Critical Care Essentials: Active Recall Review

A comprehensive vocabulary review of core critical care concepts including nutrition, PICS, brain death, ICU liberation, and palliative care.

Enteral Nutrition

The preferred route of nutrition when the gastrointestinal tract is functional, as it avoids many catheter-related and metabolic complications associated with parenteral nutrition.

Total Parenteral Nutrition (TPN)

Intravenous nutrition support considered when the gastrointestinal tract cannot be used, enteral feeding remains contraindicated, or when it provides persistently inadequate intake.

2,3-DPG

A substance produced in red blood cells requiring phosphate; it is essential for the delivery of oxygen from hemoglobin to tissues, and its production can be impaired by hypophosphatemia.

Refeeding Syndrome

A group of potentially dangerous fluid and electrolyte changes (including hypophosphatemia, hypokalemia, and hypomagnesemia) that occur after nutrition—especially carbohydrate—is introduced to a severely malnourished patient.

Dextrose (in TPN)

A component of TPN that provides carbohydrate calories but can cause hyperglycemia, increased $CO_2$ production, and hepatic steatosis if administered in excess.

Positive End-Expiratory Pressure (PEEP)

Positive airway pressure maintained at the end of expiration during mechanical ventilation to help prevent alveolar collapse and improve oxygenation.

Post-Intensive Care Syndrome (PICS)

New or worsening physical, cognitive, psychological, or social impairment occurring after critical illness.

PICS-F

A form of post-intensive care syndrome affecting family members of the patient, involving anxiety, depression, post-traumatic stress, and financial strain.

ABCDEF ICU Liberation Bundle

A coordinated strategy to reduce avoidable harms in the ICU: Assess/manage pain, Both spontaneous awakening/breathing trials, Choice of analgesia/sedation, Delirium assessment, Early mobility, and Family engagement.

ICU Diary

A tool used to help survivors reconstruct events and distinguish actual events from delirium-associated memories to reduce psychological symptoms of PICS.

Brain Death

Also called death by neurologic criteria; the permanent loss of function of the entire brain, including the brainstem.

Central Diabetes Insipidus

A condition occurring after brain death due to damage to the hypothalamus or posterior pituitary, leading to deficient ADH secretion and characterized by urine output greater than $3\text{--}4\,mL/kg/hour$.

Organ Procurement Organization (OPO)

The organization responsible for determining medical suitability for organ donation, reviewing donor registration, and coordinating the authorization and recovery of organs.

Spontaneous Awakening Trial (SAT)

A procedure involving stopping or reducing continuous sedatives daily to assess neurologic function and limit unnecessary sedation.

Spontaneous Breathing Trial (SBT)

A test to determine if a patient can breathe with minimal ventilatory assistance, often using pressure support, CPAP, or a T-piece.

Noninvasive Ventilation (NIV)

The provision of positive-pressure ventilatory support through a mask or similar interface without the use of an endotracheal tube.

CPAP

A mode of noninvasive ventilation that provides one continuous pressure throughout both inspiration and expiration to support oxygenation.

Bilevel NIV

A mode of noninvasive ventilation providing higher inspiratory pressure and lower expiratory pressure to assist with ventilation (reducing $PaCO_2$) as well as oxygenation.

Post-Extubation Laryngeal Edema

Swelling of the laryngeal tissues caused by pressure and mucosal injury from an endotracheal tube, resulting in upper-airway narrowing after extubation.

Cuff-leak Test

An assessment where the ETT cuff is deflated to check for an audible air leak or a difference in tidal volume; a small or absent leak suggests possible upper-airway narrowing.

Heliox

A mixture of helium and oxygen used as a temporary bridge to reduce airflow resistance and work of breathing in patients with upper-airway obstruction.

Critical-Care Pain Observation Tool (CPOT)

A validated behavioral tool used to assess pain in nonverbal ICU patients based on physical observations rather than vital signs alone.

Terminal Secretions

Noisy respiratory sounds near death caused by a patient's inability to swallow or cough out oropharyngeal and bronchial secretions, often managed with anticholinergics like glycopyrrolate.

Doctrine of Double Effect

An ethical principle where an action intended to achieve a good effect (e.g., pain relief) may foreseeably have an unintended harmful secondary effect (e.g., respiratory suppression).

Palliative Sedation

The monitored use of sedating medication to relieve refractory, intolerable suffering in patients with serious illness when other reasonable treatments have failed.