MANAGEMENT OF CRITICALLY
ILL PATIENTS
The following sections examine the care of patients with
some common diagnoses in critical care: sepsis, ARDS,
hepatic failure, and renal failure. Many management
plans have data supporting the use of protocol-based
therapy. Others are introductory management ideas that
may lead to integration into future protocols but are discussed
here because of their importance in critical care.
SEPSIS AND MULTISYSTEM ORGAN
FAILURE
Sepsis is the leading cause of death in critically ill patients
in the United States and develops in 750,000 people
annually.1 The economic costs of sepsis are large, with
annual expenditures totaling nearly $17 billion.1 The
high mortality rate and economic costs have led to considerable
interest in the development of effective therapies
for sepsis. As with other areas of medicine, adoption
plus integration of new treatment strategies into routine
clinical practice has been slow. After many years of unsuccessful
clinical trials, randomized controlled trials have
begun to show efficacy. The following therapies—cortisol
replacement, glucose control, and activated protein C—
have been intensively studied.