Anaesthesia, Pharmacology, Intensive Care and Emergency A.P. I.C.E. 25 Proceedings of the 25th Annual Meeting – International Symposium on Critical Care Medicine Antonino Gullo Editor 123 APICE 25 Antonino Gullo Editor Anaesthesia, Pharmacology, Intensive Care and Emergency A.P.I.C.E. Proceedings of the 25th Annual Meeting – International Symposium on Critical Care Medicine 123 Editor Antonino Gullo Department of Anesthesiaand Intensive Care, School ofMedicine Catania UniversityHospital Catania Italy ISBN 978-88-470-5515-5 ISBN 978-88-470-5516-2 (eBook) DOI 10.1007/978-88-470-5516-2 SpringerMilanHeidelbergNewYorkDordrechtLondon LibraryofCongressControlNumber:2013954017 (cid:2)Springer-VerlagItalia2014 Thisworkissubjecttocopyright.AllrightsarereservedbythePublisher,whetherthewholeorpartof the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation,broadcasting,reproductiononmicrofilmsorinanyotherphysicalway,andtransmissionor informationstorageandretrieval,electronicadaptation,computersoftware,orbysimilarordissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purposeofbeingenteredandexecutedonacomputersystem,forexclusiveusebythepurchaserofthe work. Duplication of this publication or parts thereof is permitted only under the provisions of theCopyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the CopyrightClearanceCenter.ViolationsareliabletoprosecutionundertherespectiveCopyrightLaw. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publicationdoesnotimply,evenintheabsenceofaspecificstatement,thatsuchnamesareexempt fromtherelevantprotectivelawsandregulationsandthereforefreeforgeneraluse. While the advice and information in this book are believed to be true and accurate at the date of publication,neithertheauthorsnortheeditorsnorthepublishercanacceptanylegalresponsibilityfor anyerrorsoromissionsthatmaybemade.Thepublishermakesnowarranty,expressorimplied,with respecttothematerialcontainedherein. Printedonacid-freepaper SpringerispartofSpringerScience+BusinessMedia(www.springer.com) Contents Part I Advances on Intensive and Critical Care Medicine 1 Combining Clinical Practices and Technology in Critical Care Medicine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Younsuck Koh 2 Ultrasound in Critical Care: A Holistic Discipline. . . . . . . . . . . . 13 Daniel A. Lichtenstein 3 Assessment and Management of Circulatory Failure . . . . . . . . . . 23 Kamen Valchanov 4 Simulation in Anaesthesia and Intensive Care. . . . . . . . . . . . . . . 39 Paolo Persona and Carlo Ori Part II Trauma 5 Trauma Care Organisation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Roderick Mackenzie, Simon Lewis and Basil F. Matta Part III Cardiovascular System 6 Cardiovascular Risk in Non-cardiac Surgery. . . . . . . . . . . . . . . . 75 Luca Ferdinando Lorini and Lorenzo Filippo Mantovani Part IV Kidney 7 Continuous Renal Replacement Therapy: Challenges and Evidences. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Giorgio Berlot and Antoinette Agbedjro v vi Contents Part V Lung 8 Postoperative Respiratory Complications. . . . . . . . . . . . . . . . . . . 99 Maria Vargas, Yuda Sutherasan and Paolo Pelosi 9 Old and New Strategies on Artificial Ventilation in ARDS Patients. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Paolo Pelosi, Maria Vargas and Iole Brunetti 10 Minimally Invasive Thoracic Surgery . . . . . . . . . . . . . . . . . . . . . 121 Marcello Migliore Part VI Severe Infections, Sepsis and MODS 11 Diagnosis of Ventilator-Associated Pneumonia. . . . . . . . . . . . . . . 135 Luciano Silvestri, Hendrick K. F. van Saene and Serena Tomasino 12 Rationale of Antibiotics Anti-MRSA in Pneumonia . . . . . . . . . . . 143 Francesco Scaglione 13 The Role of Microbiology for Diagnosis of Fungal Infections. . . . 149 Salvatore Oliveri and Laura Trovato 14 Sepsis and Organ(s) Dysfunction. . . . . . . . . . . . . . . . . . . . . . . . . 157 A. Gullo, C. M. Celestre, A. L. Paratore, L. Silvestri and H. K. van Saene 15 Immunoglobulin as Adjunctive Therapy in Sepsis . . . . . . . . . . . . 193 Massimo Girardis, Giulia Serafini and Ilaria Cavazzuti Part VII Cardiac Arrest: Optimization of Current Protocols 16 Determinants for More Efficient Defibrillation Waveforms. . . . . . 203 Yongqin Li and Bihua Chen 17 Post-Resuscitation Hypothermia and Monitoring. . . . . . . . . . . . . 219 Tommaso Pellis, Filippo Sanfilippo, Andrea Roncarati and Vincenzo Mione Contents vii Part VIII Humanization 18 Palliative Care in Pediatric Patients . . . . . . . . . . . . . . . . . . . . . . 233 Marinella Astuto, Giuliana Arena, Rita Scalisi and Carmelo Minardi 19 End of Life Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243 Cristina Santonocito Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253 Acronyms ABA American Board of Anaesthesiologists ACCP American College of Chest Physicians ACHF Advanced congestive heart failure ACS American College of Surgeons AECC American–European Consensus Conference AEDs Automatic external defibrillators AKI Acute kidney injury ALF Alveolar lining fluid AND Allow natural death APACHE Acute physiology and chronic health evaluation APACHE II Acute physiology and chronic health evaluation II APRV Airway pressure release ventilation ARDS Acute respiratory distress syndrome ASA American Society of Anesthesiologists ATIII Antithrombin III AUC/MIC Area under the concentration-time curve and the minimum inhibitory concentrations BAL Bronchoalveolar lavage BCs Blood cultures BG 1,3-beta-d-glucan antigen BLUE-protocol Bedside lung ultra sound in emergency BMI Body mass index BNP Brain natriuretic peptide BSIs Bloodstream infections BTE Biphasic truncated exponential CA Cardiac arrest CAGTA Candida albicans IFA IgG for germ tube antibody detection CA-MRSA Community-acquired MRSA CDC Centers of disease control and prevention CFU Colonies forming units CHF Congestive heart failure CHVVVH High volume continuous veno-venous hemofiltration CI Confidence interval CO Cardiac output ix x Acronyms COPD Chronic obstructive pulmonary disease CPAP Continuous positive airway pressure CPIS Clinical pulmonary infection score CPP Coronary perfusion pressure CPR Cardiopulmonary resuscitation CRRT Continuous renal replacement therapy CRRT Continuous renal replacement treatments CTARP Cambridgeshire trauma audit and research project CUH Cambridge university hospitals CVP Central venous pressure CVVH Continuous veno-venous hemofiltration CXR Chest radiograph DFT Defibrillation threshold DM Diabetes mellitus DNR Do-not-resuscitate DPAHC Durable power of attorney for health care DVT Deep venous thrombosis EAPC European association for palliative care EBM Evidence based medicine ECG Electrocardiogram ECMO Extracorporeal membrane oxygenation ED Emergency department EEG Electroencephalography EFISG European Fungal Infection Study Group EGDT Early goal directed therapy ELISA Enzyme-linked immunosorbent assay EMRs Electronic medical records EMS Emergency medical service EoE East of England EORTC/MSG European Organization for Research in the Treatment of Cancer/Mycosis Study Group ER Emergency rooms ERC European Resuscitation Council ESBL Extended-Spectrum-b-Lactamase ESCMID European Society of Clinical Microbiology and Infectious Diseases EtCO2 End-tidal CO 2 EUSOS European surgical outcomes study FALLS-protocol Fluid administration limited by lung sonography FEVI Forced expiratory volume (in 0.1 sec) FRC Functional residual capacity GCS Glasgow coma scale GERD Gastroesophageal reflux disease GM Galactomannan GUCH Grown up congenital heart disease Acronyms xi HAP Hospital-acquired pneumonia HCAP Health care-associated pneumonia HF Heart failure HPE Hemodynamic pulmonary edema HPS Human patient simulator hrAPC Human recombinant activated protein C IABP Intra-aortic balloon pump IAP Intraabdominal pressure IC Invasive candidiasis ICD Implantable cardioverter-defibrillator ICPCN International children’s palliative care network ICU Intensive care units IFD Invasive fungal diseases IFIs Invasive fungal infections Ig Immunoglobulin IHD Intermittent haemodialysis IL-1 Interleukin 1 IL-4 Interleukin 4 IL-6 Interleukin 6 IL-8 Interleukin 8 ILCOR International Liaison Committee on Resuscitation IMPaCCT International meeting for palliative care in children, Trento IRT Intermittent renal treatments IS Incentive spirometry ISS Injury severity score IT Information technology LAS VEGAS Local assessment of ventilatory management during general anaesthesia for surgery LUCI-FLR Lung ultrasound in the critically Ill favoring limitation of radiographies LUS Lung ultrasound LWMH Low weight molecular heparin MAP Mean arterial pressure METs Metabolic Equivalent MIC Minimum inhibitory concentration MIE Mini-invasive esophagectomy MITS Minimally invasive thoracic surgery MODS Multiple organ dysfunction syndrome MRSA Meticillin-resistant S. aureus MSSA Methicillin-susceptible S. aureus MTC Major Trauma Centre MW Molecular weight NAO National Audit Office NCAG Clinical Advisory Groups NCCN National comprehensive cancer network