Table Of ContentA. Gullo(Editor)
Anaesthesia, Pain, Intensive Care and Emergency – A.P.I.C.E.
Proceedingsofthe
22ndPostgraduateCourseinCriticalCareMedicine
Venice-Mestre,Italy–November9-11,2007
A. Gullo (Editor)
Anaesthesia, Pain, Intensive Care
and Emergency
A.P.I.C.E.
Proceedings of the
22nd Postgraduate Course in Critical Care Medicine
Venice-Mestre, Italy – November 9-11, 2007
Springer
ANTONINOGULLO,M.D.
Head,DepartmentofAnaesthesiaandIntensiveCare
Head,PostgraduatedSchoolofAnaesthesiaandIntensiveCare
CataniaUniversityHospital
Catania,Italy
LibraryofCongressControlNumber:2007939172
ISBN978-88-470-0772-7 SpringerMilanBerlinHeidelbergNewYork
e-ISBN978-88-470-0773-4SpringerMilanBerlinHeidelbergNewYork
Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthematerial
isconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation,
broadcasting,reproductiononmicrofilmorinanyotherway,andstorageindatabanks.Dupli-
cationofthispublicationorpartsthereofispermittedonlyundertheprovisionsoftheItalian
Copyright Law in its current version, and permission for use must always be obtained from
Springer.ViolationsareliabletoprosecutionundertheItalianCopyrightLaw.
SpringerisapartofSpringerScience+BusinessMedia
springer.com
©Springer-VerlagItalia2008
PrintedinItaly
Theuseofgeneraldescriptivenames,registerednames,trademarks,etc.inthispublicationdoes
notimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexemptfromthe
relevantprotectivelawsandregulationsandthereforefreeforgeneraluse.
Productliability:Thepublisherscannotguaranteetheaccuracyofanyinformationaboutdosage
and application contained in this book. In every individual case the user must check such
informationbyconsultingtherelevantliterature.
Coverdesign:SimonaColombo
Typesettingandprinting:ArtiGraficheStella,Trieste,Italy
Table of Contents
ADVANCESONCRITICALCARE
Chapter1-OrganizationoftheRapidResponseSystem
P.DIGIACOMO,M.A.DEVITA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter2-TransoesophagealEchocardiography:ClinicalAssessment,
TechniquesandProceduresinCriticalCareandICU
F.GUARRACINO,C.CARIELLO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter3-UseofPulseOximeterWaveformasaNonInvasiveFunctional
HaemodynamicMonitoringTechnique
M.CANNESSON,J.-J.LEHOT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter4-ContinuousMonitoringofOrganChemistry–aParadigmShift
inManagementofIntensiveCare
U.UNGERSTEDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Chapter5-GeneralAnaesthesiaandtheDevelopingBrain
V.JEVTOVIC-TODOROVIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
AIRWAY
Chapter6-AirwayManagement:TheEssential
G.FROVA,M.SORBELLO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Chapter7-BestMethodtoEstablishtheGradeofDifficultAirway.
ClinicalAssessment,TechniquesandProceduresinCriticalCareandICU
F.PETRINI,L.MOGGIA,G.MERLI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Chapter8-Out-Of-HospitalAirwayManagement:KnowledgeandEquipment
S.RUSSO,C.EICH,A.TIMMERMANN . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
VI
Chapter9-PracticalAspectstoManageExtubationoftheDifficultAirway
M.SORBELLO,G.MORELLO,A.GUARINO . . . . . . . . . . . . . . . . . . . . . . . . 81
TRAUMA
Chapter10-HeadInjuryTreatmentin2007
M.G.ABATE,F.SALA,G.CITERIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Chapter11-PenetratingInjuriestotheNeck:Operation,Observation
orAngiointervention
D.DEMETRIADES,J.DUBOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
OBSTETRICS
Chapter12-ClinicalDecisionMakinginObstetricPatients
R.ALEXANDER,A.PARATORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Chapter13-OrganizationofObstetricServices
R.ALEXANDER,A.SAXENA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
PAEDIATRICANAESTHESIA
Chapter14-ClinicalDecisionMakinginPaediatricAnaesthesia
P. BUSONI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Chapter15-PerioperativeCareinPaediatrics:Organization
I.SALVO,A.CAMPORESI,E.ZOIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter16-TechniquesandDrugsinPaediatrics:TIVAandTCI
M.ASTUTO,N.DISMA,E.SANALITRO . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Chapter17-DepthofAnaesthesiaMonitoringinChildren
N.DISMA,S.PELLEGRINO,M.ASTUTO . . . . . . . . . . . . . . . . . . . . . . . . . . 185
CARDIACARREST
Chapter18-NewAspectsofBasicCardiopulmonaryResuscitationResearch:
FromClinicallyRelevantAnimalModelstoCells
G.RISTAGNO,T.WANG,W.TANG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
VII
Chapter19-WarningSymptomsofSuddenCardiacDeath
G.BERLOT,A.VERGOLINI,C.CALDERAN . . . . . . . . . . . . . . . . . . . . . . . . 213
Chapter20-VasopressorsDuringCardiacArrest
G.CAMMARATA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
INFECTIONS,SEPSIS,ORGANDYSFUNCTION
Chapter21-CandidaInfectioninCriticallyIllPatients
P.H.J.VANDERVOORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Chapter22-PredispositiontoSepsis
J.C.MARSHALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Chapter23-SOFAScore:AKeystoneforGradingMultipleOrganDysfunction
J.-L.VINCENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
PERIOPERATIVECARE
Chapter24-OperatingTheatres:Organization,CostsandAudit
M.KLIMEK,M.VANHOUDENHOVEN,T.H.OTTENS . . . . . . . . . . . . . . . . . . . 263
Chapter25-UseandMisuseofPreoperativeCardiacTesting
forNoncardiacSurgery
H.-J.PRIEBE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Chapter26-PerioperativeBeta-Blockade:MythsandRealities
G.HOWARD-ALPE,P.FOËX. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Chapter27-ManagementofHypoxiaDuringOneLungVentilation
J.B. BRODSKY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Chapter28-RegionalAnaesthesiaforThoracicSurgery
J.B. BRODSKY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Chapter29-WhytheObesePatientisatRiskforPerioperativeComplications
J.B. BRODSKY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Chapter30-PerioperativeCareinNeurosurgery–IntraoperativeMonitoring
C.ORI,M.MUNARI,S.VOLPIN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
VIII
Chapter31-IncidentsProvokedSpecificallybyCertainDrugsUsed
inAnaesthesia
M.KLIMEK,T.H.OTTENS,F.GRÜNE . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Chapter32-SideEffectsInducedbyAnaestheticManipulation
orbySurgicalOperation
Y.LEYKIN,N.NOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
QUALITYOFCAREINTHEICU
Chapter33-QualityManagementintheICU:UnderstandingtheProcess
andImprovingtheArt
P.MURABITO,F.RUBULOTTA,A.GULLO . . . . . . . . . . . . . . . . . . . . . . . . . 345
List of Contributors
AbateM.G. CamporesiA.
UONeuroanestesiaeNeurorianimazione, PaediatricAnaesthesiaandIntensive
DipartimentodiMedicinaPerioperatoria Care,ChildrenHospital“VittoreBuzzi”,
eTerapieIntensive,HSanGerardo,Mon- Milan(Italy)
za(Italy),andDivisionofAnaesthesia,
UniversityofCambridge,Addenbrooke’s CannessonM.
Hospital,Cambridge(UK) DepartmentofAnaesthesiology,Hôpital
LouisPradel,Bron(France)
AlexanderR.
DepartmentofAnaesthetics,Worcester- CarielloC.
shireRoyalHospital,Worcester(UK) DepartmentofCardiothoracicAnaesthe-
siaandIntensiveCare,AziendaOspeda-
AstutoM. lieraUniversitariaPisana,Pisa(Italy)
DepartmentofAnaesthesiaandIntensive
Care,“Policlinico”UniversityHospital, CiterioG.
Catania(Italy) UONeuroanestesiaeNeurorianimazione,
DipartimentodiMedicinaPerioperatoria
BerlotG. eTerapieIntensive,HSanGerardo,Mon-
DepartmentofPerioperativeMedicine, za(Italy)
IntensiveCareandEmergency,Trieste
UniversityMedicalSchool,Trieste(Italy) DemetriadesD.
DivisionofTraumaandSurgicalCritical
BrodskyJ.B. Care,DepartmentofSurgery,University
DepartmentofAnesthesia,StanfordUni- ofSouthernCalifornia,LosAngeles(USA)
versitySchoolofMedicine,Stanford,CA
(USA) DeVitaM.A.
DepartmentofCriticalCareMedicine,
BusoniP. UniversityofPittsburgh(USA)
DepartmentofAnaesthesiaandIntensive
Care,A.MeyerHospital,Florence(Italy) DiGiacomoP.
DepartmentofCriticalCareMedicine,
CalderanC. UniversityofPittsburgh(USA)
DepartmentofPerioperativeMedicine,
IntensiveCareandEmergency,Trieste DismaN.
UniversityMedicalSchool,Trieste(Italy) DepartmentofAnaesthesiaandIntensive
Care,“Policlinico”UniversityHospital,
CammarataG. Catania(Italy)
DepartmentofAnaesthesiaandIntensive
Care,UniversityofCatania,Cannizzaro DuBoseJ.
(Italy) DivisionofTraumaandSurgicalCritical
Care,DepartmentofSurgery,University
ofSouthernCalifornia,LosAngeles(USA)
X
EichC. MarshallJ.C.
DepartmentofAnaesthesiology,Emer- DepartmentofSurgery,andtheInterde-
gencyandIntensiveCareMedicine,Uni- partmentalDivisionofCriticalCareMedi-
versityofGöttingen(Germany) cine,UniversityofToronto,LiKaShing
KnowledgeInstitute,St.Michael’sHospi-
FoëxP. tal,Toronto,Ontario(Canada)
NuffieldDepartmentofAnaesthetics,Uni-
versityofOxford(UK) MerliG.
CentroCardiologicoMonzino,Milan
FrovaG. (Italy)
EmergencyDepartmentofAnaesthesia
andICU,CiviliHospital,Brescia(Italy) MoggiaL.
AnaesthesiologyandIntensiveCare,Uni-
GrüneF. versityG.D’AnnunzioChieti-Pescara,
DepartmentofAnaesthesiology,Erasmus Chieti(Italy)
UniversityMedicalCentre,Rotterdam
(TheNetherlands) MorelloG.
DepartmentofAnaesthesiaandIntensive
GuarinoA. Care,“Policlinico”UniversityHospital,
AnaesthesiaandIntensiveCare,PO“Villa Catania(Italy)
Scassi”,Genoa(Italy)
MunariM.
GuarracinoF. DepartmentofPharmacologyand
DepartmentofCardiothoracicAnaesthe- Anaesthesiology,AnaesthesiaandInten-
siaandIntensiveCare,AziendaOspeda- siveCareUnit,UniversityofPadua,
lieraUniversitariaPisana,Pisa(Italy) Padua(Italy)
GulloA. MurabitoP.
DepartmentofAnaesthesiaandIntensive DepartmentofAnaesthesiaandIntensive
Care,“Policlinico”UniversityHospital, Care,“Policlinico”UniversityHospital,
Catania(Italy) Catania(Italy)
Howard-AlpeG. NoalN.
NuffieldDepartmentofAnaesthetics,Uni- DepartmentofAnaesthesia,S.M.degli
versityofOxford(UK) AngeliHospital,Pordenone(Italy)
Jevtovic-TodorovicV. OriC.
DepartmentsofAnesthesiologyandNeu- DepartmentofPharmacologyand
roscience,UniversityofVirginiaHealth Anaesthesiology,AnaesthesiaandInten-
System,Charlottesville(USA) siveCareUnit,UniversityofPadua,
Padua(Italy)
KlimekM.
DepartmentofAnaesthesiology,Erasmus OttensT.H.
UniversityMedicalCentre,Rotterdam DepartmentofAnaesthesiology,Erasmus
(TheNetherlands) UniversityMedicalCentre,Rotterdam
(TheNetherlands)
LehotJ.-J.
DepartmentofAnaesthesiology,Hôpital ParatoreA.
LouisPradel,Bron(France) DepartmentofAnaesthesiaandIntensive
Care,“Policlinico”UniversityHospital,
LeykinY. Catania(Italy)
DepartmentofAnaesthesia,S.M.degli
AngeliHospital,Pordenone(Italy)
Description:Improving standards of care is a real challenge in Intensive Care Medicine. Bettering clinical performance, patient safety, risk management and audit represents the cornerstone for raising the quality of care in ICU patients. Communication is the platform from where to start to reach a consensus in