Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: Proceedings of the 20th Postgraduate Course in Critical Care Medicine Trieste, Italy — November 18–21, 2005

844 Pages·2006·8.38 MB·English

by  C. S. N. B. Garcia

A. Gullo(Editor)
Anaesthesia, Pain, Intensive Care and Emergency – A.P.I.C.E.
Proceedingsofthe
20thPostgraduateCourseinCriticalCareMedicine
Trieste,Italy- November18- 21,2005
A. Gullo (Editor)
Anaesthesia, Pain, Intensive Care
and Emergency
A.P.I.C.E.
Proceedings of the
20th Postgraduate Course in Critical Care Medicine
Trieste, Italy – November 18-21, 2005
Springer
ANTONINOGULLO,M.D.
Head,DepartmentofPerioperativeMedicine,
IntensiveCareandEmergency
TriesteUniversitySchoolofMedicine
Trieste,Italy
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ISBN1088-470-0406-3 SpringerMilan,BerlinHeidelbergNewYork
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Table of Contents
BASICSINCRITICALCARE
Chapter1–Cellularresponsetomechanicalstress
C.S.N.BGARCIA,P.R.M.ROCCO,M.M.MORALES . . . . . . . . . . . . . . . . . . 3
Chapter2–Molecularbiology:fromthebenchtoclinicalapplication
M.M.MORALES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
ADVANCESINCRITICALCARE
Chapter3–Autologousbonemarrowcellstransplantation
inischaemiccardiomyopathy:initialclinicalresults
S.ALMEIDADEOLIVEIRA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Chapter4–Haemorrhagicshock
J.BOLDT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Chapter5–Microdialysis-principlesandtechniques
C.-H.NORDSTRÖM,U.UNGERSTEDT . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Chapter6–Sidestreamdark-fieldimagingandimageanalysis
oforalmicrocirculationunderclinicalconditions
D.M.J.MILSTEIN,J.A.H.LINDEBOOM,C.INCE . . . . . . . . . . . . . . . . . . . . . 79
Chapter7–Perfusionoptimisationatthemicrocirculatorylevel
D.DEBACKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Chapter8–Pacemakerresynchronisationinthetreatmentofsevereheartfailure
J.L.ATLEE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Chapter9–Theimportanceofguidelinesinairwaymanagement
F.PETRINI,M.SORBELLO,M.SCOPONI . . . . . . . . . . . . . . . . . . . . . . . . . 113
VI
Chapter10–BioGrid:acollaborativeenvironmentforlifescienceresearch
C.-H.HUANG . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
ANTIBIOTICS
Chapter11–Theclassificationsofantibiotics
R.DEGAUDIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Chapter12–Anoverviewofantibioticpharmacokinetics
M.PALAZZO 143
Chapter13–Evidenceforimmediateadequateparenteralantibiotics
V.EMMI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter14–Focusonantibiotics:useandmisuseintheintensivecareunit,
andantibioticsmonitoring
F.PEA,F.PAVAN,M.FURLANUT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
CENTRALNERVOUSSYSTEM
Chapter15–Clinicalsignificanceofmonitoringthecentralnervoussystem
intheoperationroomandtheintensivecareunit
E.FREYE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Chapter16–Globalhypothermiaforneuroprotectionaftercardiacarrest
W.BEHRINGER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Chapter17–Vegetativestate
N.LATRONICO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
CARDIOVASCULAR
Chapter18–Apersonalaccountfromfourdecadesofcardiaccare:
isthereacaseformechanicalheartrhythmmanagement?
J.L.ATLEE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Chapter19–Oesophagealpacingandcardioversion-defibrillation
J.L.ATLEE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
VII
Chapter20–Thrombolysisduringcardiopulmonaryresuscitation
B.W.BÖTTIGER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Chapter21–Cardiacresynchronisationtherapy:doweknoweverything?
C.FANTONI,A.AURICCHIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257
Chapter22–Minimisingreperfusioninjuryinsettingsofmyocardialischaemia
R.GAZMURI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Chapter23–Noninvasivehaemodynamicmonitoring:wherewearein2005
R.MUCHADA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Chapter24–Roleofshocktimingincardiacvulnerabilitytoelectricshocks
B.RODRIGUEZ,N.TRAYANOVA,D.GAVAGHAN . . . . . . . . . . . . . . . . . . . . . 287
Chapter25–Analysisofarterialpulseandventriculardevices
S.SCOLLETTA,S.M.ROMANO,B.BIAGIOLI . . . . . . . . . . . . . . . . . . . . . . . 295
Chapter26–Ventilatory-metabolicmonitoringandanalysisofarterialpulse
P.GIOMARELLI,E.CASADEI,S.SCOLLETTA . . . . . . . . . . . . . . . . . . . . . . . 305
Chapter27–Theassessmentofcardiacperformanceincriticallyillpatients
C.SORBARA,A.ROSSI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Chapter28–Haemodynamicmonitoringofsepticpatientswithpressure
recordinganalyticalmethod:preliminaryobservations
G.TULLI,S.M.ROMANO,R.FEMINÒ . . . . . . . . . . . . . . . . . . . . . . . . . . 323
Chapter29–Thedarksideofthemoon:in-hospitalcardiopulmonaryresuscitation
E.CERCHIARI,N.CILLONI,F.SEMERARO . . . . . . . . . . . . . . . . . . . . . . . . 341
LUNG
Chapter30–Physiopathologyofatelectasisduringanaesthesia
G.HEDENSTIERNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Chapter31–Effectofmechanicalventilationonrightventricularafterload
B.LACHMAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361
VIII
Chapter32–Computedtomographyevaluationoflungcollapse
andrecruitmentmanoeuvresduringanaesthesia
L.M.S.MALBOUISSON,J.O.C.AULERJR. . . . . . . . . . . . . . . . . . . . . . . . . 369
Chapter33–MechanismsofrepairandremodellinginARDS
C.DOSSANTOS,P.R.M.ROCCO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 381
Chapter34–CorticosteroidsinARDS:backtothefuture
A.B.SOUZA-FERNANDES,W.A.ZIN,P.R.M.ROCCO . . . . . . . . . . . . . . . . . . 405
Chapter35–NitricoxideshouldbeusedinARDS
H.GERLACH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
Chapter36–FormationandclearanceofpulmonaryoedemainALI/ARDS
B.ALLARIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431
FLUID,ELECTROLYTESANDACID/BASEBALANCE
Chapter37–Diabeticketoacidos:incidence,biochemicalabnormalities,
pathophysiology,anddiagnosis
K.HILLMAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
Chapter38–Endogenousmetabolicacid-baseabnormalities:lactateandotherstrongions
J.KELLUM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Chapter39–Metabolicacidosis
F.SCHIRALDI,G.ESPOSITO,E.G.RUGGIERO . . . . . . . . . . . . . . . . . . . . . . 455
Chapter40–Metabolicalkalosis
F.SCHIRALDI,E.MIRANTE,F.PALADINO . . . . . . . . . . . . . . . . . . . . . . . . 463
Chapter41–Blood-gasmonitoring
R.G.G.TERZI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
INFECTIONS,SEPSIS,MODS
Chapter42–EpidemiologyofinfectionsinthePICU
I.SALVO,F.IZZO,A.WOLFLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495
Chapter43–Strategyinthetreatmentofsecondaryperitonitis
R.HAHN,S.STORTECKY,C.SPISS. . . . . . . . . . . . . . . . . . . . . . . . . . . . 503
IX
Chapter44–Combinationtherapyforsepsis:thewaveofthefuture
ortoocomplextoconsider?
S.OPAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Chapter45–ImplementationoftheSurvivingSepsisCampaignguidelines
J.-L.VINCENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525
PERIOPERATIVEMEDICINE
Chapter46–Perioperativecardiacriskstratification
J.O.C.AULER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 537
Chapter47–Riskevaluationandanaestheticstrategy
inperioperativemyocardialischaemia
B.DRENGER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
Chapter48–Practicerecommendationsguidelinesforpulmonaryarterycatheter
J.O.C.AULER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559
Chapter49–Perioperativeneuroprotection:isitpossibletoprevent
braininjuryinhighriskpatients?
J.O.C.AULER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573
Chapter50–Druginteractionsinanaestheticpractice
V.FODALE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
Chapter51–Perioperativemyocardialischaemia
P.FOËX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 595
Chapter52–Leftventricularsystolicanddiastolicdysfunction
P.FOËX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603
Chapter53–Challengesinperioperativemedicine:positioning
M.KLIMEK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609
Chapter54–Theneurotoxicityofcommonlyusedgeneralanaesthetics:isitpossible?
V.JEVTOVIC-TODOROVIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 617
Chapter55–NeuroprotectionbyN-methyl-D-aspartateantagonists
E.KOCHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
X
Chapter56–Neuroprotectionbydexmedetomidine
E.KOCHS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 633
Chapter57–Choiceofanaestheticsforneurosurgicalanaesthesia
P.M.PATEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 641
Chapter58–Brainprotection-theclinicalreality
P.M.PATEL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 651
Chapter59–Challengesinperioperativemedicine:neuroanesthesia
K.J.RUSKIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661
Chapter60–Doesanaesthesiainfluencetheapoptosispathway?
G.DELOGU,M.SIGNORE,A.ANTONUCCI . . . . . . . . . . . . . . . . . . . . . . . . 669
Chapter61–Anaesthesiainorthopaedicsurgery
B.BORGHI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 677
CRITICALBLEEDINGANDTRANSFUSION
Chapter62–Severebleedingincriticalcare
M.GIRARDIS,S.BUSANI,M.MARIETTA . . . . . . . . . . . . . . . . . . . . . . . . 687
Chapter63–Transfusiontriggersinsurgery
P.VANDERLINDEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695
TRAUMAANDDISASTERMEDICINE
Chapter64–Pre-hospitaltraumacare:controversialaspects
G.BERLOT,B.BACER,S.ROCCONI . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
Chapter65–Theunstabletraumapatient
G.GORDINI,M.MENARINI,E.BIGI . . . . . . . . . . . . . . . . . . . . . . . . . . . 715
Chapter66–Whattodonext:majorchesttraumabeyondthe“recipebooks”
F.PLANI,J.GOOSEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727
Chapter67–Applicationofneweducationalmethodologiesindisastermedicine
F.DELLACORTE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 745