Table Of Content

A. 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)

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A. 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)

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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
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