Anaesthesia, Pain, Intensive Care and Emergency Medicine - A.P.I.C.E.: Proceedings of the 19 th Postgraduate Course in Critical Care Medicine. Trieste, Italy - November 12-15, 2004

738 Pages·2004·6.84 MB·English

by  A. Gullo

A.Gullo(Editor)
Anaesthesia, Pain, Intensive Care and Emergency – A.P.I.C.E.
Proceedingsofthe
19thPostgraduateCourseinCriticalCareMedicine
Trieste,Italy- November12- 15,2004
A. Gullo (Editor)
Anaesthesia, Pain, Intensive Care
and Emergency
A.P.I.C.E.
Proceedings of the
th
19 Postgraduate Course in Critical Care Medicine
Trieste, Italy – November 12-15, 2004
Springer
ANTONINOGULLO,M.D.
Head,DepartmentofPerioperativeMedicine,
IntensiveCareandEmergency
TriesteUniversitySchoolofMedicine
Trieste,Italy
LibraryofCongressControlNumber:2004115099
ISBN88-470-0288-5 SpringerMilanBerlinHeidelbergNewYork
Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthematerial
isconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation,
broadcasting, reproduction on microfilm or in any other way, and storage in data banks.
Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisionsofthe
ItalianCopyrightLawinitscurrentversion,andpermissionforusemustalwaysbeobtainedfrom
Springer.ViolationsareliabletoprosecutionundertheItalianCopyrightLaw.
SpringerisapartofSpringerScience+BusinessMedia
springeronline.com
©Springer-VerlagItalia2005
PrintedinItaly
Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublicationdoes
notimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromthe
relevantprotectivelawsandregulationsandthereforefreeforgeneraluse.
Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformationaboutdosage
and application contained in this book. In every individual case the user must check such
informationbyconsultingtherelevantliterature.
Coverdesign:SimonaColombo,Milan,Italy
Typesettingandprinting:ArtiGraficheStella,Trieste,Italy
V
Table of Contents
ADVANCESINCRITICALCARE
Chapter1–Effectsofbodypositiononventilation/perfusionmatching
G.HEDENSTIERNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter2–ChestPain
F.SCHIRALDI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Chapter3–Theelectrocardiogramintheemergencydepartment
F.SCHIRALDI,F.PALADINO,E.G.RUGGIERO . . . . . . . . . . . . . . . . . . . . . . 27
Chapter4–Theuseofimagingtoresolvedifficultdiagnoses
V.CIOFFI,L.CALDERAN,M.COVA . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Chapter5–AssessmentofPain
D.CARISTI,A.GALZERANO,M.PIVA . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Chapter6–Titrationofopioidsforacutepainmanagement
Y.LEYKIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Chapter7–Neonatalmechanicalventilation
A.BOUGATEF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Chapter8–Extracorporealcirculationintheintensivecareunit
V.GA[PAROVI],M.MERKLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Chapter9–Clinicaldecision-makinginthemanagementofsepsisandsepticshock
F.BARATTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Chapter10–Intracranialhaemorrhage:thesolutionofferedbyrecombinantfactorVIIa
G.MICIELI,A.CAVALLINI,S.MARCHESELLI . . . . . . . . . . . . . . . . . . . . . . 101
VI
Chapter11–AnintroductiontoOpenSourcesoftwarelicensing
anduseinanaesthesiadepartment
V.LANZA,M.SAJEVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
MICRODIALYSIS
Chapter12–Lessonswehavelearntfrommicrodialysisinanimalsandhumans
NORDSTRÖM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Chapter13–Secondarybraininjury-doesmicrodialysishavearole?
M.SMITH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Chapter14–Livergraftmonitoringwithintrahepaticmicrodialysis
G.NOWAK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Chapter15–Myocardialmetabolismduringopenheartsurgery,assessed
withmicrodialysis
L.BAHLMANN,J.PÖLING,S.KLAUS . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
CLINICALPHARMACOLOGY
Chapter16–Thejourneyofadrugtothetargetsite:whatisitdecisive?
C.THALLINGER,C.JOUKHADAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Chapter17–Thepharmacokineticsandpharmacodynamicsofantimicrobialagents
inintensivecareunitpatientsasassessedbymicrodialysis
V.KULEMANN,C.JOUKHADAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
PERIOPERATIVEMEDICINE
Chapter18–Anaestheticeffectsonregionalcerebralbloodflowandmetabolism:
threecontemporaryreasonstocare
M.ALKIRE,J.MILLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Chapter19–Whyandwhenisinhalationanaesthesiabetter
I.SALVO,P.SILVANI,A.CAMPORESI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Chapter20–Analysisandinstrumentationsforestimatingcerebralactivity
E.FACCO,S.BARBIERI,M.MUNARI . . . . . . . . . . . . . . . . . . . . . . . . . . 205
VII
Chapter21–Neuroimagingpharmacologyofattentionandmemory
U.FREO,C.ORI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Chapter22–Intracranialpressuremonitoring
M.MUNARI,S.M.VOLPIN,E.FACCO . . . . . . . . . . . . . . . . . . . . . . . . . 227
Chapter23–Improvingqualityofrecovery
M.KLIMEK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
LUNGANDARTIFICIALVENTILATION
Chapter24–Molecularbiologyandlungdisease.Whatistheimpact?
A.C.ANDRADE,M.M.MORALES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245
Chapter25–Surfactantmetabolism:factorsaffectinglipiduptakeinvivoandinvitro
D.L.H.POELNA,J.F.VANIWAARDEN,B.LACHMANN . . . . . . . . . . . . . . . . . 259
Chapter26–Respiratorymechanicsatthebedside
T.LUECKE,F.FIEDLER,P.PELOSI. . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Chapter27–PEEPandcardiacoutput
T.LUECKE,R.GIESER,P.PELOSI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Chapter28–ExpiratoryflowlimitationandintrinsicPEEP
J.MILIC-EMILI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317
Chapter29–Mechanicalventilationstrategiesforlungprotection
N.R.MACINTYRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Chapter30–Recruitmentandoxygenation
T.MUDERS,H.WRIGGE,C.PUTENSEN . . . . . . . . . . . . . . . . . . . . . . . . . 331
Chapter31–Lungoedemainacutelunginjury(ALI)
S.NUNES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
Chapter32–Gradingseverityofrespiratorydysfunction,clinicalcorrelates
andindicationsformechanicalventilation
N.THEUERKAUF,H.WRIGGE,C.PUTENSEN . . . . . . . . . . . . . . . . . . . . . . 357
Chapter33–Weaningasacardiacstresstest
B.LAMIA,J.-L.TEBOUL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
VIII
Chapter34–Respiratorymanagementinobesepatients
P.PELOSI,T.LUECKE,P.CAIRONI . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Chapter35–Istheacuterespiratorydistresssyndromeasystemicdisease?
L.BRANDER,A.S.SLUTSKY,H.ZHANG . . . . . . . . . . . . . . . . . . . . . . . . . 395
CARDIOVASCULARCRITICALCARE
Chapter36–Invasiveversusnon-invasivehaemodinamicmonitoring
inmajorvascularsurgery
B.ALLARIA,M.RESTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
Chapter37–Analysisofarterialpulse–clinicalimplications
GIOMARELLI,S.SCOLLETTA,S.M.ROMANO . . . . . . . . . . . . . . . . . . . . . . . 417
Chapter38–Beat–by–beatmonitoringofcardiacoutput
withpressurerecordinganalyticalmethod
S.SCOLLETTA,P.GIOMARELLI,B.BIAGIOLI . . . . . . . . . . . . . . . . . . . . . 425
Chapter39–Haemodynamicstandardisationproceduresinhigh-risksurgery
T.YAMAGUTI,S.MINHYEKIM,J.O.C.AULER . . . . . . . . . . . . . . . . . . . . . 437
Chapter40–FromFrank–Starlingrelationshipstoventriculo–arterialcoupling
R.NAEIJE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Chapter41–Pharmacologyandselectionofinotropictherapy
J.O.C.AULER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461
Chapter42–Decision–makingincriticalcare:cardiacarrhythmias
andrelatedtopics
J.L.ATLEE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Chapter43–Managementforthepatientwithanimplantedcardiacrhythm
managementdevice(CRMD)
J.L.ATLEE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Chapter44–Hypothemiaincardiacsurgery
J.O.C.AULER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
IX
CARDIOPULMONARYRESUSCITATION
Chapter45–Pharmacologicalmanagementofcardiopulmonaryresuscitation
T.PELLIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
Chapter46–Myocardialpreservation,reperfusioninjury,
andpostresuscitationmyocardialdysfunction
R.J.GAZMURI,J.RADHAKRISHNAN,J.KORALOVA. . . . . . . . . . . . . . . . . . . . 517
MICROCIRCULATIONANDSHOCK
Chapter47–Regionalbloodflowdistributioninseptic,cardiogenic
andhaemorrhagicshock
D.DEBACKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529
Chapter48–Orthogonalpolarisationspectralimaging:principles,techniques,
humanstudies
D.DEBACKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535
Chapter49–Carbondioxidemonitoringtoevaluatecelloxygenation
J.CRETEUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543
Chapter50–Themicrocirculationindistress;monitoringandrecruitment
P.GOEDHART,C.INCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Chapter51–Tissuemetabolismindifferenttypesofshock
S.KLAUS,J.PÖLING,L.BAHLMANN . . . . . . . . . . . . . . . . . . . . . . . . . . . 565
Chapter52–Organdysfunctionincirculatoryshock–alteredperfusion,metabolism
ortightjunctions?Doweneedashiftofparadigm?
J.TENHUNEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577
Chapter53–Haemodynamicsupportofpaediatricpatientsinsepticshock
G.ZOBEL,S.RÖDL,H.-M.GRUBBAUER . . . . . . . . . . . . . . . . . . . . . . . . 587
PAEDIATRICCRITICALCARE
Chapter54–Recentadvancesinartificialventilationinpaediatricage
G.A.MARRARO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599
X
Chapter55–Complicationsinpaediatricregionalanaesthesia
G.IVANI,V.MOSSETTI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611
Chapter56–Homeventilationinpaediatricpatientswithchronicrespiratoryfailure
B.FAUROUX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619
Chapter57–Decision–makinginpaediatricextracranialtrauma
E.CALDERINI,R.SCARANI,D.NIRO . . . . . . . . . . . . . . . . . . . . . . . . . . 633
Chapter58–Developmentinthetreatmentofpostoperativepaininpaediatrics
P.BUSONI,A.MESSERI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653
TRAUMAANDEMERGENCYSYSTEM
Chapter59–Prehospitalcare:triageandprimarysurvey
O.PREDESCU,A.BAKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 663
Chapter60–Spineandspinalcordtrauma
O.PREDESCU,A.BAKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673
Chapter61–Treatmentoftheacutepneumothoraxinthefield
G.BERLOT,D.MASSARUTTI,E.CARCHIETTI . . . . . . . . . . . . . . . . . . . . . . 683
CLINICALSTUDYDESIGN
Chapter62–Criticalappraisalskills
S.MARTINS, A.ZIN,W.ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695
Chapter63–Literaturesearch
S.MARTINS,A.ZIN,W.ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
Chapter64–Studydesign
S.MARTINS,A.ZIN,W.ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 719
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749