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A.Gullo • P.D.Lumb (Eds.) Intensive and Critical Care Medicine Reflections,Recommendations and Perspectives A.Gullo • P.D.Lumb (Eds.) Intensive and Critical Care Medicine Reflections,Recommendations and Perspectives 1 3 ANTONINOGULLO PHILIPD.LUMB Department ofPerioperative Medicine Department ofAnaesthesiology Intensive Care and Emergency Keck School ofMedicine at USC Trieste University School ofMedicine Los Angeles,CA Trieste,Italy U.S.A. Library ofCongress Control Number:2005928163 ISBN 88-470-0349-0 Springer Milan Berlin Heidelberg New York This work is subject to copyright.All rights are reserved,whether the whole or part ofthe material is concerned,specifically the rights of translation,reprinting,reuse of illustra- tions,recitation,broadcasting,reproduction on microfilm or in any other way,and storage in data banks.Duplication ofthis publication or parts thereofis permitted only under the provisions ofthe Italian Copyright Law in its current version,and permission for use must always be obtained from Springer.Violations are liable to prosecution under the Italian Copyright Law. Springer is a part ofSpringer Science+Business Media springeronline.com © Springer-Verlag Italia 2005 Printed in Italy The use of general descriptive names,registered names,trademarks,etc.in this publica- tion does not imply,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 ofany information about dosage and application contained in this book.In every individual case the user must check such information by consulting the relevant literature. Cover design:Simona Colombo,Milan,Italy Typesetting:Graphostudio,Milan,Italy Printing:Arti Grafiche Stella,Trieste,Italy Ten Steps to the Top After the Sydney meeting held in 2001,the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) reinforced its multidiscipli- nary and multi-professional identity. WFSICCM President Philip D.Lumb from the Keck School of Medicine of the University of Southern California in Los Angeles has, together with the Federation Council,envisaged a new strategy to obtain a more-visible target for its mission. In the last four years,several goals have been accomplished and the WFSICCM is now well-positioned to succeed in its global mission. – First,the functions of the Secretariat and Headquarters have been relocated to the United Kingdom.Ms Liz Taylor has been appointed the Council’s Executive Assistant,which represents a significant step towards ensuring the organisation’s administrative integrity.Clearly,this is a winning decision; – Second,the WF web-site has improved global communications and become a useful tool for effective online decision-making; – Third,Pathfinder UK has helped to develop a strong marketing plan and to cre- ate a more-visible and proactive presence in the international Critical Care com- munity; – Fourth,the President has reached all corners of the world,communicating enthusiasm and revealing leadership excellence; – Fifth,the Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine has reinforced its relationship with the World Federation; the memorable 2003 congress held in Cancun,Mexico,has represented a key- stone in the growing process ofthe WF; – Sixth, Trieste, Italy, has for three times hosted the WF during APICE, the International Congress endorsed by the WF; – Seventh,Durban,South Africa,has represented an important phase in the expansion process of the WF; an important debate for understanding possible assistance for countries with limited resources has taken place there; – Eighth,the Council has encouraged new contacts;the dream ofestablishing the Mediterranean School of Intensive and Critical Care Medicine is coming true. VI Ten Steps to the Top Furthermore,Russia and China represent a new target for the WF Council,with scientific contacts and expectations becoming increasingly promising; – Ninth,last April,in Santos,the WF Council considered the future scenario of the WF after the forthcoming 9thWorld Congress to be held in Buenos Aires;in the meantime,the capital of tango and the South American atmosphere will be an ideal environment for continuing our dreams; – Tenth,Education and Standards of Care are the pillars of the WFSICCM; the present book is a celebration of the WF Council’s quadrennial activity and sets out the reflections and perspectives that are necessary for offering care to the highest standards to critically ill patients.We hope we all agree to think about this. Buenos Aires Antonino Gullo August 27,2005 Philip D.Lumb Table of Contents Introduction:World Federation 1993-1997 M.Fisher . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Consent and Intensive Care:Is It Possible? L.Berggren . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Hepatorenal Syndrome J.Besso,C.Pru,J.Padron,J.Plaz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 HIV/AIDS in Developing Countries S.Bhagwanjee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Do Not Attempt Resuscitation Order F.J.de Latorre . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Molecular Biology in Critical Care:Is It More Than a Look Only? G.Domínguez-Cherit,J.Gutiérrez,E.Rivero . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Resource Management and Audits in Intensive Care Medicine A.O.Gallesio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Sepsis and Organ(s) Dysfunction – Key Points,Reflections,and Perspectives A.Gullo,F.Iscra,F.Rubulotta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 How to Evaluate Performance of Adult Intensive Care Units:A 30Year Experience J.R.Le Gall,E.Azoulay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Research Ethics in Critical Care Medicine P.D.Lumb . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Scoring System and Outcome R.Moreno,P.Metnitz . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 VIII Table of Contents Clinical Decision Making for Non-Invasive Ventilation S.Prayag,A.Jahagirdar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Control of Infections in Intensive Care Units J.Takezawa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Diagnosis of Pulmonary Embolism R.G.G.Terzi,M.Mello Moreira . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Critical Care Nursing,a WorldWide Perspective G.Williams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 Cost of Care in Critical Illness T.A.Williams,G.J.Dobbs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Gallery 2002 – 2005 (After Affiliation of APICE to WFSICCM) . . . . . . . . . . . . . . . . . . . . . 215 Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229 List of Contributors Azoulay E. Dominguez-Cherit G. Intensive Care Unit, Department ofCritical Care Medicine, Hôpital Saint Louis, National Institute ofMedical Sciences Paris (France) and Nutrition ‘Salvador Zubiran’, Mexico City (Mexico) Berggren L. Department ofAnaesthesiology, Fisher M. Örebro Medical Centre Hospital, Intensive Care Unit,Royal North Shore Örebro (Sweden) Hospital,St.Leonards (Australia) Besso J. Gallesio A.O. Department ofIntensive Care, Unidad de Terapia Intensiva Adulta, Hospital Centro Medico de Caracas Hospital Italiano,Buenos Aires (Venezuela) (Argentina) Bhagwanjee S. Gullo A. Department ofAnaesthesiology, Department ofPerioperative University ofWithwatersrand, Medicine,Intensive Care and Johannesburg Hospital,Johannesburg Emergency,School ofAnaesthesia and (South Africa) Intensive Care,Trieste University Medical School,Trieste (Italy) de Latorre F.J. Servei de Medicina Intensiva,Hospital Gutierrez J. Universitari Vall d’Hebron,Barcelona Department ofCritical Care Medicine, (Spain) National Institute ofMedical Sciences and Nutrition ‘Salvador Zubiran’, Dobb G.J. Mexico City (Mexico) Intensive Care Unit,Royal Perth Hospital and School ofMedicine and Iscra F. Pharmacology,University ofWestern Department ofPerioperative Australia,Perth (Australia) Medicine,Intensive Care and Emergency,School ofAnaesthesia and X List of Contributors Intensive Care,Trieste University Prayag S. Medical School,Trieste (Italy) Shree Medical Foundation,Prayag Hospital,Pune (India) Jahagirdar A. Shree Medical Foundation,Prayag Pru C. Hospital,Pune (India) Department ofIntensive Care,Hospital Centro Medico de Caracas (Venezuela) Le Gall J.R. Intensive Care Unit,Hôpital Saint Rivero E. Louis,Paris (France) Department ofCritical Care Medicine, National Institute ofMedical Sciences Lumb P.D. and Nutrition ‘Salvador Zubiran’, Department ofAnaesthesiology,Keck Mexico City (Mexico) School ofMedicine,University of Southern California,Los Angeles Rubulotta F. (USA) Department ofIntensive Care, University Hospital,Leuven (Belgium) Mello Moreira M. Department ofSurgery,Faculdade de Takezawa J. Ciências Médicas,Universidade Department ofEmergency and Estadual de Campinas UNICAMP, Intensive Care Medicine,Nagoya Campinas,São Paulo (Brazil) University School ofMedicine,Nagoya (Japan) Metnitz P. Department ofAnaesthesiology and Terzi R. Intensive Care Medicine,Medical Department ofSurgery,Faculdade de University ofVienna,Vienna (Austria) Ciências Médicas,Universidade Estadual de Campinas UNICAMP, Moreno R. Campinas,São Paulo (Brazil) Unidade de Cuidados Intensivos Polivalente,Hospital de Santo António Williams G. dos Capuchos,Centro Hospitalar de Direction ofNursing,Maroondah Lisboa,Lisbon (Portugal) Hospital,Victoria (Australia) Padron J. Williams T.A. Department ofIntensive Care,Hospital Intensive Care Unit,Royal Perth Centro Medico de Caracas (Venezuela) Hospital and School ofMedicine and Pharmacology,University ofWestern Plaz J. Australia,Perth (Australia) Department ofIntensive Care,Hospital Centro Medico de Caracas (Venezuela)

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