Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.: Proceedings of the 13th Postgraduate Course in Critical Care Medicine Trieste, Italy — November 18–21, 1998 PDF
Preview Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.: Proceedings of the 13th Postgraduate Course in Critical Care Medicine Trieste, Italy — November 18–21, 1998
Springer-Verlag Italia SrI. A. Gullo (Ed.) Anaesthesia, Pain, Intensive Care and Emergency Medicine -A.P.I.C.E. Proceedings of the 13th Postgraduate Course in Critical Care Medicine Trieste, Italy -November 18-21, 1998 Springer Praf. ANTONINO GULLO, M.D. Head, Department of Anaesthesiology and Intensive Care Trieste University School of Medicine Trieste, Italy Library of Congress Cataloging-in-Publication Data: Applied for © Springer-Verlag Italia 1999 Originally published by Springer-Verlag Italia, Milano in 1999 ISBN 978-88-470-0051-3 ISBN 978-88-470-2145-7 ( eBook) DOI 10.1007/978-88-470-2145-7 This work is subject to copyright. AII rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplications of this publication or parts thereof is permitted only under the provisions of the Italian Law of September 9, 1965, in its current vers ion, and permis sion for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the Italian Copyright Law. The use of general descriptive names, registered names, trademarks, etc. in this publication does not imp1y, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. SPIN 10707109 Table of Contents PROGRESS IN CRITICAL CARE A Life in Critical Care M. GOULON .................................................................................................................................. 23 Clinics, Technology, Ethics, and Humane Patient-Physician Relationships and Critical Care (Monitoring, Diagnosis, Intervention Strategies) R.D. BAUE, AND A.E. BAUE......................................................................................................... 29 Cerebral Resuscitation 2000 A.D. P. SAFAR....................................................................................................................................... 47 Early Goal-Directed Invasive and Noninvasive Monitoring of High Risk Postoperative and Septic Surgical Patients Improves Outcome . W.C. SHOEMAKER ........................................................................................................................ 59 Postresuscitation Myocardial Dysfunction H. YAMAGUCHI, AND M.H. WEIL.................................................................................................. 69 Telemedicine: Steps into the Future M. ZIMPFER .................................................................................................................................. 77 Evidence-Based Medicine in the ICU R. JAESCHKE, G. GUYATI, AND M. MEADE .................................................................................. 87 ETHICS AND QUALITY CONTROL IN THE ICU The Problem of Informed Consent in Critically III Patients H. BURCHARD!.............................................................................................................................. 99 Progress in Scoring Systems, Safety and Quality of Care in the ICU loR. LE GALL, AND C. ALBERTI .................................................................................................. 105 Is Mortality the Only Outcome Measure in ICU Patients? l-L. VINCENT ............................................................................................................................... 113 ANAESTHESIA AND COEXISTING DISEASES Perioperative Care: Physiology and Practicality P.D. LUMB .................................................................................................................................... 121 Coagulation Disorders C.T. PETROVITCH .......................................................................................................................... 135 VI Neuromuscular Disorders and Anaesthesia J. RUPREHT ................................................................................................................................... 141 Anaesthesia and Coexisting Diseases: Chronic Obstructive Pulmonary Disease R. ALVISI, E.R. RiGHINI, AND C.A. VOLTA ................................................................................... 147 Optimization of the Perioperative Period in High-Risk Patients A.F. HAMMERLE, AND C. TATSCHL ............................................................................................... 157 CLINICAL ANAESTHESIA Standards in Anaesthetic Practice A.R. AITKENHEAD ........................................................................................................................ 173 Hypnotics P. MASTRONARDI, T. CAFIERO, AND A.E. ROSSI........................................................................... 185 Analgesics C. MELLONI.................................................................................................................................. 193 Muscle Relaxants in Clinical Anaesthesia: An Update V. VILARDI, M. SANFILIPPO, AND M.K. VERDI ............................................................................. 217 Total Intravenous Anaesthesia L. BARVAIS, B. ICKX, AND P. PANDIN ........................................................................................... 227 PERIOPERATIVE CARE OF CARDIAC RISK PATIENTS Perioperative Care of Cardiac Risk Patients: New Pharmacological Strategies P. CORIAT ..................................................................................................................................... 239 Biochemical Markers of Myocardial Cell Injury H. METZLER, M. GRIES, S. FRUHWALD, AND W. TOLLER ............................................................. 245 Postoperative Intensive Care Therapy -In Which Patients and for How Long? T. MOLLHOFF ................................................................................................................................ 251 Diagnosis in the Early Phase of Aortic Dissection S. KLUGMANN, A. ALBERTI, F. FALETRA, AND A. RAMPOLDI ....................................................... 261 Surgical Strategies in the Management of Acute Aortic Dissection B. ZINGONE .................................................................................................................................. 269 Early Complications and Management After Bypass Circulation J.O.C. AULER JR, AND MJ.C. CARMONA ..................................................................................... 279 New Concepts of Antiarrhythmic Strategies J.L. ATLEE .................................................................................................................................... 291 Emergency Treatment of Bradycardic and Tachycardic Arrhythmias A.S. MONTENERO ......................................................................................................................... 299 VII Perioperative Arrhythmias and Outcome E. MAHLA, AND H. METZLER ....................................................................................................... 307 Therapeutic Monitoring in the Perioperative Period O. BOYD, AND A. RHODES ........................................................................................................... 313 OBSTETRIC COMPLICATIONS Uncommon Diseases in Pregnancy G.C. DI RENZO, G. IAMMARINO, AND L. DONAT!.. ....................................................................... 323 Complications of Obstetric Anaesthesia G. LyONS ...........................•.......................................................................................................... 335 Anaesthesia for Emergency Caesarean Section G. CAPOGNA, D. CELLENO, AND R. PARPAGLIONI... ...................................................................... 343 Obstetric Complications: Consumption Coagulopathy C.T. PETROVITCH .......................................................................................................................... 347 Perioperative Management of Hypertension M. ZAKOWSKI ............................................................................................................................... 355 Maternal and Foetal Mortality Rates During Pregnancy, Delivery and Puerperium E. MARGARIA, E. GOLLO, AND G. SORTINO ................................................................................. 367 ACID-BASE DISORDERS, DIAGNOSIS AND TREATMENT Dimension of Fluid Compartments in Severely III Patients H.J. ADROGUE .................................•...............•............................................................................ 375 Pathophysiology of Acid Base Regulation H.J. ADROGUE .............................................................................................................................. 383 Fluid and Electrolyte Management in Intensive Care F. BOBBIO PALLAVICINI, G. VERDE, AND P. TOSI .......................................................................... 393 Respiratory Acidosis and Alkalosis H.I. ADROGUE .............................................................................................................................. 411 Metabolic Acidosis and Metabolic Alkalosis in the Critically III F. SCHIRALDI, P. FERRARO, AND F. PALADINO ........................•.•.••...........................•.•..•.••.•.......... 421 Differential Diagnosis and Treatment of Acidosis H.P. POVOAS, AND M.H. WElL ..................................................................................................... 429 Albumin: Is It a Play-Maker, a Carrier or Both? F. MERCURIALI, AND G. INGHILLERI ............................................................................................. 441 VIII ASSESSMENT OF THE CARDIOPULMONARY FUNCTION IN THE ICU Capnography B. ALLARIA, M. DEl POLI, AND M. FAVARO ................................................................................. 459 New Insights into Cardiovascular Monitoring: Continuous Arterial Thermodilution and Intrathoracic Blood Volume A. PEREL, H. BERKENSTADT, AND E. SEGAL ................................................................................ 471 Echo Doppler Monitoring for the Evaluation of Cardiovascular Performances in Anaesthesia and in the Intensive Care Units R. MUCHADA, P. TORTOLI, AND F. GUDI ...................................................................................... 479 CEREBRAL HOMEOSTASIS -POLYNEUROPATHY Pathophysiology of Brain Temperature S. RossI, E. RONCATI ZANIER, AND N. SroCCHETTI..................................................................... 489 Exploring Cerebral Metabolism by Microdialysis L. PERSSON, AND L. HILLERED ..................................................................................................... 495 Epidemiology and Diagnosis of Polyneuropathy in Critical Dlness G. SAVETTIERI, AND B. FIERRO ..................................................................................................... 501 Polyneuropathy in Patients Undergoing a Neuromuscular Junction Blockade D. 0STERGAARD ........................................................................................................................... 509 Muscular Wasting as a Consequence of Sepsis N. LATRONICO, AND A. CANDIANI ................................................................................................ 517 CURRENT STATUS OF CRITICAL CARE Epidemiology of Trauma AJ. SUTCLIFFE ............................................................................................................................. 525 Nitric Oxide in Sepsis and ARDS H. ZHANG, T.E. STEWART, AND J.-L. VINCENT ............................................................................. 531 Management of Shock Complicating Acute Myocardial Infarction A. MARN PERNAT, M.H. WElL, AND A. PERNAT ........................................................................... 549 Management of Acute Ischaemic Stroke C. FIESCHI .................................................................................................................................... 557 Role of Heat Shock Proteins in Cytoprotection H. ZHANG, Y.K. KIM, AND A.S. SLUTSKy .................................................................................... 561 IX FOCUS ON HYPERBARIC MEDICINE Evidence-Based Hyperbaric Oxygen Therapy F. WATIEL, AND D. MATHIEU •....•..............................•.............•..•..•.......................•.........•....•....... 573 Intrinsically Safe Hyperbaric Centres R. SCANDELLA .................•...........................................•............................................•................... 589 LUNG FUNCTION IN THE ICU Lung Function Monitoring in the ICU: Available Techniques and Future Requirements B. LACHMANN, AND SJ.C. VERBRUGGE ....................................................................................... 597 Mechanical Ventilation and Lung Mechanics B. JONSON .................................................................................................................................... 601 Pulmonary Gas Exchange in the Intensive Care Unit R. NAEIJE ......•..•..•.............................•.....•.......•.................................•..•...............................•....•.. 611 Pulmonary Haemodynamics in the Intensive Care Unit R. NAEIJE ..................................................................................................................................... 621 PET and Other Nuclear Medicine Techniques P. WOLLMER ................................................................................................................................. 629 Lung Function Monitoring: Data Provided by CT Scan I. RAVAGNAN, L. BRAZZI, AND L. GATTINONI ............................................................................... 635 Bedside Replacement of Computed Tomography by Electrical Impedance Tomography P.W.A. KUNST, S.H. BOHM, AND B. LACHMANN .......................................................................... 641 VENTILATORY PERFUSION MISMATCH IN ARDS Volume Distribution and Ventilatory Modes in Patients with Acute Respiratory Distress Syndrome C. CHOPIN, AND M.C. CHAMBRIN ................................................................................................ 649 Problems Associated with Clinical Determination of Pulmonary Shunting H.M. LoHBRUNNER, AND KJ. FALKE ........................................................................................... 669 Pulmonary Hypertension J.O.C. AULER JR, AND MJ.C. CARMONA ............................•••.••••......•..................•..•....•............... 679 LUNG DYSFUNCTION AND VENTILATORY MANAGEMENT Pathophysiology of Unresolving ARDS: The Role of the Host Defense Response G.U. MEDURI ............................................................................................................................... 693 x Pathophysiology of Ventilator-Associated Pneumonia N. FABREGAS, AND A. TORRES ..................................................................................................... 711 How to Diagnose Ventilator Associated Pneumonia M. LANGER .................................................................................................................................. 721 Can Hygienic Measures Prevent Pneumonia? M.L. MORO ...... ...... ... ... ..... ... .......... ...... ..... ... ........ ...... ........... ... ........ ............ ........ ........ ........ ... ..... 727 Ventilatory Support in Different Stages of Lung Dysfunction L. BRAZZI, 1. RAVAGNAN, AND L. GATTINON! ............................................................................... 733 Strategies to Minimize Alveolar Stretch Injury During Mechanical Ventilation N.R. MACINTYRE ......................................................................................................................... 739 Modes of Ventilation and Weaning Strategies C. PUTENSEN, F. STOBER, AND H. WRIGGE .................................................................................. 749 Proportional Assist Ventilation: Technique and Implementation M. yOUNES ................................................................................................................................... 769 Index ........................................................................................................................................... 777 Authors Index Adrogue H.J. Dept. of Medicine and Renal Section, Veterans Affairs Medical Centre, Houston, Texas (U.S.A.) Aitkenhead A.R. Dept. of Anaesthesia, Queen's Medical Centre, University Hospital, Nottingham (U.K.) Alberti A. Dept. of Haemodynamics, Ca' Granda-Niguarda Hospital, Milan (Italy) Alberti C. Dept. of Anaesthesia and Intensive Care, Saint-Louis Hospital, Paris (France) Allaria B. Dept. of Anaesthesia and Intensive Care, National Institute for Cancer Research, Milan (Italy) Alvisi R. Dept. of Anaesthesia and Intensive Care, University of Ferrara, Ferrara (Italy) Atlee J.L. Dept. of Anaesthesiology, Froedtert Memorial Lutheran Hospital East, Milwaukee, Wisconsin (U.S.A.) Auler J.O.C. Dept. of Anaesthesiology, Institute of Cardiology, Sao Paulo University School of Medicine, Sao Paulo (Brazil) Barvais L. Dept. of Anaesthesiology, Free University of Brussels, Erasme Hospital, Brussels (Belgium) BaueA.E. Dept. of Surgery, St. Louis University Health Sciences Centre, St. Louis, Missouri (U.S.A.) Baue R.D. Dept. of Surgery, St. Louis University Health Sciences Centre, St. Louis, Missouri (U.S.A.) Berkenstadt H. Dept. of Anaesthesia and Intensive Care Medicine, Sackler School of Medicine, Tel Aviv University, Sheba Medical Centre, Tel Hashomer (Israel) Bobbio Pallavicini F. Dept. of Anaesthesia and Intensive Care, S. Andrea Hospital, La Spezia (Italy) Boyd O. Intensive Care Unit, Royal Sussex County Hospital, Brighton, West Sussex (U.K.) Bijhm S.H. Dept. of Anaesthesiology, Erasmus University, Rotterdam (The Netherlands) Brazzi L. Dept. of Anaesthesia and Intensive Care, Maggiore Hospital-IRCCS, Milan (Italy) Burchardi H. Dept. of Anaesthesiology, Emergency and Intensive Care Medicine, University of Giittingen, Giittingen (Germany) Cafiero T. Dept. of Anaesthesiology and Intensive Care, Federico II University, Naples (Italy) CandianiA. Dept. of Anaesthesia and Intensive Care, University of Brescia, Brescia (Italy) Capogna G. Dept. of Anaesthesia, Fatebenefratelli Hospital, Rome (Italy)
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