Chapter: Management of HIV and HCV Infection

Human immunodeficiency virus (HIV) carries a substantial disease burden, both nationally and internationally. World Health Organization (WHO) data indicate that about 39.9 million people were living with HIV globally at the end of 2023 (WHO 2024). In the United States, almost 1.2 million were living with HIV at the end of 2021, including about 150,000 undiagnosed infections and slightly more than 36,000 new diagnoses (CDC 2023) (Figure 1). Based on data from US Department of Health and Human Services (HHS), HIV continues to contribute to significant healthcare expenditures in the United States, at about 28 billion dollars annually (HHS 2023).

Chapter: Heart Failure in the ICU

Acute heart failure (AHF), manifesting as an exacerbation of the chronic condition or as a de novo disease state, is the leading cause of hospitalization among patients 65 and older (Masip 2022). This epidemiologic phenomenon, coupled with the consequential increase in associated health care–related costs, has resulted in a commensurate increase in clinical guideline recommendations surrounding AHF. The 2021 review from the European Society of Cardiology focusing specifically on AHF was released as a supplement to the organization’s general HF guidance document (Masip 2022). The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America (AHA/ACC/HFSA) HF guidelines included additional information on evaluating and managing cardiogenic shock (CS), defined as a reduction in cardiac output to the degree that precipitates end-organ dysfunction (Heidenreich 2022). This chapter focuses on managing the increasingly recognized AHF syndrome within the critical care setting and additionally underscores the pharmacist’s unique role in transitions of care to the step-down unit in anticipation of discharge.

Case Series: Rapid Sequence Intubation

Rapid sequence intubation (RSI) is the cornerstone of airway management and the primary method of facilitating intubation in critically ill patients. Rapid sequence intubation is defined as the almost simultaneous administration of a potent sedative, the induction agent, followed immediately by a neuromuscular blocking agent (NMBA) to induce paralysis after a period of preoxygenation and cardiopulmonary optimization. This approach provides optimal intubating conditions and was initially developed to safely and effectively intubate patients while minimizing the risk of aspiration. Rapid sequence intubation has thus become the standard of care as the safest and most effective approach to intubation in critically ill patients (Mosier 2015; Hampton 2011).

Chapter: Hepatorenal Syndrome

Patients with cirrhosis can be classified as having compensated or decompensated disease, and those who are decompensated are at risk of developing multiple complications, including hepatorenal syndrome (HRS) (Ojeda-Yuren 2021). Hepatorenal syndrome is characterized by kidney dysfunction that results from physiologic changes in the splanchnic circulation (Heybe 2024; Bass 2023; Biggins 2021; Ojeda-Yuren 2021). Hepatorenal syndrome is classified as HRS-acute kidney injury (HRS-AKI) (previously known as HRS-1), a rapid and life-threatening decline in kidney function, or HRS-non-acute kidney injury (HRS-NAKI) (previously known as HRS-2), renal dysfunction that does not meet the criteria for AKI (Angeli 2019; Angeli 2018). Hepatorenal syndrome-NAKI may further be classified as HRS-acute kidney disease (HRS-AKD)—AKD lasting less than 3 months, but not meeting the criteria for HRS-AKI; and HRS-chronic kidney disease (CKD), a chronic kidney dysfunction in the setting of cirrhosis (Narayanan 2024; Wang 2023).

Chapter: Burn Management

The World Health Organization estimate for the incidence of burn injury surmounts 11 million annually. In the United States, about 500,000 patients with burn injuries seek medical attention, with 10% ultimately admitted for specialized care (Carter 2022). Mortality follows a J-shaped curve with extremes of ages having the highest rates. The revised Baux score provides the best predictive estimates and can be used when discussing expectations with patient families (Buckley 2023; Smith 2019; Woods 2016). The median survival rate was reported to be a revised Baux score of about 110. Calculation for the revised Baux score and an example follow:

Equation: Age + percent total body surface area (TBSA) burned + 17 additional points for presence of inhalation injury

Example: Age 50 years + 60% TBSA burned without an inhalation injury = score of 110 and a predicted 50% chance of survival

Regardless of prognostic score used, studies support three factors as continuous drivers of mortality and poor outcomes: age, larger burns, and inhalation injury.

Case Series: Spinal Cord Injury

The spinal cord is a fundamental component of the central nervous system that facilitates the reception, interpretation, and execution of motor and sensory information. In addition to its somatic functions, the spinal cord enables the autonomic nervous system to regulate involuntary processes, including but not limited to those of the cardiovascular system such as pulse rate, blood pressure, and peripheral vasomotor responses (Garstang 2007). Acute spinal cord injury is a debilitating neurologic condition that severely impacts the functional independence and hemodynamic stability of affected patients.

Chapter: Management of Solid Organ Transplant Patients

Solid organ transplantation (SOT) is a highly regulated process and procedure to facilitate lifesaving interventions in patients with end-organ disease. In most cases, the patients and families involved have been dealing with the consequences of end-stage organ disease for a long time before proceeding to transplant listing and undergoing a SOT. This involves an in-depth workup including preventive screening, vaccination, and disease state management, allowing patients to be optimized before listing for organ transplantation. Unfortunately, patients can progress quickly with their end-stage organ disease or present with fulminant organ failure requiring urgent listing. Often, these patients present to the ICU critically ill and require quick interventions to ensure they are transplant candidates and can survive and thrive after transplantation. This chapter focuses on patients who have received a SOT and require treatment acutely or chronically in the ICU.

Chapter: Postoperative Care of the Surgical Patient

Postoperative management is a critical phase in patient care that involves a multidisciplinary approach to ensure optimal recovery and minimize complications after surgery. This phase encompasses various aspects including pain management, VTE prophylaxis, infection treatment and prevention, management of postoperative complications, and medication reconciliation. The pharmacist plays a key role in this process by optimizing medication therapy, preventing medication-related complications, and ensuring patients receive safe and effective treatment.

Case Series: Pharmacoeconomic Evaluation of Critical Care Therapies

Global health has advanced dramatically over the past 100 years, with notable progress such as the decrease in infant and child mortality and increase in overall life expectancy. These improvements, however, have been slowing in the past decade, as evidenced by the increase of maternal mortality since 2015 in most regions of the world (WHO 2023). In addition, these disparities in markers of health were exacerbated by the COVID-19 global pandemic, as well as increasing disparities in health care access, seen both when contrasting countries and when looking within each country individually.

Chapter: Best Practices in Disease-Specific Core Measures

Gauging the country’s overall health and health care performance at various levels requires basic measures that can be used to compare performance between organizations. The availability of reliable, standardized measures is essential for making these assessments. Regulatory bodies have identified a set of treatment standards known as core measures based on the best available scientific evidence. These measures have been proven to reduce complications, prevent recurrences, and improve overall clinical outcomes for patients.