Table Of ContentLessons from the ICU
Under the Auspices of the European Society of Intensive Care Medicine
Series Editors: Maurizio Cecconi · Daniel De Backer
František Duška
Mo Al-Haddad
Maurizio Cecconi Editors
Intensive Care
Fundamentals
Practically Oriented Essential Knowledge
for Newcomers to ICUs
https://avxhm.se/blogs/hill0
Lessons from the ICU
Under the Auspices of the European Society
of Intensive Care Medicine
Series Editors
Maurizio Cecconi, Head Dept Anesthesia and ICU
Humanitas Research Hospital Head Dept Anesthesia and ICU
Rozzano, Milano, Milano, Italy
Daniel De Backer, Dept Intensive Care
Université Libre de Bruxelles Dept Intensive Care Erasme University
Bruxelles, Brussels Hoofdst.ge., Belgium
https://avxhm.se/blogs/hill0
Series Editors: M. Cecconi, D. De Backer
is a Book Series published by Springer under the auspices of the European Society of Intensive Care
Medicine (ESICM). The aim of the Series is to provide focused and state-of-the-art reviews of central top-
ics in Intensive Care. Ultimately, its mission is to transfer the latest knowledge to the bedside in order to
improve patient outcomes. Accordingly, the ESICM has also developed Lessons from the ICU with the
vision or providing the best resources for everyone working in Intensive Care. Lessons from the ICU
Each volume presents a comprehensive review of topical issues in Intensive Care. The volumes are
intended to cover the majority of aspects that intensive care professionals are likely to encounter in the
course of their career. Books offer an excellent guide for residents who are new to the ICU, and for allied
professionals, senior consultants as well as nurses and allied healthcare professionals.
The chapters are organized in a way that allows the reader to quickly familiarize or reacquaint them-
selves with the pathophysiological background before moving on to diagnosis and treatment. Each chap-
ter includes a list of Take Home Messages, as well as practical examples that apply theoretical knowledge
in real clinical scenarios. Each volume in the Series is edited by international Key Opinion Leaders in
Intensive Care, and each chapter is written by experts in the field.
In summary, this Series represents a valuable contribution to fill the gap in the current Intensive Care
literature by providing top-quality literature reviews that can be easily digested and used at the bedside to
improve patient outcomes.
Corresponding Series Editors and responsible for new book proposals : Maurizio Cecconi @ maurizio.
[email protected], Daniel De Backer @ [email protected]
https://avxhm.se/blogs/hill0
František Duška • Mo Al-Haddad • Maurizio Cecconi
Editors
Intensive Care
Fundamentals
Practically Oriented Essential Knowledge for Newcomers to ICUs
https://avxhm.se/blogs/hill0
Editors
František Duška Mo Al-Haddad
Anaesthesia and Intensive Care Medicine Intensive Care Unit
Third Faculty of Medicine Queen Elizabeth University Hospital
Charles University Glasgow, UK
Prague, Czech Republic
Maurizio Cecconi
Head Dept Anesthesia and ICU
Humanitas Research Hospital
Rozzano, Milano, Italy
ISSN 2522-5928 ISSN 2522-5936 (electronic)
Lessons from the ICU
ISBN 978-3-031-21990-0 ISBN 978-3-031-21991-7 (eBook)
https://doi.org/10.1007/978-3-031-21991-7
© European Society of Intensive Care Medicine 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and trans-
mission or information storage and retrieval, electronic adaptation, computer software, or by similar or
dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
https://avxhm.se/blogs/hill0
V
How to Use This Book?
n Intended Learning Outcomes
1. Describe the background and aims of intensive care fundamentals book
2. Explain how to use the book
The Origins of Intensive Care Fundamentals
Since its dawn in Blegdams Hospital in Copenhagen during the polio pandemic in
1952, ICM specialists have been helping individuals to survive critical illness. Now-
adays, the development of many areas of healthcare is reliant on intensive care
services, and the recent pandemic fostered further developments in this field. ICM
is a multidisciplinary branch of medicine. There are different educational pathways
to become an intensivist: in some countries (Spain, Switzerland, the UK), ICM is a
primary specialty, whilst in most others ICM is a supra-specialty to different base
specialties (anaesthesia, internal medicine, respiratory medicine, cardiology, neu-
rology, nephrology, surgery, etc.). Invariably, these specialties include a degree of
exposure to intensive care through specialised training pathways. In turn, there has
been an increasing number of trainees who train and work in ICUs every year
either at the start of the pathway to become an intensivist or as part of training in
different specialties. The educational needs of these doctors-in-training are similar
across Europe, but their training is different. Only a minority of hospitals use stan-
dardised induction courses tailored to the educational needs of doctors on their
first placement in ICU.
The European Society of Intensive Care Medicine (ESICM) in close collaboration
with national ICM societies contributes significantly to the advancement of knowl-
edge in ICM. This was achieved by the promotion of the highest standards of multi-
disciplinary care of critically ill patients and their families through education,
research, and professional development. The ESICM Academy and Master Classes
offer the highest standard of education in ICM. The society also supervises summa-
tive assessment of ICM competences in the European Diploma in Intensive Care
(EDIC) examination. Yet, a standardised induction course was missing in this rich
educational landscape and ICF is an initiative aiming to fill this gap (see . Fig. 1).
ICF is a standardised face-to-face course, which includes case-based scenarios,
interactive workshops, and simulations that have been carefully prepared and stan-
dardised by ESICM expert to be delivered locally in local languages by ESICM-
trained and certified faculty members. The format was chosen to allow enough
flexibility to tailor the training according to local practices, SOPs, and customs,
whilst on the other hand embedding the principles of current evidence-based prac-
tices in the standardised content. Before coming to the face-to-face course, trainees
are required to refresh their basic knowledge, which is covered in this book.
ICF has been created based on intended learning outcomes, a priori defined using
a Delphi method by ESICM Clinical Training Committee members, having in mind
the needs of junior trainees during their first month of practice. ICF should by no
means be mistaken as an advanced educational requirement for the European
https://avxhm.se/blogs/hill0
V I How to Use This Book?
. Fig. 1 Structure of educational content offered by ESICM for intensivists in different stages of
training. ICF represent the induction for newcomers to intensive care. Note: CoBaTrICE Competency-
Based Training in Intensive Care, 7 https://www.esicm.org/education/cobatrice/; EDEC European
Diploma in Echocardiography
Diploma in Intensive Care or national exams. The competencies that define an inten-
sivist at the end of training, regardless of the pathway of the training, were defined
by EU-funded Competency-Based Training programme in Intensive Care Medicine
for Europe (CoBaTrICe) project, which has been recently updated. Rather, we con-
sider ICF as the ideal start to the long training pathway in the fascinating field of
intensive care.
How to Use This Book
We assume no previous exposure to intensive care, and we only rely on medical-
student level knowledge of basic medical disciplines. Some readers may find basic
physiology or pharmacology textbooks handy supplements when reading this book.
Most of the readers with previous experience in ICU might find some chapters too
basic. In this case, we encourage you to go straight to the self-test at the webpage:
7https://academy.esicm.org/enrol/index.php?id=376 and verify that you have the
required knowledge to make the most of the face-to-face course. Interested readers
will find at the end of each chapter a list of suggested resources to enhance their
knowledge in the respective field.
This book is intended to be read before the face-to-face course. After reading the
book, please visit 7www.academy.esicm.org/icf/precourse to sit pre-course test,
which is required for certification. Don’t worry, there is no required pass mark at this
stage. After completing the test, you can access the preparatory material for the face-
to- face course, such as introductory vignettes to cases and simulation scenarios.
https://avxhm.se/blogs/hill0
VII
How to Use This Book?
Note: If you have obtained this book without registering for ICF, you can still use the
self-testing tools and some online supplementary materials after free registration at
7www. academy. esicm. org/icf.
Further Reading
5 Common Training Framework in Intensive Care Medicine: 7https://www.
uems. eu/__data/assets/pdf_file/0007/19753/Item- 3. 2. 1- ETR-Training-requirements-
in-ICM-final-26-sept-2014. pdf.
5 Competency Based Training programme in Intensive Care Medicine for Europe
(CoBaTrICe, 2022 updates): 7https://www.esicm.org/education/cobatrice/.
n Intended Learning Outcomes
At the end of this course, the participant of ICF should be able to:
Outcomes 1: The Deteriorating Patient
5 Demonstrate the identification of the acutely ill or deteriorating patient (in a simu-
lated setting).
5 Identify life-threatening conditions in an effective and timely fashion using the
ABCDE approach (in a simulated setting).
5 Demonstrate patient stabilisation and initial treatment for a critically ill patient (in
a simulated setting).
5 Discuss the risks and possible pitfalls of transporting of the critically ill patient.
5 Recognise and manage circulatory arrest and peri-arrest states (in a simulated set-
ting).
5 Describe the patient at risk of difficult intubation and demonstrate an understand-
ing of when to call for help.
Outcomes 2: Ward Round
5 Demonstrate a routine daily reassessment of a patient in a structured manner (in a
simulated setting).
5 Adequately prescribe venous thromboembolic disease and stress ulcers prophy-
laxis.
Outcomes 3: Organ Support
3a. Acute respiratory failure
5 Describe the indications and modalities of oxygen therapy, non-invasive venti-
lation methods, indicate intubation and invasive mechanical ventilation.
5 Apply basic physiological principles of mechanical ventilation—volumes, pres-
sures, compliance, etc. to the most common lung pathologies and basic modes
of ventilation.
5 Demonstrate the ability to initially set a ventilator and adapt ventilatory set-
tings for the most common types of ventilation disorders, including obstructive
pulmonary disease and ARDS (in a simulated setting/app).
5 Select an adequate PEEP based on physiological values (in a simulated setting/
app).
5 Identify the most common types of ventilator interference.
https://avxhm.se/blogs/hill0
V III How to Use This Book?
5 List the most common cause of sudden hypoxia in the tracheostomised patient.
5 Discuss the management of the acutely hypoxic patient on mechanical ventila-
tion in ICU.
5 Describe the principles of weaning from mechanical ventilation, readiness test-
ing, and the risk factors for weaning failure.
3b. Shock and Haemodynamic monitoring
5 Describe basic cardiovascular physiology and its monitoring in the context of
the most common pathologies in the ICU, including cardiac output and its
measurement, left heart failure, and right heart failure.
5 Demonstrate assessment of fluid responsiveness in the simulated haemody-
namically unstable patient/case.
5 Discuss the indications and use of vasopressor therapy.
5 Describe the different aetiologies of shock, recognise the role of POCUS to
help assess the causes of haemodynamic instability.
3c. Sepsis and septic shock
5 Discuss the warning signs of life-threatening infection.
5 Discuss the one-hour bundle of treatment.
5 Describe the most common ICU acquired infections and propose an adequate
initial antibiotic treatment.
5 Identify the need for urgent source control in sepsis where appropriate in a
simulated setting or case.
5 Describe the basics of antibiotic stewardship.
3d. Metabolic derangements
5 Interpret arterial blood gases.
5 Describe a treatment plan for patients with life- threatening electrolyte and met-
abolic disturbances.
5 Propose adequate management for patients with the most common mineral
metabolism disorders, especially hyperkalaemia and hypernatraemia.
5 Discuss the importance of fluid choice and balance in the critically ill patient.
3e. Renal failure
5 Recognise patients indicated for urgent renal replacement therapy (in simulated
patient/case).
5 Describe common RRT modes and compare haemodialysis, haemofiltration,
and haemodiafiltration.
3f. Nutrition
5 Explain the benefits and risks of enteral and parenteral nutrition.
3g. Treatment and prevention of delirium, sedation, and analgesia
5 Discuss the physical and psychosocial needs of hospitalised patients with
regard to the prevention of delirium.
5 Describe signs of hypo- and hyperactive delirium and potential treatments
5 Safely prescribe sedation and analgesia in a simulated ICU setting or case,
including adequate use of sedation holds.
Outcomes 4: Specific Pathologies in the ICU
4a. Trauma and surgery
5 Discuss suitable options for perioperative pain management.
5 Apply the principles of blood transfusion to a simulated patient with life-
threatening haemorrhage/trauma.
https://avxhm.se/blogs/hill0
IX
How to Use This Book?
5 Diagnose and propose a treatment plan for the common coagulopathies in a
simulated scenario or case.
5 Discuss the management of haemorrhage in the setting of anticoagulant/anti-
platelet agent use.
4b. Neurological emergencies and basics of neurointensive care
5 Describe the pathophysiology of intracranial hypertension and its operative
and non- operative management.
5 Describe a treatment plan for patients with various neurological injuries (TBI
and stroke).
5 Plan neuroprotective strategies following cardiac arrest in a simulated patient
or case.
5 Discuss the immediate actions needed when the patient is showing signs of con-
ing.
5 Explain the meaning of neuroprotective measures in patients with brain injury.
5 Discuss the initial management of seizures and status epilepticus.
5 Describe the principles of post-resuscitation care prognostic assessment post-
CPR.
4c. Medical emergencies
5 Recognise life-threatening brady and tachyarrhythmias and provide treatment
options in a simulated setting.
Outcomes 5: Non-Technical Aspects of Intensive Care
5a. Ethics of intensive care, end-of-life aspects
5 Explain the limitations of intensive care, and the principles of withholding and
withdrawing treatment, including potential organ donation.
5 Describe a management and treatment plan for the patient at the end of life
and adequately prescribe symptomatic therapy.
5b. Crisis resource management and communication in crisis
5 Discuss the principles of communication in crisis and crisis resource manage-
ment (leadership, membership, situational awareness) and relate them to their
own experience and professional context.
5 Communicate in a professional but effective and assertive manner in a simu-
lated emergency.
5 Demonstrate a succinct and structured handover in a simulated setting.
Outcomes 6: Equipment
5 Troubleshoot common issues with equipment: monitoring, arterial line, central
line, chest drain.
https://avxhm.se/blogs/hill0
