Anesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.: Proceeding of the 14th Postgraduate Course in Critical Care Medicine Trieste, Italy — November 16–19, 1999

533 Pages·2000·10.188 MB·English

by  W. A. Zin (auth.), Prof. Antonino Gullo M.D. (eds.)

Springer-Verlag Italia SrI.
A. Gullo (Ed.)
Anaesthesia, Pain, Intensive Care and Emergency Medicine - A.P.I.C.E.
Proceedings of the
14th Postgraduate Course in Critical Care Medicine
Trieste, Italy -November 16-19, 1999
Springer
Prof. 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 2000
OriginaUy published bYSpringer-Verlag Italia, Milano in 2000
ISBN 978-88-470-0095-7 ISBN 978-88-470-2286-7 (eBook)
DOI 10.1007/978-88-470-2286-7
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SPIN 10753419
Table of Contents
RESPIRATORY CARE
Principles of Laboratory Research on Respiratory Mechanics
W.A. ZIN ...................................................................................................................................... 23
RESPIRATORY MONITORING AT BEDSIDE AND TECHNIQUES
Static and Dynamic Pressure -Volume Curves
G. SERVILLO, M. COPPOLA, AND R. TUFANO................................................................................ 37
Lung Function Evaluation by Capnography
U. LUCANGELO, G. BERLOT, AND A. GULLO................................................................................ 43
Clinical Implications of the Mechanical Effects of Heat and Moisture Exchangers
A. BRASCHI, M.e. OLIVEI, AND M.A. VILLANI ........................................................................... 57
FOCUS ON PULMONARY HYPERTENSION
Pulmonary Hypertension in ARDS: Management Strategies
A. BRIENZA, AND N. BRIENZA...................................................................................................... 65
Focus on Pathophysiology, Diagnosis and Management of Chronic Thromboembolic
Disease
1. LANG, AND M. KNEUSSL........................................................................................................... 69
EVIDENCE-BASED MEDICINE - PULMONARY SURFACTANT
Rationale for Exogenous Surfactant in Acute Respiratory Distress Syndrome
1.1. HAITSMA, AND B. LACHMANN................................................................................................ 79
Surfactant in the Airways: Function and Relevance in Asthma
1.M. HOHLFELD ............................................................................................................................ 85
Alveolar Surfactant and Inflammatory Mediators
M. HALLMAN ............................................................................................................................... 91
Role of Surfactant in Ventilation-Induced Lung Injury
S.l.e. VERBRUGGE, 1.1. HAITSMA, AND B. LACHMANN ................................................................ 101
UPDATE ON ARDS
Has ARDS Epidemiology Changed in the Last 30 Years?
A. ARTIGAS ................................................................................................................................... 109
VI
Mechanism of ARDS
L. BRAZZI, P. PELOSI, AND L. GATTINONI..................................................................................... 113
Dynamics of Recruitment and Collapse of the Lung in Models of ARDS
P. NEUMANN, AND G. HEDENSTIERNA........................................................................................... 121
Regional Lung Blood Flow and Inhalation of Nitric Oxide
G. HEDENSTIERNA, K. HAMBRAEUS JONZON, AND F. FREDEN ...................................................... 125
AIRFLOW LIMITATION
Mechanisms and Detection of Tidal Expiratory Flow Limitation
J. MILlC-EMILI .............................................................................................................................. 133
Clinical Consequences of the Airflow Limitation
C. TANTUCCI, A. FERRETTI, AND V. GRASSI ................................................................................. 139
Mechanisms of Intrinsic PEEP
W.A. ZIN ...................................................................................................................................... 147
Static and Dynamic Intrinsic PEEP and Respiratory Mechanics in Mechanically
Ventilated COPD Patients
V. ANTONAGLlA, A. PERATONER, AND L. DE SIMONI.................................................................... 153
Respiratory Rehabilitation
R. BRANDOLESE, AND U. ANDREOSE ............................................................................................ 161
PERIOPERATIVE MEDICINE
EVOLUTION OF THE USE OF ANAESTHETIC DRUGS
Clinical Biochemistry of N0: Recent Advances
2
J. RuPREHT................................................................................................................................... 173
Anticholinergics: Towards Selective Antimuscarinic Agents?
J. RUPREHT ................................................................................................................................... 179
Evolution of the Use of Anaesthetic Drugs: Neuromuscular Blocking Agents
A. D'HOLLANDER, AND M. BAURAIN ............................................................................................ 185
Working Mechanisms of Anaesthetic Agents
M. DZOUIC .................................................................................................................................. 191
FAST-TRACK ANAESTHESIA AND POSTOPERATIVE CARE
Fast-Track Anaesthesia in Cardiac Surgery and Postoperative Care
J.O.c. AULER JR, AND M.J.C. CARMONA .................................................................................... 201
VII
Fast-Track Program for Abdominal Surgery
F. CARLI ....................................................................................................................................... 211
Fast-Track Anaesthesia and Postoperative Care: Orthopaedic Surgery
N.E. SHARROCK ........................................................................................................................... 219
Failure to Regain Consciousness After Anaesthesia
D.F. ZANDSTRA, AND M. KUIPER ................................................................................................. 225
FOCUS ON PERIOPERATIVE MANAGEMENT IN PAEDIATRICS
New Insights into Mechanical Ventilation During Paediatric Anaesthesia
J.O.C. AULER JR, D. FANTONI, AND M.H.C. PEREIRA ................................................................. 235
Perioperative Management Strategy for Cardiac Surgery in Paediatrics
J.O.C. AULER JR, S. COPPOLA GIMENEZ, AND D. MONTEIRO ABBELAN ...................................... 251
MANAGEMENT OF ANAESTHESIA IN OBSTETRIC PATIENTS
Anaesthetic Management of Obstetric Emergencies
G. LyONS ...................................................................................................................................... 265
Neonatal Resuscitation
D. TREVISANUTO, AND F. ZACCHELLO .......................................................................................... 271
CHALLENGES IN CARDIOVASCULAR ASSESSMENT, MONITORING
AND MANAGEMENT
Preoperative Cardiovascular Assessment
B. ALLARIA, M. FAVARO, AND M. DEI POLI ................................................................................. 281
Perioperative Haemodynamic Monitoring: Invasive Vs. Non-Invasive
B. ALLARIA, M. DEI POLI, AND D. CULOTTA ............................................................................... 291
Extracorporeal Circulation: Prevention and Management of Complications
J.O.C. AULER JR .......................................................................................................................... 301
Beta Blockers and General Anaesthesia: Prevention of Myocardial Ischaemia
R. MUCHADA ................................................................................................................................ 311
Heart and Electrolytes
F. SCHIRALDI, P. FERRARO, AND B. MAGLIONE ............................................................................ 317
RECOMMENDATIONS ON PERI OPERATIVE MANAGEMENT
Patient-Assessment in the Postanaesthesia Care Unit (PACU)
H. V. SCHALK................................................................................................................................ 327
VIII
HOW TO SET UP AN ACUTE PAIN SERVICE
How to Set Up Acute Pain Services
N. RAWAL, R. ALLVIN, AND C. ZETTERBERG ................................................................................ 333
CENTRAL NERVOUS SYSTEM
DEVELOPMENT, DAMAGE AND REPAIR IN THE CENTRAL NERVOUS SYSTEM
Neural Development in the CNS: Biochemical Mechanisms of Cell Fate Determination
A. CESTELLI, G. SAVETTIERI, AND I. DI LIEGRO ........................................................................... 349
Cellular Mechanisms of Brain Damage
G. SAVETTIERI, I. DI LIEGRO, AND A. CESTELLI ........................................................................... 369
Repair Mechanisms in the CNS
D.A. SIEGEL, M. HUANG, AND S. WALKLEY ................................................................................ 377
STROKE IN THE YOUNG
Stroke in the Young: Epidemiology
G. SAVETTIERI, G. CUCCIA, AND G. SALEM!... .............................................................................. 389
Pathogenesis of Stroke in Young Adults
A. ANZINI, M. RASURA, AND C. FlESCH!...................................................................................... 401
TRAUMA OPERATIVE PROCEDURES
Update on Trauma Scoring
A.J. SUTCLIFFE ............................................................................................................................. 411
Trauma Management: From the Field to the Emergency Department
G. NARDI, S. DI BARTOLOMEO, V. MICHELUTTO .......................................................................... 417
Intensive Care for Trauma Patients: The First 24 Hours
M.J.A. PARR, AND J.P. NOLAN ..................................................................................................... 427
Intensive Treatment of the Patient with Hepatic Trauma
B. KREMZAR, AND A. SPEc-MARN ............................................................................................... 439
Mistakes in the Management of Trauma Patients
M. FISHER .................................................................................................................................... 449
FOCUS ON NEUROTRAUMA
Integrated Intensive Care Management of Severe Head Injury
N. STOCCHETTI, L. LONGHI, AND S. MAGNON!. ............................................................................ 457
IX
METABOLISM, ARTIFICIAL NUTRITION, CRRT
Organ Transplantation and Metabolism
G. SGANGA, AND M. CASTAGNETO ............................................................................................... 469
Clinical Aspects of Nutrition in Acute Renal Failure
H.P. KrERDORF ............................................................................................................................. 477
The Tricks and Traps of Enteral Nutrition
G.J.DOBB .................................................................................................................................... 489
Update on CRRT Therapy
P. ROGIERS .................................................................................................................................... 499
Haemofiltration in Neonates
G. ZOBEL, S. RbDL, AND B. URLESBERGER ................................................................................. 507
DRUGS IN ICU -USE, ABUSE AND MISUSE
Use, Abuse and Misuse of Drugs in ICU: Muscle Relaxants
G. CONTI, R. MARELLA, AND M. C. MARINI.... ... ...... ....... ... ............. ... ...... ....... ....................... ..... 517
Use of Corticosteroids in the Severely III Patient
M. ANTONELLI, AND M. PASSARIELLO .......................................................................................... 523
ADVANCES IN CPR
On Field Resuscitation
M.A. BAUBIN ............................................................................................................................... 535
The Chain of Survival: Focus on Early Defibrillation
F. KETTE ....................................................................................................................................... 543
EVIDENCE-BASED MEDICINE AND POLICY IN THE ICU
Evidence-Based Medicine in the ICU
J.-L. VINCENT ............................................................................................................................... 551
The Performance of an ICU
G.J. DOBB .................................................................................................................................... 557
Care of Dying Patients in ICU
M. FISHER .................................................................................................................................... 567
Cost-Effectiveness in the ICU
D. REIS MIRANDA, AND M. JEGERS .............................................................................................. 573
Index ........................................................................................................................................... 579
Authors Index
Allaria B.
Dept. of Intensive Care National Institute for Cancer Research, Milan (Italy)
Allvin R.
Dept. of Anaesthesiology and Intensive Care, brebro Medical Centre Hospital, brebro (Sweden)
Andreose U.
Rehabilitation Centre, Intensive Care Unit, Padua City Hospital, Conselve (Italy)
Antonaglia V.
Dept of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy)
Antonelli M.
Dept. of Anaesthesia and Intensive Care, La Sapienza University, Umberto I Hospital, Roma (Italy)
A. Anzini
Dept of Neurological Sciences, La Sapienza University, Rome (Italy)
Artigas A.
Intensive Care Unit, Sabadell Hospital, and Dept. of Cellular Biology and Physiology, Medical Physiology
Unit, Autonomous University of Barcelona (Spain)
Auler J.O.c. Jr
Dept. of Anaesthesia and Intensive Care, Heart Institute, Hospital das Clfnicas, Sao Paulo University,
Sao Paulo (Brazil)
Baubin M.A.
Dept of Anaesthesia and Intensive Care Medicine, University ofInnsbruck, Innsbruck (Austria)
Baurain M.
Dept. of Anaesthesiology and Resuscitation, Erasme Hospital, University of Bruxelles, Bruxelles (Belgium)
Berlot G.
Dept. of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy)
Brandolese R.
Rehabilitation Centre, Intensive Care Unit, Padua City Hospital, Conselve (Italy)
Braschi A.
1s t Dept. of Anaesthesia and Intensive Care, S, Matteo University Hospital -IRCCS, Pavia (Italy)
Brazzi L.
Dept. of Anaesthesia and Intensive Care, Maggiore University Hospital -IRCCS, Milan (Italy)
BrienzaA.
Dept. of Emergency Medicine and Organ Transplantation, Anaesthesia and Intensive Care Unit, Bari
University, Bari (Italy)
Brienza N.
Dept of Emergency Medicine and Organ Transplantation, Anaesthesia and Intensive Care Unit, Bari
University, Bari (Italy)
Carli F.
Dept. of Anaesthesia, McGill University, Montreal, Quebec (Canada)
Carmona M.J.C.
Dept. of Anaesthesia and Intensive Care, Heart Institute, Hospital das Clfnicas, Sao Paulo University,
Sao Paulo (Brazil)
XII
Castagneto M.
Dept. of Surgery, Division of Organ Transplantation, Catholic University, and CNR, Centre for the
Pathophysiology of Shock, Rome (Italy)
Cestelli A.
Dept. of Cellular Biology and of Development, Palermo University School of Medicine, Palermo (Italy)
Conti G.
Dept. of Anaesthesia and Intensive Care, La Sapienza University, Umberto I Hospital, Roma (Italy)
Coppola Gimenez S.
Dept. of Paediatric Critical Care, Heart Institute, Hospital das Clfnicas, Sao Paulo University, Sao Paulo
(Brazil)
Coppola M.
Dept. of Surgery, Anaesthesiology, Intensive Care and Emergency Medicine, Federico II University, Naples
(Italy)
Cuccia G.
Dept. of Neuropsychiatry, Palermo University School of Medicine, Palermo (Italy)
Culotta D.
Dept. of Intensive Care National Institute for Cancer Research, Milan (Italy)
De Simoni L.
Dept. of Anaesthesiology and Intensive Care, Trieste University School of Medicine, Trieste (Italy)
Dei Poli M.
Dept. ofIntensive Care National Institute for Cancer Research, Milan (Italy)
Di Liegro I.
Dept. of Cellular Biology and of Development, Palermo University School of Medicine, Palermo (Italy)
D' Hollander A.
Dept. of Anaesthesiology and Resuscitation, Erasme Hospital, University of Bruxelles, Bruxelles (Belgium)
Di Bartolomeo S.
Friuli-Venezia Giulia Emergency Helicopter Service (Italy)
Dobb. G.J.
Intensive Care Unit, Royal Perth Hospital, Perth (Australia)
Dzoljic M.
Dept. of Anaesthesiology, Academic Medical Centre, Amsterdam (The Netherlands)
Fantoni D.
Dept. of Veterinary Medicine, Heart Institute, Hospital das Clfnicas, Sao Paulo University, Sao Paulo (Brazil)
Favaro M.
Dept. of Intensive Care National Institute for Cancer Research, Milan (Italy)
Ferraro P.
Dept. of Emergency Medicine, San Paolo Hospital, Naples (Italy)
Ferretti A.
Dept. of Pneumology, Sant'Orsola-Malpighi Hospital, Bologna (Italy)
Fieschi C.
Dept. of Neurological Sciences, La Sapienza University, Rome (Italy)
Fisher M.
Dept. of Anaesthesia and Intensive Care, University of Sydney (Australia)
Freden F.
Dept. of Thoracic Anaesthesia, Uppsala University Hospital, Uppsala (Sweden)