bluuebunny/crossref_metadata_2025_split huggingface dataset:
High-flow Nasal Oxygen Therapy
Authors: Longhini Federico , Navalesi Paolo , Ippolito Mariachiara , Gregoretti Cesare 
Published: March 2024

Abstract
Summary
Oxygen therapy and non-invasive ventilation are first-line treatments for hypoxaemic and hypercapnic acute respiratory failure (ARF), respectively. High-flow oxygen through nasal cannula (HFNC) may represent an alternative treatment. By providing humidified and heated air–oxygen admixture at high flow, HFNC ensures a pharyngeal dead space washout, decreases airway resistance, generates a positive end-expiratory pressure, and enhances the delivery of oxygen. The emerging evidence suggests that HFNC is effective in patients with hypoxaemic and hypoxaemic–hypercapnic ARF, after extubation during the weaning process, after surgery, and possibly immediately prior to intubation. In this chapter, we discuss the use of HFNC in these settings, following discussion of its potential advantageous mechanisms.
Medical Gases and Humidification
Authors: Ball Lorenzo , Tasso Francesco , Vercesi Veronica , Tixi Marco , Firpo Iacopo , Pelosi Paolo 
Published: March 2024

Abstract
Summary
This chapter illustrates the role of medical gases and gas conditioning in the treatment of patients requiring different degrees of respiratory support. Indications for use of medical gases including oxygen, nitric oxide, and helium are discussed. Oxygen has specific indications and toxicity. Thus, hypoxia and hyperoxia should both be avoided for better patient outcomes. Inhaled nitric oxide modifies ventilation perfusion matching and can improve oxygenation in hypoxaemic respiratory failure. Gas conditioning is the process through which inspiratory gases are heated and humidified before being delivered to the patient’s airways. Active and passive devices are available for use during both invasive and non-invasive ventilation, and their use is also mandatory during brief periods of mechanical ventilation.
Monitoring Airway Inflammation and Infection
Authors: Rostron Anthony , Hellyer Thomas , John Simpson A 
Published: March 2024

Abstract
Summary
Lung inflammation is a major cause of respiratory failure. Although infection is a common precipitant of inflammation, it is far from the only cause. Distinguishing sterile from infective inflammation is a challenge. This chapter discusses the approaches to sampling the lungs directly for microbiological and host response assessment. It also examines the role of clinical examination and testing of the systemic and pulmonary compartments in monitoring lung inflammation.
Monitoring Lung-protective Ventilation
Authors: Formenti Paolo , Marini John J 
Published: March 2024

Abstract
Summary
Lung-protective ventilation strategies have been developed to reduce ventilator-associated lung tissue injury and simultaneously improve systemic oxygenation. We now know that mechanical ventilation per se can aggravate lung injury, a process referred to as ‘ventilator-induced lung injury’ (VILI), through several mechanisms, including volutrauma, barotrauma, and biotrauma. Lung-protective ventilation regulates positive end-expiratory pressure (PEEP), maintains a greater number of pulmonary alveoli in an open state, and avoids excessive end-expiratory lung volume and mechanical power while maintaining an adequate tidal volume and minute ventilation. Moreover, in preventing the collapse of open pulmonary alveoli, PEEP not only helps maintain production and function of pulmonary surfactants but also reduces the shear stress. Current research suggests that reduction of ventilator-associated lung injury or VILI is a main avenue for further reducing mortality in this syndrome. In this chapter, we offer a review of the current literature regarding the use of transpulmonary pressure (Ptp), driving pressure, mechanical power, and stress index in reducing the risk of VILI.
Monitoring Respiratory Muscle Function
Authors: Garfield Benjamin , Patel Sunil 
Published: March 2024

Abstract
Summary
Respiratory muscle wasting is an important complication of critical illness. A number of modalities allow monitoring of respiratory muscle function in the critical care unit. Ventilators can produce pressure and surrogate physiological monitoring data that can be used to determine the strength of the respiratory system in a patient who is spontaneously breathing. More detailed assessment of diaphragmatic pressure generation can be undertaken through measurements of oesophageal and gastric pressures by insertion of a specialized nasogastric tube. The addition of phrenic nerve stimulation can be used to avoid the need for voluntary effort in these assessments. Measures of respiratory muscle energy usage and work of breathing add important information about the (un)loading of the respiratory muscles, whilst electromyography and imaging also provide multi-modal approaches to determining function as well as structure. Due to the invasive nature of many of these tests, the variability inherent to their measurement, and the lack of data on clinical outcomes, the development of clinical utility for such monitoring is in its infancy. However, as we improve our abilities to protect the lungs during mechanical ventilation, muscle dysfunction and its measurement are likely to become ever more important determinants of outcomes for those ventilated on critical care units.
Nutrition
Authors: Bear Danielle E , Puthucheary Zudin 
Published: March 2024

Abstract
Summary
The provision of nutrition during critical illness is an essential component of care, providing therapeutic benefit. However, questions surrounding the optimal energy and protein intake remain controversial and are likely dependent on the individual patient characteristics such as severity of illness and co-morbidities. The timing, type of delivery route, and the impact that different formulations have on patient related outcomes like muscle wasting, functional outcomes as well as survival, will be discussed. Common challenges such as delayed gastric emptying will be addressed, and trial based evidence shall be presented for interpretation. This chapter describes the current recommendations for best practice and suggests topics for future research.
Physiotherapy
Authors: Connolly Bronwen , Twose Paul 
Published: March 2024

Abstract
Summary
Physiotherapy in the intensive care unit integrates both respiratory treatments and physical rehabilitation in the management of critically ill patients depending on individual patient assessment and clinical need. Respiratory techniques aim to enhance airway secretion clearance, optimize lung volume and improve oxygenation, reduce airway resistance and work of breathing, and minimize respiratory complications. Physical rehabilitation strategies target the effects of intensive-care-unit-acquired weakness and resulting physical and functional disability. Combining respiratory and physical rehabilitation skillsets, physiotherapists actively contribute to ventilator and tracheostomy weaning as well as holistic rehabilitation programmes for critically ill patients. Aspects of both respiratory and rehabilitation practice require further investigation to inform the evidence base.
Mycobacterial Infections
Authors: Orton Christopher , Jarvis Hannah , Kon Onn Min 
Published: March 2024

Abstract
Summary
Admission of active tuberculosis cases to critical care is rare but associated with a high mortality rate. Diagnostic approaches combining radiology and microbiological aspects allow for rapid commencement of appropriate treatment. Polymerase chain reaction based rapid diagnostics improve diagnostic accuracy and ability to quickly identify resistance patterns. Standard treatment choices and route of administration may need to be modified given uncertain enteral absorption and concerns over drug interactions and drug resistance. Infection control measures continue to be important in a critical care setting for the safety of staff and other patients.
Asthma
Authors: Ricci Mara , Iovino Giovanni Carmine , Mincione Lucrezia , Dell’atti Ivan , Maggiore Salvatore Maurizio 
Published: March 2024

Abstract
Summary
Asthma is a heterogeneous clinical syndrome characterized by recurring episodes of reversible airflow obstruction due to bronchial hyper-reactivity in susceptible subjects. It is the commonest chronic respiratory diseases worldwide, and severe exacerbations frequently require intensive care unit (ICU) care and mechanical ventilation. Exacerbations of asthma lead to impaired alveolar gas exchange and dynamic hyperinflation of the lungs, which if left untreated can rapidly become life threatening. The keys to management of asthma in ICU are medical therapy aimed to reducing airway inflammation and bronchoconstriction, and preservation of safe gas exchange including the use of mechanical ventilation. Asthma requires careful attention to ventilator settings and monitoring to avoid worsening dynamic hyperinflation. The role of non-invasive ventilation, high-flow nasal oxygen, and heliox remain uncertain and are discussed in this chapter.
Thromboembolic Disease
Authors: Patterson Caroline , Bell Derek 
Published: March 2024

Abstract
Summary
Venous thromboembolism (VTE), both deep venous thrombosis (DVT) and pulmonary thromboembolism (PE), represent a significant and often under-recognized threat to the critically ill patient. Critically ill patients’ risk of VTE is influenced by their underlying co-morbidities, the pro-thrombotic effects of the acute illness, and the effects of organ support measures including immobility, sedation, and venous catheter placement. DVT can be readily diagnosed by bedside compression ultrasound, while PE is ideally diagnosed by computed tomography. Bedside echocardiography is insensitive for PE but may help risk stratification or identification of potential massive PE in the context of cardiovascular collapse. High-risk PE, defined by haemodynamic instability, should be managed with systemic thrombolysis and anticoagulation. In intermediate- and low-risk PE, the risk of bleeding outweighs any benefit from thrombolysis, and these patients should be managed with anticoagulation alone. Thromboprophylaxis is important in critically ill patients and needs careful management in the context of acute illness and renal failure.
The Haematological Patient
Authors: Parry-Jones Nilima , Parry-Jones Jack , Wise Matthew P 
Published: March 2024

Abstract
Summary
Haematological patients are at increased risk of critical illness, arising from both infectious and non-infectious insults. Admission should follow discussion between senior haematology and critical care physicians, with consideration of a ‘trial of intensive care’ where there is uncertainty as to whether a patient will benefit from organ support. Outcomes for haematology patients are improving due to better patient selection and advances in patient management, including novel therapies such as chimeric antigen receptor engineered T-cells and immune checkpoint inhibitors. Survival depends more upon reversible aetiology of the critical illness rather than the underlying haematological diagnosis. Good communication, understanding, and realistic discussions regarding outcomes between the haematologist, patient, patient’s family, and critical care physician are crucial.
Sickle-cell Disease
Authors: Fartoukh Muriel , Voiriot Guillaume , Gibelin Aude , Lopinto Julien , Mekontso-Dessap Armand 
Published: March 2024

Abstract
Summary
Sickle-cell disease (SCD) is a pleiotropic genetic disorder caused by a mutation of haemoglobin. Haemolysis and vaso-occlusive phenomena account for both acute and chronic clinical manifestations of the disease that are related to the polymerization of deoxygenated haemoglobin S within the red blood cells and to their subsequent sickling. Associated cellular changes are implicated within a complex network contributing to a multisystem vascular disease. Acute chest syndrome (ACS) is the major critical acute complication, accounting for 70% of the admissions to the intensive care unit, and is the primary cause of death in adult patients. It is characterized by the combination of chest pain, fever, leucocytosis, and new radiological infiltrates, and usually develops in 10%–20% hospitalized patients with vaso-occlusive crisis, after 2.5 days of hospitalization. It may result from several causes (lower respiratory tract infection, fatty embolism, and pulmonary infarction) that lead to regional alveolar hypoventilation and haemoglobin S polymerization. The therapeutic management of ACS includes pain relief and respiratory support and simple or exchange transfusions. Invasive mechanical ventilation is associated with increased morbidity and mortality. Clinical trials are needed for the management and the monitoring of individuals with SCD to improve their survival and quality of life.
Obesity
Authors: Jong Audrey de , Jaber Samir 
Published: March 2024

Abstract
Summary
Obese patients admitted to the intensive care unit (ICU) are at risk of pulmonary complications, mainly because of their predisposition to atelectasis. Non-invasive ventilation (NIV) has proven its safety and efficacy to treat and/or prevent acute respiratory failure. Use of high-flow nasal cannula oxygen (HFNC) allows warm, humidified oxygen to be administered and provides a moderate level of positive end-expiratory pressure (PEEP). Mask ventilation and intubation are more difficult in obese than in non-obese patients. Then, a protocol of difficult airway management should be applied, using difficult airway devices such as videolaryngoscopes, to prevent complications related to intubation (severe hypoxaemia, arterial hypotension, and cardiac arrest). Preoxygenation optimization in a semi-sitting position using positive-pressure ventilation (continuous positive airway pressure or NIV) may be helpful. Apnoeic oxygenation using HFNC may be considered in obese patients with the aim of preventing desaturation. After securing the airway, a lung-protective ventilation, using low tidal volume (TV), moderate-to-high PEEP, and recruitment manoeuvres should be applied to avoid both baro-volutrauma and atelecto-biotrauma. TV should be set according to ideal body weight (IBW) and not actual body weight as the height of the lung is correlated with the height of the patient. The optimal TV recommended is between 6 and 8 mL/kg IBW. In case of acute respiratory distress syndrome, prone positioning can be used safely, facilitating improvements in oxygenation and respiratory mechanics. Obesity hypoventilation syndrome and obstructive-apnoea syndrome should be sought, and treated, including the use of positive airway pressure at home. These measures can prevent or reduce obesity-associated pulmonary complications.
Pneumothorax and Air Leaks
Authors: Rocca Giorgio Della , Vetrugno Luigi 
Published: March 2024

Abstract
Summary
Pneumothorax in critically ill patients is a potentially life-threatening condition requiring prompt recognition and management. It occurs most commonly in the context of thoracic trauma or following an invasive procedure, such as mechanical ventilation, central venous catheterization, or thoracentesis. Over the past years, due to the introduction of lung-protective ventilation strategies and the extensive use of ultrasound for central venous catheterization, the incidence of pneumothorax appears to be declining. Pneumothorax can present itself with or without the classic symptoms, which are acute thoracic pain, shortness of breath, tachypnoea, tachycardia, and hypoxia. Additional clinical signs include reduction in lung expansion, diminished breath sounds, and cyanosis. However, these symptoms and signs may be concealed in the context of critically ill, sedated patients. Moreover, occult pneumothorax cannot be recognized by means of a supine chest X-ray, but instead requires thoracic computed tomography or lung ultrasound scanning for diagnosis. To date, no specific guidelines have been published for the treatment of traumatic and iatrogenic pneumothorax in the intensive care setting; however, a consensus exists among experts that the volume of pneumothorax should constitute a determining factor in the decision of whether to insert a chest tube or whether conservative treatment is more appropriate.
The Obstetric Patient
Authors: Crozier Timothy 
Published: March 2024

Abstract
Summary
Critical illness in the obstetric patient (pregnant or within 6 weeks of delivery) requiring intensive care unit admission is uncommon. Respiratory failure/severe respiratory illness may occur secondary to a variety of insults, some of which are unique to pregnancy. Physiological changes that occur in pregnancy and the postpartum period may confound interpretation of vital signs and investigations, in addition to having important implications for interventions such as intubation and ventilation and maternal positioning. Deep venous thrombosis prophylaxis must be undertaken. The presence of a ‘second patient’ in the form of the unborn foetus poses additional challenges in this population. Medication prescription and radiological investigations should be carefully evaluated in terms of risk/benefit for both mother and child, and physiological target setting should consider implications for utero-placental flow and foetal well-being. There is minimal high-quality evidence available to guide practice in the critically ill obstetric population, and specific management is usually extrapolated from the non-pregnant population and modified. A multi-disciplinary team with early and close involvement of an obstetrician is vital for the management of these women. In pregnancies of a viable gestation, consideration of obstetric delivery should be planned for although evidence to guide decision-making is lacking.
Principles of infectious disease control
Authors: Kim-Farley Robert J. 
Published: March 2024

AbstractInfectious diseases remain a leading cause of morbidity, disability, and mortality worldwide. Lower respiratory infections are the fourth leading causes of death worldwide and their control is a constant challenge that faces health workers and public health officials in both industrialized and developing countries. This chapter provides a global and comprehensive view of the principles of infectious disease control through examination of the magnitude of disease burden, the chain of infection (agent, transmission, and host) of infectious diseases, the varied approaches to their prevention and control (measures applied to the host, vectors, infected humans, animals, environment, and agents), and the factors conducive to their eradication as well as emergence and re-emergence.
History and examination
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Hateley Peter , Kelly Dearbhla , McGurgan Iain 
Published: March 2024

Abstract
This chapter discusses taking a history and examination of a patient. It includes systemic enquiry, non-specific symptoms, physical examination, non-specific signs, cardiovascular system, pulses, jugular venous pressure, heart sounds, cardiac murmurs, respiratory system, gastrointestinal system, abdomen, neurological system, mental health examination cranial nerves, musculoskeletal examination, peripheral vascular system, genitourinary system, breast, thyroid, higher mental function, and method and order for a routine examination.
Gastroenterology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Hateley Peter , Kelly Dearbhla , McGurgan Iain 
Published: March 2024

Abstract
This chapter explores gastroenterology, including healthy eating, the mouth, endoscopy and biopsy, dysphagia, nausea and vomiting, dyspepsia and peptic ulcer disease, gastro-oesophageal reflux disease (GORD), upper gastrointestinal bleeding, diarrhoea, constipation, ulcerative colitis (UC), Crohn’s disease, gastrointestinal malabsorption, Coeliac disease, irritable bowel syndrome (IBS), chronic pancreatitis, carcinoma of the pancreas, jaundice, liver failure, cirrhosis, viral hepatitis, alcohol misuse, primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), autoimmune hepatitis (AIH), non-alcoholic fatty liver disease (NAFLD), Wilson’s disease/hepatolenticular degeneration, liver tumours, hereditary haemochromatosis (HH), and a1-antitrypsin (A1AT) deficiency.
Rheumatology
Authors: Wilkinson Ian B. , Raine Tim , Wiles Kate , Hateley Peter , Kelly Dearbhla , McGurgan Iain 
Published: March 2024

Abstract
This chapter explores rheumatology, including rheumatological history, assessing the locomotor system, rheumatological investigations, back pain, osteoarthritis (OA), septic arthritis, rheumatoid arthritis (RA), gout, calcium pyrophosphate deposition, ankylosing spondylitis (AS), enteropathic, psoriatic, and reactive arthritis, systemic sclerosis, mixed connective tissue disease, relapsing polychondritis, polymyositis and dermatomyositis, systemic lupus erythematosus (SLE), giant cell arteritis, polyarteritis nodosa, microscopic polyangiitis, polymyalgia rheumatica, fibromyalgia, ocular manifestations, dermatological manifestations, acute SLE, acute systemic vasculitis, acute cord compression, GCA, methotrexate-induced pneumonitis, neutropenic sepsis, scleroderma: pulmonary hypertensive or renal crisis, and septic arthritis.
Heritable human genome editing: correction, selection and treatment
Authors: Scott Rosamund 
Published: March 2024

Abstract
Heritable human genome editing (HHGE) to correct a nuclear gene sequence that would result in a serious genetic condition in a future child is presented as ‘treatment’ in various ethics and policy materials, and as morally preferable to the ‘selection’ practice of preimplantation genetic testing (PGT), which is subject to the disability critique. However, whether HHGE is ‘treatment’ for a future child, or another form of ‘selection’, or whether HHGE instead ‘treats’ prospective parents, are now central questions in the debate regarding its possible legalisation. This article argues that the idea of ‘treatment’ for a future child is largely a proxy for ‘seriousness of purpose’, intended to distinguish HHGE to avoid serious genetic conditions from less obviously justifiable uses; that HHGE is best understood, and morally justified, as a form of ‘treatment’ for prospective parents who strongly desire an unaffected genetically related child and who have no, or poor, options to achieve this; that HHGE would be morally permissible if consistent with that child’s welfare; that legalisation is supportable with reference to the right to respect for private and family life under Article 8 of the European Convention on Human Rights; and that HHGE is morally distinguishable from PGT.