| Anatomy, Physiology, and Assessment Techniques | p. 1 |
| Introduction to the Care of Critically III and Injured Patients | p. 3 |
| Clinical Limitations of Hemodynamic Measurements | p. 3 |
| Other Important Considerations | p. 5 |
| Pulmonary Anatomy and Physiology | p. 9 |
| Pulmonary Anatomy and Physiology | p. 10 |
| Ventilation | p. 10 |
| Distribution | p. 15 |
| Diffusion | p. 19 |
| Perfusion/Transport | p. 23 |
| Physical Factors that Affect Distribution of Lung Blood Volume | p. 28 |
| Transport | p. 35 |
| Physical Assessment of the Pulmonary System | p. 43 |
| Overview of Physical Assessment | p. 43 |
| Symptoms and Signs of Pulmonary Disease | p. 44 |
| Specific Techniques of Physical Assessment | p. 51 |
| Cardiovascular Anatomy and Physiology | p. 57 |
| Overview of the Cardiovascular System | p. 57 |
| Heart | p. 57 |
| Factors Affecting Cardiac Output | p. 73 |
| Coronary Circulation | p. 74 |
| Factors That Determine Coronary Blood Flow | p. 75 |
| Circuit (Vascular System) | p. 79 |
| Physical Assessment of the Cardiovascular System | p. 91 |
| Symptoms and Signs of Cardiovascular Disease | p. 91 |
| Specific Techniques of Physical Assessment | p. 94 |
| Monitoring Techniques | p. 111 |
| Fluid-Filled Monitoring Systems | p. 113 |
| Fluid-Filled Monitoring Systems | p. 113 |
| Types of Monitoring Systems | p. 113 |
| Components of the Fluid-Filled Electronic Monitoring System | p. 115 |
| Physical Principles Involved in Pressure Monitoring Systems | p. 117 |
| Dynamic Response Testing | p. 121 |
| Orientation of the Intravascular Catheter Relative to the Flow of Blood and Catheter Whip Artifact | p. 123 |
| Assembly of the Monitoring System | p. 123 |
| Patient Position for Zero Referencing and Pressure Monitoring | p. 124 |
| Zero Referencing | p. 125 |
| Leveling | p. 125 |
| Monitor and Transducer Calibration | p. 129 |
| Conclusion | p. 129 |
| Glossary | p. 130 |
| Arterial Pressure Monitoring | p. 133 |
| Definition of Arterial Pressure | p. 133 |
| Clinical Caveats for All Types of Arterial Pressure Measurements | p. 134 |
| Indirect Methods of Measuring Blood Pressure | p. 135 |
| Direct Arterial Pressure Measurement | p. 142 |
| Comparison of Direct and Indirect Blood Pressure Measurements | p. 158 |
| Establishment of Central Venous Access | p. 161 |
| Insertion Sites | p. 162 |
| Equipment for Cannulation of the Central Veins | p. 164 |
| Preinsertion Protocol and Considerations | p. 164 |
| Techniques for Gaining Venous Access | p. 166 |
| Percutaneous Access Systems and Techniques | p. 167 |
| Sites of Central Venous Catheter Insertion | p. 169 |
| Immediate Life-Threatening Complications | p. 173 |
| Postinsertion Protocol and Site Maintenance | p. 174 |
| Central Venous Catheter Removal | p. 174 |
| Monitoring Central Venous Pressure | p. 177 |
| Clinical Application of Central Venous Pressure Measurements | p. 177 |
| Limitations of Central Venous Pressure Monitoring | p. 180 |
| Central Venous Pressure Measurements Obtained by a Pressure Transducer Versus a Calibrated Water Manometer | p. 181 |
| Central Venous Insertion Sites and Protocol for Catheter Insertion | p. 182 |
| Types of Catheters Used for Central Venous Pressure Measurement | p. 182 |
| Protocols for Obtaining Central Venous Pressure Measurements Using a Pressure Tranducer/Electronic Monitor | p. 183 |
| Complications of Central Venous Pressure Monitoring | p. 185 |
| Catheter Removal | p. 189 |
| Pulmonary Artery Pressure Monitoring | p. 191 |
| Indications for Pulmonary Artery Catheterization | p. 192 |
| Contraindications and Special Considerations of Pulmonary Artery Catheterization | p. 192 |
| Effects of Pulmonary Artery Catheterization on Patient Outcome | p. 193 |
| Catheter Design and Types | p. 195 |
| Methods and Sites of Pulmonary Artery Catheter Insertion | p. 199 |
| Preparation and Equipment Setup | p. 199 |
| Removal of the Pulmonary Artery Catheter | p. 213 |
| Clinical Application of the Pulmonary Artery Catheter | p. 213 |
| Potential Problems and Pitfalls in Obtaining Accurate Hemodynamic Measurements | p. 222 |
| Identification and Solution of Monitoring Problems | p. 234 |
| Complications of Pulmonary Artery Catheterization | p. 236 |
| Monitoring Cardiac Output | p. 245 |
| Factors Affecting Cardiac Output | p. 245 |
| Effect of Anatomic Shunting and Regurgitant Flow on Cardiac Output Measurements | p. 246 |
| Clinical Application of Cardiac Output Measurements | p. 248 |
| Invasive Methods of Calculating Cardiac Output | p. 248 |
| Noninvasive Means of Calculating Cardiac Output | p. 259 |
| Monitoring Oxygenation | p. 263 |
| Physiologic Effects of Hypoxia | p. 264 |
| Oxygen Supply, Demand, and Consumption Balance | p. 264 |
| Conditions That May Compromise Tissue Oxygenation | p. 267 |
| Compensatory Mechanisms | p. 268 |
| Monitoring Techniques for Continuously Assessing the Effectiveness of the Oxygen Transport and Utilization Systems | p. 269 |
| Clinical Applications and Considerations of Combined Arterial and Mixed Venous Oxygen Saturation Monitoring | p. 274 |
| Conditions Associated with Increases In Svo[subscript 2] | p. 278 |
| Summary | p. 280 |
| Care of Critically Ill and Injured Patients | p. 283 |
| Infusion-Related Sepsis | p. 285 |
| Incidence | p. 286 |
| Standardized Microbiologic Definitions of Intravascular Device-Related Infections | p. 286 |
| Clinical Syndromes of Infusion-Related Infection | p. 287 |
| Pathogenesis of Infusion-Related Sepsis | p. 288 |
| Diagnosis of Infusion-Related Sepsis | p. 290 |
| Microorganisms Associated with Infusion-Related Sepsis | p. 292 |
| Risk Factors for Infusion-Related Sepsis | p. 293 |
| Septic Risk Specific to Types of Vascular Catheters | p. 295 |
| Treatment | p. 297 |
| Prevention and Management | p. 297 |
| Pharmacologic Influences on Hemodynamic Parameters | p. 305 |
| Role of Hemodynamic Monitoring in Intensive Care Unit Drug Therapy | p. 305 |
| Factors That Determine Drug Absorption, Distribution, Metabolism, and Excretion | p. 306 |
| Mechanisms of Action of Cardiovascular Medications | p. 308 |
| Pharmacologic Modification of Autonomic Nervous System Influences on the Cardiovascular System | p. 309 |
| Antiarrhythmic Drug Therapy | p. 311 |
| Intravenous Medications Commonly Used for Hemodynamic Support of Critically Ill or Injured Patients | p. 315 |
| Discussion | p. 344 |
| Intraaortic Balloon Counterpulsation | p. 347 |
| Definition | p. 347 |
| Principles Underlying Balloon Counterpulsations | p. 347 |
| Technique of Catheter Placement | p. 349 |
| Effects of the Intraaortic Balloon Pump on the Arterial Waveform | p. 349 |
| Triggers for Balloon Inflation and Deflation | p. 350 |
| Timing of Inflation/Deflation Cycles | p. 350 |
| Physical Assessment Considerations for Patients Being Maintained on the Intraaortic Balloon Pump | p. 354 |
| Balloon Pressure Waveform | p. 355 |
| Causes of Abnormal Balloon Pressure Waveform Morphology | p. 356 |
| Types and Causes of Abnormal Balloon Pressure Waveforms | p. 356 |
| Complications and Risk Factors | p. 357 |
| Conclusion | p. 357 |
| Monitoring the Patient in Shock | p. 361 |
| Pathophysiology | p. 361 |
| Stages of Shock | p. 366 |
| Diagnosis of Shock | p. 370 |
| General Principles of Therapy | p. 372 |
| Classification of Shock by Cause | p. 376 |
| Other Categories of Shock | p. 397 |
| Monitoring the Patient with Multiple-System Organ Dysfunction | p. 403 |
| Historical Perspective | p. 403 |
| Definition | p. 404 |
| Epidemiology | p. 404 |
| Diagnostic Criteria for Organ System Dysfunction and Failure | p. 404 |
| Pathophysiology | p. 404 |
| Hemodynamic Profile | p. 409 |
| Clinical Presentation and Course | p. 412 |
| Laboratory Examination | p. 413 |
| Management | p. 415 |
| Prognosis | p. 418 |
| Monitoring Patients with Acute Pulmonary Disease | p. 421 |
| Acute Respiratory Failure | p. 422 |
| Causes of Acute Respiratory Failure | p. 427 |
| Summary | p. 467 |
| Pediatric Evaluation and Monitoring Considerations | p. 471 |
| Cardiopulmonary Physiology and Maturation in Cardiovascular Function | p. 471 |
| Clinically Relevant Differences Between Children and Adults | p. 479 |
| Clinical Assessment of Hemodynamic Competency in Pediatric Patients | p. 480 |
| Congenital Heart Disease | p. 485 |
| Fluid-Filled Monitoring Systems | p. 494 |
| Monitoring System Setup to Ensure Accurate Display of Hemodynamic Measurements | p. 496 |
| Application of Hemodynamic Monitoring Systems in Assessment of Pediatric Patients | p. 499 |
| Noninvasive and Invasive Techniques of Blood Pressure Measurement | p. 499 |
| Conclusions | p. 511 |
| Specific Monitoring Considerations for Patients with Cardiac Disease | p. 515 |
| Factors Affecting Cardiac Function and Stroke Colume | p. 515 |
| Heart Failure | p. 522 |
| Conclusion | p. 526 |
| Ischemic Heart Disease | p. 527 |
| Epidemiology and Causes | p. 527 |
| Pathophysiology | p. 527 |
| Angina Pectoris | p. 531 |
| Acute Myocardial Infarction | p. 540 |
| Valvular Heart Disease | p. 561 |
| Aortic Stenosis | p. 561 |
| Aortic Regurgitation (Insufficiency) | p. 569 |
| Mitral Stenosis | p. 574 |
| Mitral Regurgitation (Insufficiency) | p. 584 |
| Tricuspid Regurgitation (Insufficiency) | p. 592 |
| Complex Valvular Heart Disease | p. 597 |
| Cardiomyopathies and Pericardial Disease | p. 601 |
| Cardiomyopathies | p. 601 |
| Constrictive Pericardial Disease (Constrictive Pericarditis) | p. 624 |
| Pericardial Tamponade (Cardiac Tamponade) | p. 627 |
| Monitoring the Patient Following Open Heart Surgery | p. 637 |
| Historical Perspective | p. 637 |
| Preoperative Evaluation | p. 638 |
| Preoperative Preparation of the Patient and Family | p. 640 |
| Postoperative Management | p. 640 |
| Index | p. 659 |
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