【簡介】 重症治療包涵多專科領域，且常於不確定情境下需做出整合性的治療計劃，尤其未來將面對的是高齡、更嚴重的病人，故此專科醫師是需要有承擔風險及多面向綜合解析的訓練，而重症團隊要能及早關注尚未住到加護病房的重症病人，如此才能早期監測出病況不穩定或處於高危狀態的患者，及時提供高效的重症照護。《重症醫學實證精要》（第二版）由重症醫學會主導，邀集多位專家共同編撰，匯聚了此領域的最新研究與臨床經驗，並提供跨專科合作與醫療品質提升的策略，是學習重症醫學領域不可或缺的工具書，更是醫療團隊面對高風險患者時能作出最佳決策的指引。 【目錄】 1. 心 (Cardiac) 1.1 血流動力監測 .......................................................................................................... 1 1.2 中央靜脈壓 (CVP) 與體液容積評估 ................................................................... 4 1.3 Pulmonary artery (Swan- Ganz) catheter ................................................................... 8 1.4 Intra-aortic balloon pump (IABP) ............................................................................. 11 1.5 Circulatory Shock ...................................................................................................... 14 1.6 復甦溶液 ................................................................................................................ 20 1.7 非開心手術的心臟風險評估 .............................................................................. 22 1.8 非開心手術病，手術間期心肌梗塞的處置 ..................................................... 31 1.9 心房顫動治療 ........................................................................................................ 34 1.10 Long QT Syndrome and Torsade de Pointes .......................................................... 40 1.11 Pacemaker ................................................................................................................ 42 1.12 深層靜脈栓塞 ........................................................................................................ 44 1.13 肺栓塞 ..................................................................................................................... 51 1.14 抗凝血及抗血小板藥物 ....................................................................................... 57 2. 肺 (Pulmonary) 2.1 常見肺病診斷 ........................................................................................................ 71 2.2 急性呼吸衰竭 ........................................................................................................ 73 2.3 呼吸器設定 ............................................................................................................ 77 2.4 插管時機 ................................................................................................................ 82 2.5 拔管時機 ................................................................................................................ 84 2.6 肺水腫 ..................................................................................................................... 86 2.7 ARDS 病理機轉與分期 .......................................................................................... 88 2.8 ARDS 病史演進 ....................................................................................................... 89 2.9 ARDS 的病因 ........................................................................................................... 91 2.10 ARDS 的病理機轉 ................................................................................................... 92 2.11 ARDS 流行病學 ....................................................................................................... 96 2.12 ARDS 治療演進 ....................................................................................................... 98 2.13 保護性機械式通氣 ............................................................................................. 103 2.14 俯臥姿勢治療 ..................................................................................................... 111 2.15 慢性阻塞性肺部疾病 ........................................................................................ 112 3. 腦 (Cerebral) 3.1 麻醉深度評估 ...................................................................................................... 127 3.2 ICU 常用量表 ........................................................................................................ 132 3.3 ICU 譫妄 ................................................................................................................ 135 3.4 昏迷評估 .............................................................................................................. 139 3.5 神經學急症 .......................................................................................................... 142 3.6 癲癇重積症 .......................................................................................................... 153 3.7 神經重症之鎮靜止痛 ......................................................................................... 157 3.8 顱內壓增加(Incrased Intracranial Pressure, IICP) ...............................................158 3.9 頭部外傷 .............................................................................................................. 163 3.10 加護病房的周邊神經及肌肉併發症 ................................................................166 4. 腎 (Renal) 4.1 急性腎損傷(Acute kidney injury) 和急性腎臟病(AKD) ...................................169 4.2 顯影劑腎病變 ...................................................................................................... 173 4.3 連續性腎臟替代療法(CRRT) ............................................................................. 179 4.4 電解質不平衡(Electrolyte imbalance) ................................................................181 4.5 代謝性酸血症(Metabolic acidosis) ..................................................................... 192 5. 腸道 (Gut) 5.1 急性壓力期代謝變化 ......................................................................................... 195 5.2 營養評估 .............................................................................................................. 202 5.3 營養治療 .............................................................................................................. 205 5.4 腸道營養 .............................................................................................................. 213 5.5 靜脈營養 .............................................................................................................. 222 5.6 維生素/ 微量元素 .............................................................................................. 227 5.7 特殊營養素 .......................................................................................................... 229 6. 感染 (Inflammation/Infection) 6.1 發燒與不明原因發燒 ......................................................................................... 233 6.2 敗血症的生物標記 ............................................................................................. 239 6.3 全身炎症反應症候群與敗血症 ........................................................................242 6.4 什麼是多重器官失能症候群(MODS) ？ .........................................................248 6.5 導管相關血流感染(catheter-related blood stream infection, CRBSI) ...............249 6.6 泌尿道感染(Urinary tract infection, UTI) .............................................................251 6.7 HAP/VAP ................................................................................................................. 253 6.8 腹內感染(Intra-abdominal infection, IAI) ............................................................256 6.9 心內膜炎(Infective endocarditis, IE)....................................................................260 6.10 Solid organ transplantation .................................................................................... 267 6.11 Skin and Soft Tissue Infection (SSTI) ....................................................................... 268 6.12 Hematopoietic Stem cell Transplantation .............................................................. 275 6.13 COVID-19................................................................................................................ 276 6.14 Steroid .................................................................................................................... 283