Practical Issues Updates in Anesthesia and Intensive Care

201 Pages·2015·3.77 MB·English

by  Davide Chiumello (eds.)

Practical Issues
Updates in Anesthesia
and Intensive Care
Davide Chiumello
Editor
123
Practical Issues Updates in Anesthesia
and Intensive Care

Davide Chiumello
Editor
Practical Issues Updates
in Anesthesia
and Intensive Care
Editor
Davide Chiumello
Dipartimento di Anestesia, Rianimazione e
Terapia del Dolore
Ospedale Maggiore Policlinico Fondazione
IRCCS Ca’ Granda
Milano
Italy
ISBN 978-3-319-18065-6 ISBN 978-3-319-18066-3 (eBook)
DOI 10.1007/978-3-319-18066-3
Library of Congress Control Number: 2015943786
Springer Cham Heidelberg New York Dordrecht London
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Al Nostro Maestro
Biagio Allaria
Cambiare la vita degli altri è un dono concesso a pochi,
Ai maestri, ad esempio.
Ma i veri maestri diventano sempre più rari e incontrarli è un privilegio per pochi.
Noi che abbiamo vissuto con te quei che il poeta chiamò
“ I migliori anni della nostra vita” siamo qui a ricordare che ne è valsa la pena viverli
insieme con te, intensamente, caro Maestro!
… the physician without physiology practices a sort of popgun pharmacy, hitting now the
malady and again the patient, he himself not knowing which. William Osler
Professor Biagio Allaria left us suddenly on May 3, 2014, the victim of a devas-
tating heart attack, the illness he spent his life fi ghting against but which hit him
from behind, in a cowardly manner, during the nighttime.
M any of the readers and some of the authors of this book will have had Biagio
Allaria as Director and Mentor during their clinical careers and will have been fi red
by his enthusiastic, modern and smart medical approach. But we all have Biagio as
a Maestro, in the full meaning that the Italian word deserves.
From the very beginning of his involvement in the fi eld of care of the critically
ill, Biagio taught his pupils to go deeper into each single case encountered in every-
day medical practice, never to be convinced by the fi rst explanation or the fi rst
glance, and never to be afraid of challenging what is considered fact. This is why the
gift of changing the course of others’ lives is reserved for the few, and among them
are those we consider true masters, or Maestri. Unfortunately, Maestri are becoming
increasingly rare. We had the privilege and the unique, invaluable opportunity to be
guided by a Maestro in our fi rst medical steps (and beyond…), during times often
remembered as “the best years of our lives”.
This book offers the opportunity to have Biagio with us once again.
On behalf of all the alumni who were nurtured and inspired by Professor Biagio
Allaria and who have been and will continue to be involved in the care of critically
ill patients.
Milano, Italy Furio Zucco
Marco Dei Poli
Andrea De Gasperi
v

Contents
1 The Prone Position in the Treatment of Patients
with ARDS: Problems and Real Utility. . . . . . . . . . . . . . . . . . . . . . . . . 1
Davide A. Chiumello, Ilaria Algieri, Matteo Brioni,
and Giovanni Babini
2 Therapeutic Hypothermia in the Intensive Care Unit . . . . . . . . . . . . . 15
Massimo Girardis and Emanuela Biagioni
3 Which Among Septic Patients Are the Best Candidate
for Immunoglobulins? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Giorgio Berlot, Perla Rossini, and Federica Turchet
4 The Role of Noradrenaline, Vasopressin, and Terlipressin
in Septic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Biagio Allaria
5 The Most Recent Strategies for VAP
(Ventilator-Associated Pneumonia) Prevention . . . . . . . . . . . . . . . . . . 43
Davide A. Chiumello, Silvia Coppola, and Sara Froio
6 Hemodynamic Optimization in the Perioperative Period:
General Guidelines and a Comparison of Personalized Strategies . . . 57
Biagio Allaria
7 Management Strategies in the Postoperative Course,
with Particular Attention to Pain Treatment:
Revision of the Most Recent Knowledge . . . . . . . . . . . . . . . . . . . . . . . . 77
Gennaro Savoia and Maria Loreto
8 Optimum Management of Perioperative Coagulation
in Patients with Spontaneous Intracranial Haemorrhage . . . . . . . . . 91
Patrizia Fumagalli
9 Postpartum Haemorrhage (PPH): Diagnosis,
Prevention and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
Giorgio Tulli
vii
viii Contents
10 Noninvasive Ventilation Outside the Critical Care Unit . . . . . . . . . . . 139
Cesare Gregoretti, Alessio Mattei, and Annalisa Carlucci
11 Interventional Cardiology: The Role of the Anesthesiologist . . . . . . . 149
Franco Cavaliere
12 All You Need to Know About the Meaning
of Plasmatic Lactate Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
L. di Girolamo, R. Iorio, G. Spinelli, and M. Dei Poli
13 Clinical Use of Indocyanine Green (ICG) Kinetics in Liver
Anaesthesia and ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Andrea De Gasperi and Ernestina Mazza
1
The Prone Position in the Treatment
of Patients with ARDS: Problems
and Real Utility
Davide A. Chiumello , Ilaria Algieri , Matteo Brioni ,
and Giovanni Babini
1.1 Introduction
P rone positioning during mechanical ventilation is a type of treatment used in severe
ARDS patients when conventional ventilation with low tidal volume and high posi-
tive end-expiratory pressure (PEEP) is not able to improve gas exchange and
exposes lungs to high risk of ventilation-induced lung injury (VILI). In this chapter
we will discuss the pathophysiological rationale of this procedure and current evi-
dences in literature regarding improvement in clinical outcomes, indications, con-
traindications, and any complications.
1.2 Background
Prone positioning as a treatment for acute respiratory failure was fi rst described in
the mid-1970s. In these years Piehl et al. investigated the effects of posture chang-
ing in patients with acute respiratory failure, describing a signifi cant improvement
in oxygenation during prone ventilation [1 ].
However, the clinical application of prone positioning in ARDS patients became
popular in the mid-1980s. During this time, the fi rst reports on the use of computed
tomography (CT) in ARDS patients were published, demonstrating the nonhomo-
geneous nature of the disease: ventral lung regions (non-dependent) were spared
and maintained good aeration and instead dorsal lung regions (dependent) appeared
D. A. Chiumello (*)
Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore ,
Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico , Milan , Italy
e-mail: [email protected]
I. Algieri (cid:129) M. Brioni (cid:129) G. Babini
Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti ,
Università degli Studi di Milano , Milan , Italy
© Springer International Publishing Switzerland 2015 1
D. Chiumello (ed.), Practical Issues Updates in Anesthesia and Intensive Care,
DOI 10.1007/978-3-319-18066-3_1