Topical Issues in Anesthesia and Intensive Care

207 Pages·2016·4.46 MB·English

by  Davide Chiumello (eds.)

T opical Issues
in Anesthesia and
Intensive Care
Davide Chiumello
Editor
123
Topical Issues in Anesthesia and
Intensive Care

Davide Chiumello
Editor
Topical Issues in
Anesthesia and
Intensive Care
Editor
Davide Chiumello
Responsabile SC Anestesia
e Rianimazione
ASST Santi Paolo e Carlo
Milano , Italy
ISBN 978-3-319-31396-2 ISBN 978-3-319-31398-6 (eBook)
DOI 10.1007/978-3-319-31398-6
Library of Congress Control Number: 2016947074
© Springer International Publishing Switzerland 2016
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does not imply, even in the absence of a specifi c statement, that such names are exempt from the relevant
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Pref ace
T his book describes the state of the art concerning some of the most hotly debated
topics in anesthesia and intensive care and is at the same time intended to serve as a
useful practical guide that will assist in improving outcomes. The topics covered are
wide ranging and include, for example, the use of antibiotic during renal r eplacement
therapy, the role of video laryngoscopy, the management of mechanical ventilation
in the operating room, the use of high frequency ventilation in respiratory failure,
the management of potential brain dead patient, the perioperative delirium, and the
single lung ventilation and the use of lung imaging in critically ill patients.
Written by recognized experts in the fi eld, this book will offer a comprehensive
and easy to understand update for specialists and students of anesthesia and inten-
sive care.
Milano , Italy Davide Chiumello
v

Contents
1 Antibiotic Dosing During Continuous Renal Replacement
Therapy (CRRT) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Giorgio Tulli
2 Video Laryngoscope: A Review of the Literature . . . . . . . . . . . . . . . . . 35
Andrea De Gasperi , Francesca Porta , and Ernestina Mazza
3 Lung Ultrasound in the Critically Ill Patient . . . . . . . . . . . . . . . . . . . . . 55
Davide Chiumello , Sara Froio , Andrea Colombo , and Silvia Coppola
4 Does High-Frequency Ventilation Have Still a Role
Among the Current Ventilatory Strategies? . . . . . . . . . . . . . . . . . . . . . . 69
Rosa Di Mussi and Salvatore Grasso
5 Noninvasive Assessment of Respiratory Function:
Capnometry, Lung Ultrasound, and Electrical
Impedance Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Gaetano Florio , Luca Di Girolamo , Andrea Clarissa Lusardi ,
Giulia Roveri , and Marco Dei Poli
6 Protective Mechanical Ventilation in Brain Dead Organ Donors . . . 101
Chiara Faggiano , Vito Fanelli , Pierpaolo Terragni , and Luciana Mascia
7 Management of Perioperative Arrhythmias . . . . . . . . . . . . . . . . . . . . . 111
Fabio Guarracino and Rubia Baldassarri
8 Obstructive Sleep Apnoea Syndrome: What the
Anesthesiologist Should Know . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Ruggero M. Corso , Andrea Cortegiani , and Cesare Gregoretti
9 Postsurgical Liver Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Gianni Biancofi ore
10 Postoperative Delirium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Franco Cavaliere
vii
viii Contents
11 Perioperative Protection of Myocardial Function . . . . . . . . . . . . . . . . 165
Luigi Tritapepe , Giovanni Carriero , and Alessandra Di Persio
12 Regional Anesthesia in Ambulatory Surgery . . . . . . . . . . . . . . . . . . . . 179
Edoardo De Robertis and Gian Marco Romano
13 One-Lung Ventilation in Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Giorgio Della Rocca and Luigi Vetrugno
Antibiotic Dosing During Continuous 1
Renal Replacement Therapy (CRRT)
Giorgio Tulli
1.1 Introduction
In critically ill patients, antibiotic dosing is much more complex than other thera-
peutic classes such as sedatives, analgesics, vasoactive drugs, and other drugs com-
monly used in the ICU, because the so-called effect “end-of-needle” does not
immediately manifest itself. This complicates a lot of attempts to titrate the antibi-
otic dosing on the basis of clinical evolution. Moreover, many critically ill patients
develop severe sepsis and septic shock inward or in the ICU setting; many of them
have acute kidney failure and need kidney care support: renal replacement therapy
(RRT) or more often continuous renal replacement therapy (CRRT). Combination
of sepsis and acute renal failure is common in critically ill patients [1, 2], and it is
associated with a high mortality [3]. A suitable treatment is essential to optimize
patient survival. Antibiotic underdosing may result to a decrease of the “killing” of
bacteria and lead to a defeat in clinical resolution of infections and to an increased
bacterial resistance; furthermore, antibiotic overdosing results in toxicity [4].
1.2 Pharmacokinetics and Pharmacodynamics
of Antibiotics (Figs. 1.1, 1.2, and 1.3)
Study of drug effects in animals and humans includes pharmacokinetics, or pro-
cesses by which the body absorbs, distributes, and disposes of a drug, and pharma-
codynamics with reference to the processes by which the drug produces its desired
effect. For critically ill patients with renal failure, the elimination of a drug may be
altered compared to that observed in healthy volunteers, and the ability of a
G. Tulli
Department of Intensive Care Units and Perioperative Medicine Azienda Sanitaria,
Fiorentina (ASL CENTRO Regione Toscana), Piazza Santa Maria Nuova 1, Florence, Italy
e-mail: [email protected]
© Springer International Publishing Switzerland 2016 1
D. Chiumello (ed.), Topical Issues in Anesthesia and Intensive Care,
DOI 10.1007/978-3-319-31398-6_1