Intensive Care Medicine The Essential Guide
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Dedication to Dr Alexander Murray Fletcher
Alex, one of the contributing authors for several of the chapters in this
book, brought boundless enthusiasm, laughter and kindness to all those
with whom he worked. Greatly valued by his patients, he was able to
connect with people from all walks of life with a common-sense approach
to medicine.
He was a fantastic clinician, father, husband, brother, son and friend who
is missed dearly by his family, friends and colleagues. He touched so many
lives, though his was far too brief, and we are so grateful to be able to leave
this dedication as a small way of recognising Alex’s love for life and his
contribution to the world.
Dedication to Dr Kevin Hamilton
This book is also dedicated to Kevin Hamilton, another intensivist whose
loss is so keenly felt by the many colleagues and trainees he inspired and
encouraged during his too brief life. His great gift was that which is easy
to recognise but hard to define, and indeed, this book cannot teach you –
‘humanity’. Let this be the chapter he is not here to write. If you cannot
understand the lesson, proceed no further with this book – the specialty is
not for you.
Dedicated to all our fellow intensive care and hospital staff for their
bravery and resilience in the face of this awful pandemic.
Carl, Ned and Dev
To my father Dinesh Chandra Dutta who ignited my passion in life with
unrivalled support. Also to my family for the gift of love, patience and
support.
Debashish Dutta
To Grace, Arlo and Luxley
They say patience is a virtue, and you have all demonstrated oodles of it.
Thank you, thank you and thank you.
Ned GK
Dedication to Dr Alexander Murray Fletcher
Alex, one of the contributing authors for several of the chapters in this
book, brought boundless enthusiasm, laughter and kindness to all those
with whom he worked. Greatly valued by his patients, he was able to
connect with people from all walks of life with a common-sense approach
to medicine.
He was a fantastic clinician, father, husband, brother, son and friend who
is missed dearly by his family, friends and colleagues. He touched so many
lives, though his was far too brief, and we are so grateful to be able to leave
this dedication as a small way of recognising Alex’s love for life and his
contribution to the world.
Dedication to Dr Kevin Hamilton
This book is also dedicated to Kevin Hamilton, another intensivist whose
loss is so keenly felt by the many colleagues and trainees he inspired and
encouraged during his too brief life. His great gift was that which is easy
to recognise but hard to define, and indeed, this book cannot teach you –
‘humanity’. Let this be the chapter he is not here to write. If you cannot
understand the lesson, proceed no further with this book – the specialty is
not for you.
‘Every clinician must be modest enough to question their line of thinking and
their decisions made.’
Anonymous
Contents
Contributors Page xvii
Preface xxiii
Foreword xxv
Section 1: Resuscitation and 2.2 Principles of Performing an Accurate Clinical
Examination 24
Management of the Acutely Ill Claire Moorthy
Patient 1 2.3 How to Undertake Timely and Appropriate
1.1 General Introduction to the Recognition, Investigations 27
Assessment and Stabilisation of the Acutely Claire Moorthy
Ill Patient with Disordered Physiology 1 2.4 General Principles of Performing and
Claire Moorthy Interpretation of Electrocardiography
1.2 Management of Cardiopulmonary Results 29
Resuscitation – Advanced Life Support 2 Kyron Chambers
Jonny Coppel 2.5 General Principles of Obtaining Appropriate
1.3 Principles of Management of the Patient Microbiological Samples and Interpretation
Post-resuscitation 6 of Results 34
Jonny Coppel Tom Bottomley
1.4 Principles of Triaging and Prioritising 2.6 Obtaining and Interpretation of Results
Patients Appropriately, Including Timely from Blood Gas Samples (Acid–Base Balance
Admission to ICU 9 and Disorders) 37
Claire Moorthy Ed McIlroy
1.5 Initial Assessment and Management 2.7 Principles of Interpreting Imaging Studies
of the Trauma Patient 11 (X-ray/CT/MRI) 43
Anil Dhadwal Chun Wah So and Matthew Gale
1.6 Principles of Assessment and Initial 2.8 Imaging of the Chest 47
Management of the Patient with Burns 14 Chun Wah So and Matthew Gale
Behrad Baharlo 2.9 Imaging of the Head 61
1.7 Description and Management of Mass Chun Wah So and Matthew Gale
Casualties 18 2.10 Imaging of the Abdomen 68
Jonny Price and Scott Grier Chun Wah So and Matthew Gale
2.11 Importance of Monitoring and Responding
Section 2: Diagnosis, Assessment, to Trends in Physiological Variables 75
Claire Moorthy
Investigation, Monitoring and Data
Interpretation 21 2.12 How to Integrate Clinical Findings with
Laboratory Investigations to Form a
2.1 Principles of Obtaining a History 21 Differential Diagnosis 79 ix
Claire Moorthy Claire Moorthy
Contents
Domain 3: Disease Management: Section 3.3: Acute Liver
Recognition, Causes Failure 157
and Management 83 3.3.1 Acute-on-Chronic Liver Failure 157
Michael Spiro and Jeremy Fabes
Section 3.1: Cardiac and Circulatory
3.3.2 Jaundice 160
failure 85 Michael Spiro and Jeremy Fabes
3.1.1 Acute Coronary Syndromes 85
3.3.3 Ascites 164
Michael Hoy
Michael Spiro and Jeremy Fabes
3.1.2 Cardiac Pacing, Implantable
Cardioverter–Defibrillators and Cardiac 3.3.4 Portal Hypertension 168
Resynchronisation Therapy 90 Michael Spiro and Jeremy Fabes
Paul Harris 3.3.5 Hepatorenal Syndrome and
3.1.3 Acute Heart Failure 93 Hepatopulmonary Syndrome 171
Paul Harris Michael Spiro and Jeremy Fabes
3.1.4 Valvular Heart Disease 96 3.3.6 Encephalopathy 174
Katarina Lenartova Michael Spiro and Jeremy Fabes
3.1.5 Congenital Heart Disease 105
Anne-Marie Leo
Section 3.4: Neurological Impairment
3.1.6 Endocarditis 111
Selina Ho and Michael Hoy
and Injury 177
3.4.1 Decreased Consciousness 177
3.1.7 Management of Hypertensive Crises 117
Chris Whitehead and Ian Tweedie
Katarina Lenartova and Anne-Marie Leo
3.4.2 Seizures and Status Epilepticus 181
3.1.8 Atrial fibrillation in the Intensive Care
Unit 122 Chris Whitehead
Paul Harris 3.4.3 Acute Cerebrovascular Accident and Its
3.1.9 Myocarditis 126 Complications 185
Niklas Tapper Chris Whitehead
3.1.10 Pericardial Disease 128 3.4.4 Meningitis 188
Niklas Tapper Arun Krishnamurthy
3.1.11 Shock 132 3.4.5 Tetanus 191
Michael Hoy Sachin Mehta and Manpreet Bahra
3.1.12 Aortic Dissection 137 3.4.6 Delirium 194
Simon Mattison Tamas Bakonyi and Valerie Page
3.4.7 Neuromuscular Disorders 197
Section 3.2: Acute Renal Failure 141 Sachin Mehta and Manpreet Bahra
3.2.1 Acute Kidney Injury 141 3.4.8 Non-traumatic Spinal Cord
Nuttha Lumlertgul, Alistair Connell and Injury 201
Marlies Ostermann Manpreet Bahra and Sachin Mehta
x
Contents
Section 3.5: Acute Gastrointestinal 3.7.2 Host Defence Mechanisms and
Immunodeficiency Disorders 248
Failure 205 Claire McCann
3.5.1 Gastrointestinal Haemorrhage 205 3.7.3 HIV and AIDS 251
Megan Fahy and Liza Keating Claire McCann
3.5.2 Acute Pancreatitis 208 3.7.4 Sepsis and Septic Shock 254
Mike Peters and Liza Keating Ravi Bhatia
3.5.3 Peritonitis and the Acute Abdomen 211 3.7.5 Multiple Organ Dysfunction
Shona Johnson and Liza Keating Syndrome 257
3.5.4 Ileus and Bowel Obstruction 214 Ravi Bhatia
Charles Rich and Liza Keating 3.7.6 Nosocomial Infections 259
3.5.5 Intra-abdominal Hypertension and Ravi Bhatia
Abdominal Compartment Syndrome 216 3.7.7 Severe Soft Tissue Disorders 262
Dominic Moor, Katie Wimble and Ravi Kumar Elizabeth Potter, Gabor Dudas and Alexander
Fletcher
3.7.8 Principles of Antibiotic Use in Intensive
Section 3.6: Acute Respiratory Care 267
Failure 219 James McKinlay and Alexander Fletcher
3.6.1 Pulmonary Embolism 219 3.7.9 Mechanism of Action and Activity of
Benjamin Post Commonly Used Antibiotics 273
James McKinlay, Alexander Fletcher and
3.6.2 Asthma 222
Armine Sefton
Leon Cloherty and Gary Masterson
3.7.10 Antibiotic Prophylaxis, Resistance and
3.6.3 Chronic Obstructive Pulmonary Future Directions 278
Disease 226
James McKinlay and Alexander Fletcher
Lee Poole and Gary Masterson
3.7.11 Anti-fungal Therapies 282
3.6.4 Pneumonia 229
James McKinlay and Alexander Fletcher
Mahmoud Wagih
3.7.12 Antiviral Therapies 285
3.6.5 Acute Respiratory Distress Syndrome 234
James McKinlay and Alexander Fletcher
Mahmoud Wagih
3.7.13 Malaria and Tropical Diseases 287
3.6.6 Pulmonary Oedema 238
Clare Morkane
Marc Zentar and Kate Tatham
3.7.14 The COVID-19 Pandemic 292
3.6.7 Pulmonary Hypertension 242
Christopher Hellyar, Debashish Dutta and Carl
Raj Saha Waldmann
Section 3.7: Infection Section 3.8: Intoxication with Drugs
and Immunity 245 or Environmental Toxins 297
3.7.1 Anaphylaxis 245 3.8.1 Toxicology 297
Claire McCann Timothy Snow
xi
Contents
Section 3.9: Obstetrics and Maternal 3.11.4 Calcium 370
Clare Morkane
Peripartum Complications 307
3.11.5 Magnesium 373
3.9.1 Obstetric Emergencies 307 Clare Morkane
Shrijit Nair and Audrey Quinn
3.11.6 Phosphate 375
3.9.2 Pre-eclampsia and Eclampsia 316 Clare Morkane
Louise Swan and Audrey Quinn
3.9.3 Pre-existing Disease in Pregnancy 320
Laura Vincent and Audrey Quinn
Section 3.12: Endocrine
Disorders 377
Section 3.10: Haematological 3.12.1 Diabetic Emergencies 377
Sridhar Nallapareddy and Jon Griffiths
and Oncological Disorders 327
3.12.2 Syndrome of Inappropriate Anti-diuretic
3.10.1 Disorders of Haemostasis in Intensive Hormone Secretion 381
Care 327 Thomas Leith
Victoria Stables and Mari Thomas
3.12.3 Diabetes Insipidus and Other Polyuric
3.10.2 Thrombotic Disorders in Intensive Care 331 Syndromes 384
Victoria Stables and Mari Thomas Thomas Leith
3.10.3 Anticoagulation, Bridging and Emergency 3.12.4 Thyroid Emergencies 387
Reversal in Intensive Care 333 Sridhar Nallapareddy and Justin Ang
Victoria Stables and Mari Thomas
3.12.5 Adrenocortical Insufficiency in Critical
3.10.4 General Haematology for Intensive Illness 391
Care 336 Tom Parker
Dunnya De-Silva, Emma Drasar and William
Townsend
3.10.5 Malignant Haematology in Intensive
Section 3.13: Severe Trauma
Care 343 and Multiple Injuries 393
Jenny O’Nions and William Townsend
3.13.1 Traumatic Brain Injury 393
3.10.6 Haemostasis, Coagulopathies and the Wilson Fandino
Bleeding Patient 353
3.13.2 Maxillofacial and Upper Airway
Ben Clevenger
Injuries 398
Rajamani Sethuraman
Section 3.11: Metabolic 3.13.3 Traumatic Chest Injuries 402
Disorders 361 Harish Venkatesh and Sanjeev Ramachandran
3.11.1 Acute Electrolyte Abnormalities – An 3.13.4 Traumatic Spinal Cord Injuries 406
Overview 361 Manpreet Bahra and Sachin Mehta
Clare Morkane 3.13.5 Traumatic Abdominal and Pelvic
3.11.2 Sodium 363 Injuries 408
Clare Morkane Karina Goodwin
3.11.3 Potassium 366 3.13.6 Mediastinitis 411
xii Arun Krishnamurthy
Clare Morkane
Contents
Section 3.14: Environmental Pharmacodynamics and Drug
Monitoring) 457
Injuries 415 Caroline Moss
3.14.1 Drowning 415 4.2 Antibiotic Management and
Tom Parker Monitoring 461
3.14.2 Burns 418 James McKinlay and Alexander Fletcher
Behrad Baharlo 4.3 Administration of Blood and Blood
Products in Intensive Care 467
3.14.3 Thermal Disorders 422
Ben Clevenger
Behrad Baharlo
4.4 Monitoring Coagulation, Including
3.14.4 Envenomation 425
Thromboelastography 473
Timothy Snow
Ben Clevenger
3.14.5 Ballistic Injuries 428
4.5 Fluids, Inotropes and Vasopressors,
Tim Hartley
Vasodilators and Anti-hypertensives 477
Ed McIlroy
Section 3.15: Psychiatric Disorders 4.6 Principles of Mechanical Circulatory
Encountered in Intensive Care 433 Support in the Acute Setting 492
Susanna Price and Stephane Ledot
3.15.1 Capacity and Consent Issues in Intensive
Care 433 4.7 Mechanical Ventilation: Initiation,
Ruth Taylor and Peter Byrne Maintenance and Weaning 495
Ranil Soysa and Kate Tatham
3.15.2 Managing Aggression in Intensive Care 437
Ruth Taylor and Peter Byrne 4.8 Renal Replacement Therapy in Critical
Care 500
3.15.3 Overdose, Serotonin Syndrome and Nuttha Lumlertgul, Marlies Ostermann and
Neuroleptic Malignant Syndrome 441 Gursharan Paul Singh Bawa
Ruth Taylor and Peter Byrne
4.9 Nutritional Assessment and Support in
3.15.4 Suicidal Patients in Intensive Care 445 Intensive Care (Enteral and Parenteral
Ruth Taylor and Peter Byrne Nutrition) 510
3.15.5 Anxiety, Psychological Trauma and the Liesl Wandrag
Difficult Patient in Intensive Care 448 4.10 Neuromonitoring and Cerebral
Ruth Taylor and Peter Byrne Protection 515
3.15.6 Substance Misuse and Withdrawal in Wilson Fandino
Intensive Care 452
Ruth Taylor and Peter Byrne
3.15.7 Staff Burnout in Intensive Care 455
Domain 5: Practical
Ruth Taylor and Peter Byrne Procedures 519
Section 5.1: Practical Respiratory
Section 4: Therapeutic Interventions System 521
and Organ Support 457 5.1.1 Oxygen Administration in Intensive
4.1 Principles of Safe Prescription of Drugs and Care 521
Therapeutics (Including Pharmacokinetics, Jo Hackney xiii
Contents
5.1.2 Emergency Front of Neck Airway 5.2.7 Needle Pericardiocentesis in Intensive
Management 523 Care 584
Jo Hackney Peter Remeta
5.1.3 Difficult Intubation Guidelines and Failed 5.2.8 Cardiac Output Measurement and
Airway Management 526 Interpreting the Derived Data 589
Jo Hackney and Benjamin Post Charles M. Oliver
5.1.4 Principles of Performing Fibreoptic 5.2.9 Echocardiography in Intensive Care 592
Bronchoscopy and Broncho-alveolar Andrew P. Walden and Karim Fouad Alber
Lavage in the Intubated Patient 534
Nicola Rowe and Ramprasad Matsa
5.1.5 Percutaneous Tracheostomies and
Section 5.3: Practical Central Nervous
Management of Tracheostomy System 603
Emergencies 538
5.3.1 Principles of Performing a Lumbar Puncture
Ramprasad Matsa (Intradural/‘Spinal’) 603
5.1.6 Chest Drain Insertion 544 Jonathan Barnes
Jonathan Barnes 5.3.2 Management and Administration of
5.1.7 Lung Ultrasound 549 Analgesia via an Epidural Catheter 608
Arthur W. E. Lieveld and Andrew P. Walden Jonathan Barnes
5.1.8 Lung Function Testing 555
Lola Loewenthal Section 5.4: Practical Gastrointestinal
System 611
Section 5.2: Practical Cardiovascular 5.4.1 Abdominal Paracentesis 611
System 561 Jonathan Barnes
5.2.1 Arterial Line Insertion 561 5.4.2 Sengstaken–Blakemore Tube
Oliver Sanders Insertion 614
Jonathan Barnes
5.2.2 Use of Ultrasound for Vascular
Localisation 564 5.4.3 Nasogastric Tube Placement and Position
Jonathan Barnes Confirmation 617
Jonathan Barnes
5.2.3 Central Venous Catheterisation 567
Oliver Sanders
5.2.4 Pulmonary Artery Catheterisation: Insertion
Section 5.5: Practical Genitourinary
and Interpretation 571 System 621
Suehana Rahman
5.5 Urinary Catheterisation 621
5.2.5 Principles of Defibrillation and Oliver Sanders
Cardioversion 576
Jonny Coppel
5.2.6 Cardiac Pacing, Implantable
Section 6: Perioperative Care 623
Cardioverter–Defibrillators and Cardiac 6.1 Management of Pre- and Post-operative
Resynchronisation Therapy 580 Care of the High-Risk Surgical Patient 623
Edward Rintoul and Jeff Philips John Whittle
xiv
Contents
6.2 Management of the Critical Care Patient
Following Cardiac Surgery 627
Section 8: End-of-Life Care 671
Nick Lees 8.1 How to Manage the Process of Withholding
or Withdrawing Treatment with the
6.3 Management of the Critical Care Patient Multidisciplinary Team 671
Following Craniotomy 632 Margaret Presswood
Wilson Fandino
8.2 How to Discuss End-of-Life Care
6.4 Management of the Critical Care Patient with Patients and Their Families/
Following Liver Transplant 635 Surrogates 674
Michael Spiro and Jeremy Fabes Edward Presswood
6.5 Management of the Critical Care Patient 8.3 Managing Palliative Care of the Critically Ill
Following Heart Transplant 638 Patient 677
Nick Lees Shankara Nagaraja
6.6 Management of the Critical Care Patient 8.4 Brainstem Death Testing 680
Following Lung Transplant 642 Shankara Nagaraja
Nick Lees
8.5 Physiological Support of the Organ
6.7 Pre- and Post-operative Management of the Donor 683
Critical Care Trauma Patient 645 Shankara Nagaraja
Rebecca Brinkler and Anthony O’Dwyer
8.6 Management of Organ Donation Following
6.8 Management of the Critical Care Patient Circulatory Death 686
Following Major Abdominal Surgery 648 Shankara Nagaraja
Anthony O’Dwyer and Rebecca Brinkler
Section 9: Paediatric Care 689
Section 7: Comfort and Recovery 653
9.1 Assessment and Management of the Sick
7.1 How to Identify and Attempt to Child 689
Minimise the Physical and Psychosocial Andrew J. Jones and Thomas Brick
Consequences of Critical Illness for Patients
and Families? 653 9.2 Organisation of Paediatric Intensive Care
Alexa Strachan and Paediatric Intensive Care Transport
Services in the UK 692
7.2 Principles of Assessment, Prevention and Andrew J. Jones and Thomas Brick
Treatment of Pain in Intensive Care 656
Harriet Kemp and Helen Laycock 9.3 Safeguarding and Non-accidental
Injury 695
7.3 Sedation and Neuromuscular Blockade in Andrew J. Jones and Thomas Brick
Intensive Care 660
Edward Rintoul and Jeff Philips 9.4 Respiratory Failure 698
Andrew J. Jones and Thomas Brick
7.4 Intensive Care Unit-Acquired Weakness and
Physical Rehabilitation 663 9.5 Paediatric Sepsis 703
Mandy Jones, Alex Harvey and Eve Corner Andrew J. Jones and Thomas Brick
7.5 Follow-Up after Critical Illness 666 9.6 Acute Neurological Disorders 708
Joel Meyer and Andy Slack Andrew J. Jones and Thomas Brick
xv
Contents
9.7 The Collapsed Infant 711 11.3 Principles of Outcome Prediction,
Andrew J. Jones and Thomas Brick Prognostic Indicators and Treatment
Intensity Scales and Limitations of Scoring
9.8 Congenital Heart Disease 714 Systems in Predicting Individual Patient
Andrew J. Jones and Thomas Brick Outcome 746
9.9 Trauma 719 Andrew Selman, Peter Odor and Sam
Andrew J. Jones and Thomas Brick Bampoe
9.10 Acute Liver Failure, Inborn Errors of 11.4 Scoring Systems for Severity of Illness in
Metabolism and Diabetic Ketoacidosis 722 Critical Care 749
Andrew J. Jones and Thomas Brick Katie Samuel and Sam Bampoe
9.11 Analgesia and Sedation in the Paediatric 11.5 Managerial and Administrative
Intensive Care Unit 726 Responsibilities of the Intensive Care
Andrew J. Jones and Thomas Brick Medicine Specialist 752
Alison Pittard
11.6 Communication in Intensive
Section 10: Transport 731 Care 754
10.1 Principles of Transport of the Mechanically Orlanda Allen and Dev Dutta
Ventilated Critically Ill Patient outside the
11.7 Professional Relationships with Members of
ICU 731
the Healthcare Team 756
Jonny Price and Scott Grier
Orlanda Allen and Dev Dutta
10.2 Pre-hospital (Helicopter) Emergency
11.8 Legal and Ethical Issues in Intensive
Medical Services 733
Care 758
Marc Wittenberg and Dominik Krzanicki
Chris Danbury
11.9 The Legal Framework 761
Section 11: Professionalism, Patient Jo Samanta and Dev Dutta
Safety, Governance and Health 11.10 CoBaTrICE: The Importance of
Systems Management 739 Learning Opportunities and Integration
of New Knowledge in Clinical
11.1 Leading the Daily Intensive Care Ward Practice 766
Round 739 Alison Pittard
Julian Howard
11.2 Principles and Compliance with Local
Infection Control Measures 744
Julian Millo Index 769
xvi
Contributors
Authors Affiliation
Alex Harvey Senior Lecturer, Department of Clinical Sciences, Brunel University London,
London, UK
Alexa Strachan Consultant Anaesthetist, Royal Free London NHS Foundation Trust, London, UK
Alexander Fletcher Anaesthetic and Intensive Care Medicine Consultant, Royal Surrey NHS
Foundation Trust, Guildford, UK
Alison Pittard Anaesthetic and Intensive Care Medicine Consultant, Leeds Teaching Hospitals
NHS Trust, Leeds, UK
Alistair Connell Renal Specialist Registrar, University College London Institute for Human Health
and Performance, London, UK
Andrew J. Jones Paediatric Intensive Care Medicine Consultant and Children’s Acute Transport
Service (CATS) Great Ormond Street Hospital, London, UK
Andy Slack Nephrology and Intensive Care Medicine Consultant, Guy’s and St Thomas’ NHS
Foundation Trust, London, UK
Andrew Selman Anaesthetic Specialist Registrar, St George’s Hospital, London, UK
Andrew P. Walden Acute Internal Medicine and Intensive Care Medicine Consultant, Royal Berkshire
Hospital, Reading, UK
Anil Dhadwal Trauma and Orthopaedic Specialist Registrar, Royal Liverpool University Hospital,
Liverpool, UK
Anne-Marie Leo Anaesthetic and Intensive Care Medicine Consultant, Cork University Hospital,
Wilton, Cork, Ireland
Anthony O’Dwyer Anaesthetic Specialist Registrar, London School of Anaesthesia, London, UK
Armine Sefton Consultant Microbiologist, The Princess Alexandra Hospital NHS Trust/Emerita,
Harlow, UK
Arthur W. E. Lieveld Acute Internal Medicine Consultant, Amsterdam Public Health Research Institute,
Amsterdam UMC, Amsterdam, The Netherlands
Arun Krishnamurthy Anaesthetic and Intensive Care Medicine Consultant, The Princess Alexandra
Hospital NHS Trust, Harlow, UK
Audrey Quinn Consultant Anaesthetist, James Cook University Hospital NHS Trust,
Middlesbrough, UK
Behrad Baharlo Anaesthetic and Intensive Care Medicine Consultant, Queen Elizabeth Hospital,
University Hospitals Birmingham, Birmingham, UK
Ben Clevenger Consultant Anaesthetist, Royal National Orthopaedic Hospital, Stanmore, UK
Benjamin Post Anaesthetic and Intensive Care Medicine Specialist Registrar, The Royal London
Hospital, London, UK
Carl Waldmann Anaesthetic and Intensive Care Medicine Consultant, Royal Berkshire Hospital,
Reading, UK
Caroline Moss Anaesthetic and Intensive Care Medicine Consultant, Western Sussex Hospitals
Foundation Trust, Chichester, UK
Charles M. Oliver Consultant Anaesthetist, University College London Hospital, London, UK xvii
List of Contributors
Charles Rich Emergency Medicine and Intensive Care Medicine Specialist Registrar, Thames
Valley, London, UK
Chris Danbury Intensive Care Medicine Consultant, Royal Berkshire Hospital and Visiting Fellow
in Health Law, University of Reading, Reading, UK
Chris Whitehead Anaesthetic and Intensive Care Medicine Consultant, The Walton Centre NHS
Foundation Trust, Liverpool, UK
Christopher Hellyar Anaesthetics Core Trainee, The Princess Alexandra Hospital NHS Trust, Harlow, UK
Chun Wah So Radiology Specialist Registrar, London North West University Healthcare NHS
Trust, London, UK
Claire McCann Anaesthetic Specialist Registrar, Central London School of Anaesthesia,
London, UK
Claire Moorthy Intensive Care Medicine Specialist Registrar, Hospital of St John and St Elizabeth,
London, UK
Clare Morkane Anaesthetic and Intensive Care Medicine Specialist Registrar, Royal Free Hospital
NHS Trust, Royal Free Perioperative Research, London, UK
Debashish Dutta Anaesthetic and Intensive Care Medicine Consultant, The Princess Alexandra
Hospital NHS Trust, Harlow, UK
Dominic Moor Anaesthetic and Intensive Care Medicine Consultant, Basingstoke and North
Hampshire Hospital, Basingstoke, UK
Dominik Krzanicki Consultant Anaesthetist, Royal Free Hospital NHS Trust and Consultant in
Pre-hospital Emergency Medicine Barts Health NHS Trust and London’s Air
Ambulance, London, UK
Dunnya De-Silva Consultant Haematologist, Maidstone and Tunbridge Wells NHS Trust, Tunbridge
Wells, UK
Ed McIlroy Anaesthetic Specialist Registrar, Royal London Hospital, London, UK
Edward Presswood Palliative Medicine Consultant, Dorothy House Hospice Care, Bradford-on-
Avon, UK
Edward Rintoul Anaesthetic Specialist Registrar, The Princess Alexandra Hospital NHS Trust,
Harlow, UK
Elizabeth Potter Intensive Care Medicine and Anaesthetic Consultant, Royal Surrey County
Hospital, Guildford, UK
Emmar Drasar Consultant Haematologist, University College London Hospital, London, UK
Eve Corner Lecturer and Research Physiotherapist, Brunel University London and Imperial
College Healthcare NHS Trust, London, UK
Gabor Dudas Anaesthetic Consultant, Royal Surrey County Hospital NHS Foundation Trust,
Guildford, UK
Gary Masterson Anaesthetic and Intensive Care Medicine Consultant, Royal Liverpool University
Hospital, Liverpool, UK
Gursharan Paul Anaesthetic and Intensive Care Medicine Consultant, BHR University NHS Trust,
Singh Bawa Romford, UK
Harish Venkatesh Anaesthesia and Intensive Care Medicine Specialty Registrar, Royal Berkshire
Hospital, Royal Berkshire NHS Foundation Trust, Reading, UK
Harriet Kemp Anaesthetic and Pain Specialist Registrar, Chelsea and Westminster NHS
Foundation Trust, London, UK
Helen Laycock Anaesthetic and Pain Consultant, Great Ormond Street Hospital, London, UK
Ian Tweedie Anaesthetic and Intensive Care Medicine Consultant, The Walton Centre NHS
Foundation Trust, Liverpool, UK
James McKinlay Senior Clinical Research Fellow, Royal Surrey NHS Foundation Trust,
xviii Guildford, UK
Jeff Phillips Anaesthetic and Intensive Care Medicine Consultant, The Princess Alexandra
Hospital NHS Trust, Harlow, UK
List of Contributors
Jenny O’Nions Consultant Haematologist, University College London Hospital, London, UK
Jeremy Fabes Anaesthetic Specialist Registrar, Royal Free Hospital NHS Trust, London, UK
Jo Hackney Anaesthetic Specialist Registrar, The Princess Alexandra Hospital NHS Trust,
Harlow, UK
Jo Samanta Professor of Medical Law, De Montfort University, Leicester, UK
Joel Meyer Intensive Care Medicine Consultant, Guy’s and St Thomas’ NHS Foundation Trust,
London, UK
John Whittle Anaesthetic and Intensive Care Medicine Consultant, Duke University Medical
School, and Centre for Perioperative Medicine, Durham, NC, USA
Jon Griffiths Anaesthetic and Intensive Care Medicine Specialty Registrar, Ipswich Hospital, East
Suffolk, and North Essex NHS Foundation Trust, Ipswich and Colchester, UK
Jonathan Barnes Anaesthetic and Intensive Care Medicine Specialist Registrar, Severn Deanery, UK
Jonny Coppel Anaesthetic Specialist Registrar, University College London, London, UK
Jonny Price Anaesthetic and Intensive Care Medicine Consultant, Royal United Hospital Bath &
Prehospital Care Doctor, Dorset and Somerset Air Ambulance, UK
Julian Howard Anaesthetic and Intensive Care Medicine Consultant, Royal Free Hospital NHS
Trust, London, UK
Julian Millo Consultant Anaesthetist, Oxford University Hospital, Oxford, UK
Justin Ang Emergency Medicine Specialist Registrar, Ipswich Hospital, East Suffolk and North
Essex NHS Foundation Trust, Ipswich and Colchester, UK
Karim Fouad Alber Anaesthetic and Intensive Care Medicine Specialist Registrar, Thames Valley,
London, UK
Karina Goodwin Anaesthetic and Intensive Care Medicine Specialist Registrar, Harefield Hospital,
Royal Brompton & Harefield NHS Foundation Trust, London, UK
Katarina Lenartova Anaesthetic and Intensive Care Medicine Consultant, Harefield Hospital, Royal
Brompton & Harefield NHS Foundation Trust, London, UK
Kate Tatham Anaesthetic and Intensive Care Medicine Consultant, Royal Marsden NHS
Foundation Trust, London, UK
Katie Samuel Anaesthetic Consultant, Southmead Hospital, North Bristol NHS Trust,
Bristol, UK
Katie Wimble Anaesthetic Specialist Registrar, Royal Surrey County Hospital, Guildford, UK
Kyron Chambers Anaesthetic and Intensive Care Medicine Specialist Registrar, Whittington Health
NHS Trust, London, UK
Laura Vincent Intensive Care Medicine Consultant, John Radcliffe Hospital, Oxford, UK
Lee Poole Anaesthetic and Intensive Care Medicine Consultant, Royal Liverpool University
Hospital, Liverpool, UK
Leon Cloherty Anaesthetic and Intensive Care Medicine Consultant, Whangarei Base Hospital,
Northland DHB, Whangarei, New Zealand
Liesl Wandrag Nutrition & Dietetic Department, Guy’s and St Thomas’ NHS Foundation Trust,
London, UK
Liza Keating Anaesthetic and Intensive Care Medicine Consultant, Royal Berkshire NHS
Foundation Trust, Reading, UK
Lola Loewenthal Respiratory Specialist Registrar, National Heart and Lung Institute, Imperial
College London, London, UK
Louise Swan Specialist Registrar, Royal Victoria Hospital, Newcastle, UK
Mahmoud Wagih Anaesthetic and Intensive Care Medicine Consultant, The Princess Alexandra
Hospital NHS Trust, Harlow, UK
Mandy Jones Reader in Physiotherapy, Brunel University, London, UK
Manpreet Bahra Anaesthetic Specialist Registrar, Royal National Orthopaedic Hospital NHS Trust, xix
London, UK
List of Contributors
Marc Wittenberg Consultant Anaesthetist, Royal Free Hospital NHS Trust and Ex-HEMS Registrar,
Essex & Herts Air Ambulance, London, UK
Marc Zentar Intensive Care Medicine Specialist Registrar, The Royal London Hospital,
London, UK
Margaret Presswood Palliative Medicine Consultant, University Hospital of Wales, Cardiff, UK
Mari Thomas Consultant Haematologist, University College London Hospital, London, UK
Marlies Ostermann Nephrology and Intensive Care Medicine Consultant, Guy’s and St Thomas’ NHS
Foundation Trust, London, UK
Matthew Gale Radiology Specialist Registrar, Nottingham University Hospitals NHS Trust,
Nottingham, UK
Megan Fahy Intensive Care Medicine Specialist Registrar, Queen Elizabeth Hospital
Birmingham, University Hospitals Birmingham NHS Foundation Trust,
Birmingham, UK
Michael Hoy Anaesthetic and Intensive Care Medicine Specialist Registrar, Harefield Hospital,
Royal Brompton & Harefield NHS Foundation Trust, London, UK
Michael Spiro Anaesthetic and Intensive Care Medicine Consultant, Royal Free Hospital NHS
Trust, London, UK
Mike Peters Intensive Care Medicine and Renal Specialty Registrar, Thames Valley Deanery,
London, UK
Ned Gilbert-Kawai Consultant in Intensive Care Medicine and Anaesthesia, Royal Liverpool University
Hospital, Liverpool, UK
Nick Lees Anaesthetic and Intensive Care Medicine Consultant, Royal Brompton & Harefield
NHS Foundation Trust, London, UK
Nicola Rowe Respiratory Specialist Registrar, Royal Shrewsbury Hospital, Shrewsbury and
Telford Hospital NHS Trust, UK
Niklas Tapper Anaesthetic and Intensive Care Medicine Consultant, St Vincent’s Hospital, Sydney,
Australia
Nuttha Lumlertgul Clinical Research Fellow, Guy’s and St Thomas’ NHS Foundation Trust and
Excellence Center for Critical Care Nephrology and Division of Nephrology,
Department of Internal Medicine, King Chulalongkorn Memorial Hospital,
Bangkok, Thailand
Oliver Sanders Otolaryngology Core Surgical Trainee, Southend University Hospital NHS
Foundation Trust, Westcliff-on-Sea, UK
Orlanda Allen Anaesthetic Specialist Registrar, University College London Hospitals, London, UK
Paul Harris Anaesthetic and Intensive Care Medicine Consultant, Harefield Hospital, Royal
Brompton & Harefield NHS Foundation Trust, London, UK
Pete Odor Consultant Anaesthetist, University College London Hospitals, London, UK
Peter Byrne Consultant Liaison Psychiatrist, The Royal London Hospital, East London
Foundation NHS Trust and Visiting Professor at University of Strathclyde, UK
Peter Remeta Anaesthetic and Intensive Care Medicine Specialist Registrar, University Hospital of
Leicester NHS Trust, Leicester, UK
Raj Saha Anaesthetic and Intensive Care Medicine Consultant, The Princess Alexandra
Hospital NHS Trust, Harlow, UK
Rajamani Sethuraman Anaesthetic and Intensive Care Medicine Consultant, The Princess Alexandra
Hospital, Harlow, UK
Ramprasad Matsa Intensive Care Medicine Consultant, Royal Stoke University Hospitals, Stoke, UK
Ranil Soysa Anaesthetic and Intensive Care Medicine Specialist Registrar, Imperial School of
Anaesthesia, London, UK
xx Ravi Bhatia Consultant Anaesthetist, King’s College Hospital NHS Foundation Trust, London, UK
