Subspecialty

Critical Care Medicine

Resuscitation, ventilation, and multi-organ support.

Anesthesiologists practicing critical care manage the sickest patients — septic shock, ARDS, multi-organ failure, post-cardiac arrest. Familiarity with ventilator modes, vasoactive choices, hemodynamic targets, and end-of-life conversations is essential.

Key concepts

Sepsis bundle

Lactate, blood cultures before antibiotics, broad-spectrum antibiotics within 1 h, 30 mL/kg crystalloid if hypotensive/lactate >4, vasopressor if MAP <65 after fluids.

ARDS ventilation

Low tidal volume 6 mL/kg PBW, plateau <30, driving pressure <15, PEEP per FiO2 table, prone if PaO2/FiO2 <150.

Shock classification

Hypovolemic, distributive, cardiogenic, obstructive — each demands different fluid/vasoactive/inotrope strategy.

Post-arrest care

Targeted temperature management 32–36°C ×24 h, treat reversible causes, hemodynamic targets MAP >65, glucose 140–180.

Monitoring

Arterial line
Central venous catheter
Continuous SvO2 (some)
Lactate trend
POCUS / bedside echo

Common drugs

NorepinephrineVasopressinEpinephrineHydrocortisonePropofolDexmedetomidineFentanyl

Clinical pearls

1POCUS rapidly distinguishes shock states — IVC, cardiac windows, lungs.

2Fluid responsiveness is dynamic — passive leg raise or pulse pressure variation > static CVP.

References & Further Reading

1
Guideline
Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med. 2021;49(11):e1063-e1143.
2
Journal
The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes for acute lung injury and ARDS. N Engl J Med. 2000;342(18):1301-1308.
3
GuidelineOpen source
Panchal AR, et al. Part 3: Adult Basic and Advanced Life Support: 2020 American Heart Association Guidelines for CPR and ECC. Circulation. 2020;142(16_suppl_2):S366-S468.
4
Textbook
Gropper MA, Miller RD, Cohen NH, et al., eds. Miller's Anesthesia. 9th ed. Philadelphia: Elsevier; 2020.

Citations are provided to direct further study. Always check the most current edition of guidelines and society recommendations — the information in this chapter is a teaching summary, not primary source material.