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A.Gullo(Editor) Anaesthesia, Pain, Intensive Care and Emergency – A.P.I.C.E. Proceedingsofthe 19thPostgraduateCourseinCriticalCareMedicine Trieste,Italy- November12- 15,2004 A. Gullo (Editor) Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E. Proceedings of the th 19 Postgraduate Course in Critical Care Medicine Trieste, Italy – November 12-15, 2004 Springer ANTONINOGULLO,M.D. Head,DepartmentofPerioperativeMedicine, IntensiveCareandEmergency TriesteUniversitySchoolofMedicine Trieste,Italy LibraryofCongressControlNumber:2004115099 ISBN88-470-0288-5 SpringerMilanBerlinHeidelbergNewYork Thisworkissubjecttocopyright.Allrightsarereserved,whetherthewholeorpartofthematerial isconcerned,specificallytherightsoftranslation,reprinting,reuseofillustrations,recitation, broadcasting, reproduction on microfilm or in any other way, and storage in data banks. Duplicationofthispublicationorpartsthereofispermittedonlyundertheprovisionsofthe ItalianCopyrightLawinitscurrentversion,andpermissionforusemustalwaysbeobtainedfrom Springer.ViolationsareliabletoprosecutionundertheItalianCopyrightLaw. SpringerisapartofSpringerScience+BusinessMedia springeronline.com ©Springer-VerlagItalia2005 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,Milan,Italy Typesettingandprinting:ArtiGraficheStella,Trieste,Italy V Table of Contents ADVANCESINCRITICALCARE Chapter1–Effectsofbodypositiononventilation/perfusionmatching G.HEDENSTIERNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Chapter2–ChestPain F.SCHIRALDI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Chapter3–Theelectrocardiogramintheemergencydepartment F.SCHIRALDI,F.PALADINO,E.G.RUGGIERO . . . . . . . . . . . . . . . . . . . . . . 27 Chapter4–Theuseofimagingtoresolvedifficultdiagnoses V.CIOFFI,L.CALDERAN,M.COVA . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Chapter5–AssessmentofPain D.CARISTI,A.GALZERANO,M.PIVA . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Chapter6–Titrationofopioidsforacutepainmanagement Y.LEYKIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Chapter7–Neonatalmechanicalventilation A.BOUGATEF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Chapter8–Extracorporealcirculationintheintensivecareunit V.GA[PAROVI],M.MERKLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Chapter9–Clinicaldecision-makinginthemanagementofsepsisandsepticshock F.BARATTO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Chapter10–Intracranialhaemorrhage:thesolutionofferedbyrecombinantfactorVIIa G.MICIELI,A.CAVALLINI,S.MARCHESELLI . . . . . . . . . . . . . . . . . . . . . . 101 VI Chapter11–AnintroductiontoOpenSourcesoftwarelicensing anduseinanaesthesiadepartment V.LANZA,M.SAJEVA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 MICRODIALYSIS Chapter12–Lessonswehavelearntfrommicrodialysisinanimalsandhumans NORDSTRÖM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Chapter13–Secondarybraininjury-doesmicrodialysishavearole? M.SMITH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Chapter14–Livergraftmonitoringwithintrahepaticmicrodialysis G.NOWAK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Chapter15–Myocardialmetabolismduringopenheartsurgery,assessed withmicrodialysis L.BAHLMANN,J.PÖLING,S.KLAUS . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 CLINICALPHARMACOLOGY Chapter16–Thejourneyofadrugtothetargetsite:whatisitdecisive? C.THALLINGER,C.JOUKHADAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Chapter17–Thepharmacokineticsandpharmacodynamicsofantimicrobialagents inintensivecareunitpatientsasassessedbymicrodialysis V.KULEMANN,C.JOUKHADAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177 PERIOPERATIVEMEDICINE Chapter18–Anaestheticeffectsonregionalcerebralbloodflowandmetabolism: threecontemporaryreasonstocare M.ALKIRE,J.MILLER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187 Chapter19–Whyandwhenisinhalationanaesthesiabetter I.SALVO,P.SILVANI,A.CAMPORESI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Chapter20–Analysisandinstrumentationsforestimatingcerebralactivity E.FACCO,S.BARBIERI,M.MUNARI . . . . . . . . . . . . . . . . . . . . . . . . . . 205 VII Chapter21–Neuroimagingpharmacologyofattentionandmemory U.FREO,C.ORI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217 Chapter22–Intracranialpressuremonitoring M.MUNARI,S.M.VOLPIN,E.FACCO . . . . . . . . . . . . . . . . . . . . . . . . . 227 Chapter23–Improvingqualityofrecovery M.KLIMEK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237 LUNGANDARTIFICIALVENTILATION Chapter24–Molecularbiologyandlungdisease.Whatistheimpact? A.C.ANDRADE,M.M.MORALES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245 Chapter25–Surfactantmetabolism:factorsaffectinglipiduptakeinvivoandinvitro D.L.H.POELNA,J.F.VANIWAARDEN,B.LACHMANN . . . . . . . . . . . . . . . . . 259 Chapter26–Respiratorymechanicsatthebedside T.LUECKE,F.FIEDLER,P.PELOSI. . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Chapter27–PEEPandcardiacoutput T.LUECKE,R.GIESER,P.PELOSI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297 Chapter28–ExpiratoryflowlimitationandintrinsicPEEP J.MILIC-EMILI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 Chapter29–Mechanicalventilationstrategiesforlungprotection N.R.MACINTYRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323 Chapter30–Recruitmentandoxygenation T.MUDERS,H.WRIGGE,C.PUTENSEN . . . . . . . . . . . . . . . . . . . . . . . . . 331 Chapter31–Lungoedemainacutelunginjury(ALI) S.NUNES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 Chapter32–Gradingseverityofrespiratorydysfunction,clinicalcorrelates andindicationsformechanicalventilation N.THEUERKAUF,H.WRIGGE,C.PUTENSEN . . . . . . . . . . . . . . . . . . . . . . 357 Chapter33–Weaningasacardiacstresstest B.LAMIA,J.-L.TEBOUL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 VIII Chapter34–Respiratorymanagementinobesepatients P.PELOSI,T.LUECKE,P.CAIRONI . . . . . . . . . . . . . . . . . . . . . . . . . . . 379 Chapter35–Istheacuterespiratorydistresssyndromeasystemicdisease? L.BRANDER,A.S.SLUTSKY,H.ZHANG . . . . . . . . . . . . . . . . . . . . . . . . . 395 CARDIOVASCULARCRITICALCARE Chapter36–Invasiveversusnon-invasivehaemodinamicmonitoring inmajorvascularsurgery B.ALLARIA,M.RESTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405 Chapter37–Analysisofarterialpulse–clinicalimplications GIOMARELLI,S.SCOLLETTA,S.M.ROMANO . . . . . . . . . . . . . . . . . . . . . . . 417 Chapter38–Beat–by–beatmonitoringofcardiacoutput withpressurerecordinganalyticalmethod S.SCOLLETTA,P.GIOMARELLI,B.BIAGIOLI . . . . . . . . . . . . . . . . . . . . . 425 Chapter39–Haemodynamicstandardisationproceduresinhigh-risksurgery T.YAMAGUTI,S.MINHYEKIM,J.O.C.AULER . . . . . . . . . . . . . . . . . . . . . 437 Chapter40–FromFrank–Starlingrelationshipstoventriculo–arterialcoupling R.NAEIJE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449 Chapter41–Pharmacologyandselectionofinotropictherapy J.O.C.AULER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461 Chapter42–Decision–makingincriticalcare:cardiacarrhythmias andrelatedtopics J.L.ATLEE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473 Chapter43–Managementforthepatientwithanimplantedcardiacrhythm managementdevice(CRMD) J.L.ATLEE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483 Chapter44–Hypothemiaincardiacsurgery J.O.C.AULER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495 IX CARDIOPULMONARYRESUSCITATION Chapter45–Pharmacologicalmanagementofcardiopulmonaryresuscitation T.PELLIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509 Chapter46–Myocardialpreservation,reperfusioninjury, andpostresuscitationmyocardialdysfunction R.J.GAZMURI,J.RADHAKRISHNAN,J.KORALOVA. . . . . . . . . . . . . . . . . . . . 517 MICROCIRCULATIONANDSHOCK Chapter47–Regionalbloodflowdistributioninseptic,cardiogenic andhaemorrhagicshock D.DEBACKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 529 Chapter48–Orthogonalpolarisationspectralimaging:principles,techniques, humanstudies D.DEBACKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 535 Chapter49–Carbondioxidemonitoringtoevaluatecelloxygenation J.CRETEUR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 543 Chapter50–Themicrocirculationindistress;monitoringandrecruitment P.GOEDHART,C.INCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557 Chapter51–Tissuemetabolismindifferenttypesofshock S.KLAUS,J.PÖLING,L.BAHLMANN . . . . . . . . . . . . . . . . . . . . . . . . . . . 565 Chapter52–Organdysfunctionincirculatoryshock–alteredperfusion,metabolism ortightjunctions?Doweneedashiftofparadigm? J.TENHUNEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577 Chapter53–Haemodynamicsupportofpaediatricpatientsinsepticshock G.ZOBEL,S.RÖDL,H.-M.GRUBBAUER . . . . . . . . . . . . . . . . . . . . . . . . 587 PAEDIATRICCRITICALCARE Chapter54–Recentadvancesinartificialventilationinpaediatricage G.A.MARRARO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 599 X Chapter55–Complicationsinpaediatricregionalanaesthesia G.IVANI,V.MOSSETTI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 611 Chapter56–Homeventilationinpaediatricpatientswithchronicrespiratoryfailure B.FAUROUX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619 Chapter57–Decision–makinginpaediatricextracranialtrauma E.CALDERINI,R.SCARANI,D.NIRO . . . . . . . . . . . . . . . . . . . . . . . . . . 633 Chapter58–Developmentinthetreatmentofpostoperativepaininpaediatrics P.BUSONI,A.MESSERI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 653 TRAUMAANDEMERGENCYSYSTEM Chapter59–Prehospitalcare:triageandprimarysurvey O.PREDESCU,A.BAKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 663 Chapter60–Spineandspinalcordtrauma O.PREDESCU,A.BAKER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673 Chapter61–Treatmentoftheacutepneumothoraxinthefield G.BERLOT,D.MASSARUTTI,E.CARCHIETTI . . . . . . . . . . . . . . . . . . . . . . 683 CLINICALSTUDYDESIGN Chapter62–Criticalappraisalskills S.MARTINS, A.ZIN,W.ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 695 Chapter63–Literaturesearch S.MARTINS,A.ZIN,W.ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707 Chapter64–Studydesign S.MARTINS,A.ZIN,W.ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 719 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 749

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In modern medicine the most functional methodologies are taking an increasing importance in spreading informations, rendering it credible while at the same time using reliable data to focus interaction between basic science and clinical medicine. Critical care medicine embraces these needs and more
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Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.: Proceedings of the 19th Postgraduate Course in Critical Care Medicine Trieste, Italy — November 12–15, 2004 PDF

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In modern medicine the most functional methodologies are taking an increasing importance in spreading informations, rendering it credible while at the same time using reliable data to focus interaction between basic science and clinical medicine. Critical care medicine embraces these needs and more

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