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,CRITICAL
CARE
MEDICINE
An Algorithmic Approach

,CRITICAL
CARE
MEDICINE
An Algorithmic Approach
Alexander Goldfarb-Rumyantzev, MD, PhD, PhD
Lecturer
Medicine
Harvard Medical School, Beth Israel Deaconess Medical Center
Boston, Massachusetts

Contributing Author

Robert Stephen Brown, MD
Associate Chief for Academic Affairs, Nephrology Division Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Associate Professor of Medicine
Harvard Medical School
Boston, Massachusetts

Associate Editor

Martin Shao Foong Chong, MBBS, MA (Oxon), MRCP,
FRCA, FFICM, FHEA
Magill Department of Anaesthesia
Chelsea and Westminster Hospital
London, UK

,Elsevier
1600 John F. Kennedy Blvd.
Ste 1800
Philadelphia, PA 19103-2899


CRITICAL CARE MEDICINE: AN ALGORITHMIC APPROACH, FIRST EDITION ISBN:978-0-323-696074
Copyright © 2023 by Elsevier, Inc. All rights reserved.



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ALGrawany

, Dedication




To my family, and speci¿cally to my mom Tatiana, my late uncle Veniamin,
and my children Levi and Ben – my constant source of inspiration.

Alexander Goldfarb-Rumyantzev


To my wife Judy, son Bobby, and daughter Debbie
who have always supported my hours at work
and to the late Frank Epstein –
mentor, colleague, and friend for 40 years.

Robert S. Brown

, Dedicated in memory of Alexander Goldfarb-Rumyantzev, MD, PhD, PhD,
a colleague, co-author and friend,


This book is all Alex’ doing – its conception, structure and writing. His unexpected
passing on January 18th, 2021 was a loss to us all – his innovative thinking,
logic, spirit, wit and humor will not be forgotten.

Robert S. Brown, MD

,Contributing Author
Robert Stephen Brown, MD
Associate Chief for Academic Aairs, Nephrology Division Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts
Associate Professor of Medicine
Harvard Medical School
Boston, Massachusetts




Associate Editor
Martin Shao Foong Chong, MBBS, MA (Oxon), MRCP, FRCA, FFICM,
FHEA
Magill Department of Anaesthesia
Chelsea and Westminster Hospital
London, UK




ix

,Preface


Critical Care Medicine is a broad subject that covers many areas and almost all subspecialties of
internal medicine. As one might remember from one’s years in residency, the ICU rotation is exciting
and the favorite of many. In this book we discuss practical issues of critical care medicine divided into
chapters by subspecialty. Speci¿cally, we separated the following aspects of critical care medicine:
respiratory, cardiac and circulation, infectious disease, water and electrolytes and acid-base disor-
ders, acute kidney injury and dialysis, gastroenterology, rheumatology, endocrinology, neurology,
and COVID-19. Arguably, many aspects of critical care medicine are also relevant to general internal
medicine. In eect, critical care is an internal medicine subspecialty focused on very sick people
(plus invasive procedures). As such, the chapters in this book are applicable to the practice of general
medicine as well. Therefore, the intended audience for this book includes critical care practitioners,
as well as internal medicine physicians, and fellows and residents in critical care, internal medicine,
and its subspecialties.
Let me point out what this book is NOT. First of all, it is important to note that the goal of this book
is not to give comprehensive coverage of the topics, nor to provide a fundamental understanding of
the physiology of the discussed conditions. Rather, we address the need for quick decision making
in situations where timing is of essence. This book is intended to be a source of quick reference to
provide help in approaching conditions frequently encountered in the intensive care unit, in formu-
lating the plan of care, and in making a decision regarding the next step in management of a critical
patient. In essence, this book allows the provider to alleviate the most urgent clinical matter and buy
some time to regroup, think, call consults, and obtain more detailed and comprehensive information.
By no means does it eliminates the need for a physician to read further and have a deeper understand-
ing of the subject—of special importance is the understanding of the physiology of critical illnesses.
Medicine is practiced in a rapidly changing environment and new information is coming daily. This
book does not substitute the need to be on the top of contemporary literature. Understanding of the
underlying disease process is very important, so, once the initial strategy is established and next steps
are clear in general terms, the provider should probably step back and get additional information from
more detailed sources. Along the same lines, this book cannot cover all topics, and the authors had to
be selective. Because the purpose of the book is to be a source of quick reference, we selected top-
ics representing common issues in critical care medicine, those that practitioners are dealing with on
almost a daily basis, and those that require decisive steps.
The format of this book is dierent from most textbooks in that it is based mostly on graphical
representation of information: diagrams, tables, algorithms. We believe that this format will be help-
ful to practitioners looking for concise data and references in an environment where decisions need
to be made quickly.
Most of the references used for this book are open access sources. We speci¿cally made an eort
to select appropriate sources that would be easily available to readers, unless these sources were
insucient.
Four chapters in this book (Water and electrolyte disorders, Acid-base disorders, Acute kidney
injury and dialysis, and COVID-19) were co-authored by Dr. Robert S. Brown.
We feel sure that you will ¿nd this book helpful in your daily practice and we are very much open
to suggestions how to make the next edition better.

Alexander S. Goldfarb-Rumyantzev, MD, PhD, PhD




xi

, Contents


1. Respiratory Failure, 1
Alexander Goldfarb-Rumyantzev

2. Critical Care Cardiology and Hypertension, 32
Alexander Goldfarb-Rumyantzev

3. Renal Failure and Renal Replacement Therapy, 64
Robert Stephen Brown
Alexander Goldfarb-Rumyantzev

4. Water and Electrolyte Disorders, 90
Robert Stephen Brown
Alexander Goldfarb-Rumyantzev

5. Acid-Base Disorders, 118
Alexander Goldfarb-Rumyantzev
Robert Stephen Brown

6. Infectious Disease in Critical Care Practice, 132
Alexander Goldfarb-Rumyantzev

7. Critical Care Gastroenterology, 180
Alexander Goldfarb-Rumyantzev

8. Hematology and Oncology Aspects of Critical Care, 198
Alexander Goldfarb-Rumyantzev

9. Rheumatology, Immunology, Allergy, 223
Alexander Goldfarb-Rumyantzev

10. Endocrinology Issues in Critical Care, 242
Alexander Goldfarb-Rumyantzev

11. Toxicology Highlights, 260
Alexander Goldfarb-Rumyantzev

12. Neurology Aspects of Critical Care, 265
Alexander Goldfarb-Rumyantzev

13. COVID-19 and Critical Care, 283
Alexander Goldfarb-Rumyantzev
Robert Stephen Brown

14. Useful Formulae and Abbreviations, 299
Alexander Goldfarb-Rumyantzev

Index, 309




xiii