilation;50 5.6;The role of tracheostomy in ventilatory care;60 6;B. Acute circulatory failure;68 6.1;Controversies in cardiac output monitoring;70 6.2;Crystalloids versus colloids versus albumin: Where do we stand?;76 6.3;ScvO2 as a marker for resuscitation in intensive care;90 6.4;Calcium sensitisers versus dobutamine in acute heart failure ;96 6.5;Macro vs. micro targets for haemodynamic support;116 6.6;Right heart failure determines outcome;124 6.7;Do we really need SPV/PPV to detect low filling status? ;132 6.8;Vasopressors in the patient with shock;140 6.9;Controversies in coronary care;146 7;C. Acute kidney injury;156 7.1;Renal replacement therapies: When, how, and how much?;158 7.2;Anticoagulation for renal replacement therapy: Heparin or citrate;166 8;D. Sepsis and infection;176 8.1;Diagnosis of Ventilator-associated Pneumonia;178 8.2;Antibiotic combination vs. monotherapy in critically ill patients with pneumonia;188 8.3;Do antibiotic protocols impact on resistance?;196 8.4;The activated protein C controversy;206 8.5;Corticosteroids in septic shock;218 8.6;Controversies in goal-directed therapy: Venous saturations and lactate;224 8.7;Starting and stopping antibiotic therapy;232 8.8;MRSA control;240 9;E. Neuro-intensive care;250 9.1;Does ICP monitoring improve outcome after traumatic brain injury?;252 9.2;What care should be provided for poor grade subarachnoid haemorrhage patients?;260 9.3;Induced hypothermia to treat neurological injuries;270 9.4;Can we increase/lengthen the time window from 3-6 hours for thrombolysis after stroke?;280 9.5;Neuroprotective ventilation;288 10;F. Acute bleeding;298 10.1;Monitoring the coagulation;300 10.2;Management of refractory bleeding;324 11;G. Organisational issues;334 11.1;Optimisation of patient process and workflow;336 11.2;Reducing the number of adverse events in intensive care units;350 11.3;Early discharge from the ICU is safe;356 11.4;Implementation of surveillance networks;366 11.5;Should hospitals have a medical emergency team?;376 11.6;E-learning;386 11.7;High acuity nurse patient ratio - is it cost-effective?;406 11.8;The role of specialist (neurological critical care) units;420 11.9;Building and using outcome prediction models: Should we be lumpers or splitters?;428 11.10;Specialty of intensive care: Primary specialty vs. supraspecialty;434 12;H. Surgical intensive care and trauma;444 12.1;Fast track after cardiac surgery;446 12.2;Fluid: Replace or restrict?;456 12.3;Bedside surgery in the ICU;462 13;I. Adjunctive issues;474 13.1;Technology assessment and procurement: 'Monitoring the monitor';476 13.2;Controversies in intensive care sedation: Continuous infusions in awake patients and end-of-life sedation;486 13.3;Tight glucose control: Should we target normoglycemia or an intermediate level?;494 13.4;Goals for nutrition support in the ICU;500 13.5;Pain and stress in the ICU: All in the mind?;506 13.6;Controversies on donation after cardiac death;516 13.7;Is there a role for extracorporeal support in hepatic failure? ;526