Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: Proceedings of the 21st Postgraduate Course in Critical Care Medicine Venice-Mestre, Italy — November 10–13, 2006

468 Pages·2007·4.16 MB·English

by  K. Hillman (auth.), Antonino Gullo M.D. (eds.)

A. Gullo(Editor)
Anaesthesia, Pain, Intensive Care and Emergency – A.P.I.C.E.
Proceedingsofthe
21stPostgraduateCourseinCriticalCareMedicine
Venice-Mestre,Italy–November10-13,2006
A. Gullo (Editor)
Anaesthesia, Pain, Intensive Care
and Emergency
A.P.I.C.E.
Proceedings of the
21st Postgraduate Course in Critical Care Medicine
Venice-Mestre, Italy – November 10-13, 2006
Springer
ANTONINOGULLO,M.D.
Head,DepartmentofAnaesthesiaandIntensiveCare
Head,PostgraduatedSchoolofAnaesthesiaandIntensiveCare
CataniaUniversityHospital
Catania,Italy
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V
Table of Contents
ETHICS
Chapter1–DyingintheIntensiveCareUnit
K.HILLMAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
LUNG
Chapter2–Geneticsandmolecularbiologyinacutelunginjury
R.VASCHETTO,J.HAITSMA,H.ZHANG . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Chapter3–Lung,respiratorymechanics,artificialventilation
A.KOUTSOUKOU,J.MILIC-EMILI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Chapter4–Thepressure-volumecurve
V.R.CAGIDO,W.A.ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Chapter5–Methodsforassessingexpiratoryflowlimitationduringtidalbreathing
N.G.KOULOURIS,S.-A.GENNIMATA,A.KOUTSOUKOU . . . . . . . . . . . . . . . . . . 41
Chapter6–Howtoventilatebrain-injuredpatientsinrespiratoryfailure
P.PELOSI,P.SEVERGNINI,M.CHIARANDA . . . . . . . . . . . . . . . . . . . . . . . . 53
Chapter7–Helpingsurgicalpatientstogiveupsmoking
D.O.WARNER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Chapter8–Respiratoryissuesandventilatorystrategiesformorbidlyobesepatients
J.SPRUNG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
FLUIDANDELECTROLYTEEMERGENCY
Chapter9–Fluidandelectrolyteemergency
J.BOLDT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
VI
Chapter10–Electrolyteemergencies,aniongap,osmolality
F.SCHIRALDI,G.GUIOTTO,L.MORELLI . . . . . . . . . . . . . . . . . . . . . . . . . 97
Chapter11–Acuterenalfailure
M.PALAZZO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Chapter12–Acuteliverfailure
P.FELTRACCO,M.L.BREZZI,C.ORI . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
INFECTIONSANDSEPSIS
Chapter13–Pneumoniainventilatedpatients.SevereGramnegativeinfections;
theimpactonmortalityanditsprevention
D.F.ZANDSTRA,H.K.F.VANSAENE . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Chapter14–Gram-positiveventilator-associatedpneumonia:impactonmortality
A.R.DEGAUDIO,S.RINALDI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Chapter15–FungalinfectionsintheICU
A.DEGASPERI,A.CORTI,L.PERRONE . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter16–Focusonthediagnosisandtreatmentofseveremeningitis
R.LUZZATI,D.GIACOMAZZI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Chapter17–Plasmafiltrationinsepsis:aresearchprotocol
S.LIVIGNI,M.MAIO,G.BERTOLINI . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
HIGHLIGHTSONCIRCULATORYFAILURE,CPRANDTRAUMA
Chapter18–Thecellinshock
M.M.MORALES,H.PETRS-SILVA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Chapter19–Tissuepartialpressureofcarbondioxidetensionmeasurements
andmicrocirculationvisualisation.Newtechniquesforthestudyoflowflowstates
G.RISTAGNO,W.TANG,M.H.WEIL . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
Chapter20–Ventricularfibrillationanddefibrillation:contemporaryunderstanding
ofmechanisms
R.D.WHITE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
VII
Chapter21–Arterialwaveformanalysistodeterminecardiovascularparameters
S.SCOLLETTA,B.BIAGIOLI,P.GIOMARELLI . . . . . . . . . . . . . . . . . . . . . . . . 225
Chapter22–TheUtsteinstyleforthereportingofdatafromcardiacarrest
J.P.NOLAN,C.L.GWINNUTT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Chapter23–Challengesintraumacare
P.D.LUMB . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Chapter24–Advancesintraumacare
F.PLANI,J.GOOSEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
PERIOPERATIVEMEDICINE
Chapter25–Standardsofcareinoperatingtheatres
F.GRÜNE,T.OTTENS,M.KLIMEK . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Chapter26–Audit
M.KLIMEK,F.GRÜNE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Chapter27–Focusonentropyandsurgicalstressindex
M.SORBELLO,S.MANGIAMELI,A.GULLO. . . . . . . . . . . . . . . . . . . . . . . . . 301
Chapter28–Neuraxialanaesthesiaandanticoagulation
D.J.WEDEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319
Chapter29–Regionalanaesthesiainthepatientwithpre-existing
neurologicaldysfunction
T.T.HORLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Chapter30–Infectiouscomplicationsofregionalanaesthesia
D.J.WEDEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
Chapter31–TheMayoClinictotaljointanalgesicpathway
T.T.HORLOCKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Chapter32 –Acutetherapyinpatientswithwide-QRScomplextachyarrhythmias
R.D.WHITE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
VIII
OBSTETRICSANDPAEDIATRICS
Chapter33–Obstetricsathighrisk
R.ALEXANDER,N.VOLPE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365
Chapter34–Resuscitationofthenewborn
D.TREVISANUTO,N.DOGLIONI,F.MARIO . . . . . . . . . . . . . . . . . . . . . . . . 377
Chapter35–Regionalanaesthesiainneonates
M.ASTUTO,D.SAPIENZA,G.RIZZO . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
Chapter36–Locoregionalanaesthesiainchildren
N.DISMA,G.ROSANO,D.LAURETTA . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Chapter37–ManagementofCRRTinpaediatrics
G.ZOBEL,S.RÖDL,E.RING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Chapter38–Severityscoresinpaediatricintensivecareunits
I.SALVO,A.WOLFLER,A.MANDELLI. . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Chapter39–Analgesiaandsedationduringmechanicalventilationinpaediatrics
ML.MASSONE,L.MANFREDINI,G.OTTONELLO . . . . . . . . . . . . . . . . . . . . . 421
COMPUTING
Chapter40–Latencyreductioninclinicalandtranslationalresearch
C.-H.HUANG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 437
CRITICALCAREBLEEDING
Chapter41–Newfrontiersincriticalbleeding
S.BUSANI,L.DONNO,M.GIRARDIS . . . . . . . . . . . . . . . . . . . . . . . . . . .449
Chapter42–EvaluationofperformanceofICUs
J.R.LEGALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 455
IX
List of Contributors
AlexanderR. ChiarandaM.
DepartmentofAnaesthetics,Worcester- DepartmentfortheEnvironment,Health
shireRoyalHospital,Worcester(UK) andSafety,UniversityofInsubria–
AnaesthesiaandIntensiveCareUnitB,
AstutoM. DistrictHospitalandMacchiFoundation,
DepartmentofAnaesthesiaandIntensive Varese(Italy)
Care,PostgraduateSchoolofAnaesthesia
andIntensiveCare,CataniaUniversity CortiA.
Hospital,Catania(Italy) 2ndAnaesthesia,IntensiveCareandAb-
dominalTransplantationUnit,Niguarda
BertoliniG. Ca’GrandaHospital,Milan(Italy)
GiViTICoordinatingCentre,Laboratory
ofClinicalEpidemiology,“MarioNegri” DeGasperiA.
InstituteforPharmacologicalResearch, 2ndAnaesthesia,IntensiveCareandAb-
Ranica-BG(Italy) dominalTransplantationUnit,Niguarda
Ca’GrandaHospital,Milan(Italy)
BiagioliB.
DepartmentofCardiothoracicAnaesthe- DeGaudioA.R.
siaandIntensiveCareUnit,Universityof DepartmentofCriticalCare,Sectionof
Siena(Italy) AnaesthesiologyandCriticalCare,Uni-
versityofFlorence(Italy)
BoldtJ.
DepartmentofAnaesthesiologyandIn- DismaN.
tensiveCareMedicine,Klinikumder DepartmentofAnaesthesiaandIntensive
StadtLudwigshafen(Germany) Care,CataniaUniversityHospital,
Catania(Italy)
BrezziM.L.
DepartmentofPharmacologyand DoglioniN.
AnaesthesiologyUniversityHospitalof PaediatricDepartment,SchoolofMedi-
Padua(Italy) cine,UniversityofPadua,AziendaOspe-
dalieraPadua(Italy)
BusaniS.
AnaesthesiaandIntensiveCareUnitI, DonnoL.
ModenaUniversityHospitalandModena AnaesthesiaandIntensiveCareUnitI,
andReggioEmiliaUniversity(Italy) ModenaUniversityHospitalandModena
andReggioEmiliaUniversity(Italy)
CagidoV.R.
LaboratoryofRespirationPhysiology, FeltraccoP.
CarlosChagasFilhoInstituteofBiophy- DepartmentofPharmacologyand
sics,FederalUniversityofRiodeJaneiro AnaesthesiologyUniversityHospitalof
(Brazil) Padua(Italy)
X
GennimataS.-A. HorlockerT.T.
RespiratoryFunctionLaboratory,Depart- DepartmentofAnesthesiologyandOrtho-
mentofRespiratoryMedicine,University pedics,MayoClinicCollegeofMedicine,
ofAthensMedicalSchool,“Sotiria”Hos- Rochester,Minnesota(USA)
pital,Athens(Greece)
HuangC.-H.
GiacomazziD. DepartmentofComputerScienceandEn-
InfectiousDiseasesUnit,UniversityHos- gineering,UniversityofConnecticut
pitalofTrieste,Trieste(Italy) (USA)
GiomarelliP. KlimekM.
DepartmentofAnaesthesiaandIntensive ErasmusMC,DepartmentofAnaesthesio-
CareUnit,UniversityofSiena(Italy) logy,Rotterdam(TheNetherlands)
GirardisM. KoulourisN.G.
AnaesthesiaandIntensiveCareUnitI, RespiratoryFunctionLaboratory,Depart-
ModenaUniversityHospitalandModena mentofRespiratoryMedicine,University
andReggioEmiliaUniversity(Italy) ofAthensMedicalSchool,“Sotiria”Hos-
pital,Athens(Greece)
GoosenJ.
TraumaUnit,JohannesburgHospital,Di- KoutsoukouA.
visionofTraumaandCriticalCare,De- CriticalCareDepartment,GeneralEvan-
partmentofSurgery,Universityofthe gelismosHospital,MedicalSchool,Uni-
Witwatersrand,Johannesburg(South versityofAthens(Greece)
Africa)
LaurettaD.
GrüneF. DepartmentofAnaesthesiaandIntensive
ErasmusMC,DepartmentofAnaesthesio- Care,“Policlinico”UniversityHospital,
logy,Rotterdam(TheNetherlands) Catania(Italy)
GuiottoG. LeGallJ.R.
EmergencyMedicineDivision,S.Paolo IntensiveCareUnit,HôpitalSaintLouis,
Hospital,Naples(Italy) Paris(France)
GulloA. LivigniS.
DepartmentofAnaesthesiaandIntensive DepartmentofAnaesthesiaandIntensive
Care,PostgraduateSchoolofAnaesthesia Care,OspedaleTorinoNordEmergenza
andIntensiveCare,CataniaUniversity SanGiovanniBosco,Turin(Italy)
Hospital,Catania(Italy)
LumbP.D.
GwinnuttC.L. DepartmentofAnesthesiology,Keck
DepartmentofAnaesthesia,Salford Schoolof MedicineatUSC,
RoyalHospitalsNHSTrust,HopeHospi- LosAngeles(USA)
tal,Salford(UK)
LuzzatiR.
HaitsmaJ.J. InfectiousDiseasesUnit,University
InterdepartmentalDivisionofCritical HospitalofTrieste,Trieste(Italy)
CareMedicine,UniversityofToronto,St.
Michael’sHospital,Toronto,Ontario MaioM.
(Canada) DepartmentofAnaesthesiaandIntensive
Care,OspedaleTorinoNordEmergenza
HillmanK. SanGiovanniBosco,Turin(Italy)
AreaCriticalCareServices,Liverpool
Hospital,Liverpool,NSW(Australia)