Intensive and Critical Care Medicine Antonino Gullo José Besso Philip D. Lumb • • Ged F. Williams (Eds.) Intensive and Critical Care Medicine WFSICCM World Federation of Societies of Intensive and Critical Care Medicine Foreword by Frédéric Shuind 123 Editors Antonino Gullo José Besso Department and School of Anesthesia Department of Critical Care Medicine and Intensive Care Hospital Centro Medico de Caracas Catania School of Medicine Caracas, Venezuela and University-Hospital Catania, Italy Philip D.Lumb Ged F.Williams Department of Anesthesiology World Federation of Critical Care Nurses Keck Medical School C/- Nursing Administration Los Angeles, CA, USA Gold Coast Health Southport, Queensland, Australia ISBN 978-88-470-1435-0 e-ISBN 978-88-470-1436-7 DOI 10.1007/978-88-470-1436-7 Springer Dordrecht Heidelberg London Milan New York Library of Congress Control Number: 2009933285 © Springer Verlag Italia2009 This work is subject to copyright. 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In every individual case the user must check such information by consulting the relevant literature. Cover design: Simona Colombo, Milan, Italy Typesetting: Graphostudio, Milan, Italy Printing and binding: Grafiche Porpora, Segrate, Italy Printed in Italy Springer-Verlag Italia S.r.l. – Via Decembrio 28 – I-20137 Milan Springer is a part of Springer Science+Business Media (www.springer.com) Preface The World Federation of Societies of Intensive and Critical Care Medicine (WFSIC- CM) has reached the age of maturity. Physicians, nurses, and many others associated with the field of Intensive and Critical Care Medicine will be coming from all corners of the world to Florence, Italy in August, 2009 to celebrate the 10th quadrennial congress. Every 4 years for the last 36 years, congresses in the magnificent venues of London (1973), Paris (1977), Washington (1981), Jerusalem (1985), Kyoto (1989), Madrid (1993), Ottawa (1997), Sydney (2001), and Buenos Aires (2005) have signi- fied an ever-developing process which has resulted in the four pillars of the field of Intensive and Critical Care Medicine, namely partnership, ethics, professionalism, and competence. The first pillar is based on a stronger interdisciplinary collaboration and a multi- professional partnership in the field of Intensive and Critical Care Medicine. In recent decades, professional activity in medicine has been regulated by well-defined, universal principles, such as the welfare of the patient, autonomy, social justice, and the patient–physician relationship. The second pillar, ethics, has offered welcomed assistance to all these principles in establishing an ethics curriculum. The third pillar, professionalism, is based on “the image of the ethical and moral conduct of those who practice the medical profession.” Professionalism aspires to altruism, accountability, excellence, duty, service, honor, integrity, and respect for others. In order to maintain the highest level of professionalism, physicians and nurs- es must be committed to their own continuing education as a means of increasing both their knowledge base and manual skills. Equally important for achieving the best results possible is their willingness and ability to collaborate with others as a team with the goal of establishing continuity to assure the patients good medical practice and a better quality of care. The fourth pillar, professional competence, is “the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and the reflection in daily practice for the benefit of the individual and community v vi Preface being served.” Maintaining competence means continuing to learn as medical under- standing and technologies rapidly change. Coming from these reflections the Council of the WFSICCM, during the period 2001–2009, has alimented an important debate to develop a global communication network establishing a sort of bridge from the past to the present. The way into the future for the affiliated national societies is the planning of common strategies according to the objectives of the WFSICCM: • To assist and encourage the cooperation of national societies for management of acute critical illness • To promote the dissemination of knowledge, education programs, and scientific information • To advise, upon request, national and international organizations • To monitor the needs of the community • To achieve a politically correct collaboration with governments, national health systems, and local authorities • To support countries with limited resources • To achieve equitable resource allocation • To recommend desirable standards of training for intensivists, critical care per- sonnel, emergency physicians, and nurses • To provide information regarding opportunities for postgraduate training and research • To ameliorate health care delivery and to promote the importance of intensive and critical care regionalization • To implement the standards of care • To encourage the establishment of safety measures, including procedures and equipment • To achieve better accuracy regarding patient information • To stimulate research into all aspects of intensive and critical care medicine • To focus the importance of continuing education programs • To consider mandatory the respect for ethics principles, the patient’s welfare, and the quality of care • To promote professional accomplishment by individuals, which will provide not only job satisfaction but also an improvement in the efficiency of the team • To remark that intensive care nursing is younger than most healthcare specialties, but note that it already possesses a wealth of nursing knowledge and experience • To increase the emphasis on the importance of improvement in competence, not only in terms of skills but also in behavior • To maintain awareness about the priority and the mission of the WFSICCM: a good clinical practice From 2001 the development agenda of the World Federation (WF) Council recog- nized the importance of promoting scientific and cultural integration across the world with prestigious editorial initiatives. Much success was achieved in Buenos Aires (2005) when the Council on the occasion of the 9th World Congress decided to publish its first book, from the beginning of the Federation Societies, edited by Springer: Intensive and Critical Care Medicine – Reflections, Recommendations, and Preface vii Perspectives. Education and standard of care were the pillars of the book. At that time each component of the Council contributed by updating chapter(s). Florence (2009) will represent an important step in improving knowledge in the field of Intensive and Critical Care Medicine and reinforcing communication and good practice in the era of partnership, ethics, professionalism, and competence. Everyone believes it is important to take advantage of the opportunity to take a leadership position on clinical decision-making. Prevention and management of life- threatening conditions in intensive and critical care and the importance of putting global strategies in place for surviving during and after natural or man-made disas- ters have become priorities. As chairman of the Scientific Committee of the Florence 2009 meeting I am grateful to the Board and Colleagues of Italian Scientific Society (SIAARTI) and the Italian College of the Anesthesiologists (ICA), the Italian Society of Intensive Care (SITI) and the Italian Society of Nursing (ANIARTI) for their encouraging support during the long period of preparation of the World Congress. I would like to keep attention on the role of the Members of the WFSICCM Council for their active par- ticipation in assuring a bright future. Besides, I wish to mention some distinguished persons for their institutional and active role in the success of the World Federation. Prof. José Besso is a special per- son full of humanity and devoted to optimizing the standards of care. I like to remem- ber Prof. José Besso as superb and courageous President in the last mandate of WF (2005–2009). Further I offer sincere appreciation to the following individuals: Prof. Philip Lumb, for taking on the roles of both Editor-in-Chief of the Critical Care Journal and Past President of the WF (2001–2005), and for his very active presence and promotion of intercontinental cooperation; Prof. Edgar Jimenez, Treasurer of WF in the last 4 years (2005–2009), for his admirable efforts in pushing strongly for the globalization of WF and for his efforts to impart to everybody an understanding of the importance of maximizing communications between eastern and western coun- tries; Prof. Ged Williams, as President of World Federation of Critical Care Nurses in the period 2001–2009, congratulations due, overall, for his important contribution to reinforce the independent, but collaborative role of nurses and the importance of their active cooperation in the care of critical illness. Moreover, my sincere gratitude to Phil Taylor, Executive Director of the WF, for his own enormous personal contri- bution to WFSICCM and for his continuing professional assistance to thousands and thousands of affiliates. Particularly, I wish to express my sincere appreciation to the Council’s Members who in the period 2001–2008 have worked intensively on the common project; so we were able to improve friendship, collaboration, and the strategic plan to get to the top in the critical care arena. Last but not least, a particular mention regarding Prof. Raffaele De Gaudio who had the merit and the power to drive thousands of physi- cians, nurses, students, and all allied people and companies interested to support the present and the future of the WFSICCM. On the other side, the Organizing and Scientific Secretary established a high spirit of cooperation and professionalism. My dear Raffaele, thanks a lot for the warm welcome in Florence and for showing us its magnificent heritage. viii Preface The working team is ready. Considering several assumptions, I think that we are at the right time to reach an exciting and remarkable goal: to continue the mission for serving critically ill patients and the community. Prof.Antonino Gullo Head and Director Department and School of Anesthesia and Intensive Care Catania School of Medicine and University-Hospital, Catania, Italy Chairman of the Scientific Committee of the WFSICCM, Florence, 2009 Contents Section I - Introduction and Mission 1 History of Critical Care Medicine: The Past,the Present and the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Giuseppe Ristagno, Max H. Weil 2 The Mission of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Philip D. Lumb Section II - Professionalism,Ethics and Evidence-Based Practice 3 Professionalism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Antonino Gullo, Paolo Murabito, José Besso 4 Ethics of Decision Making in Critical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Satish Bhagwanjee 5 Evidence-Based Medicine in Critical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Premnath F. Kotur Section III - Clinical Governance 6 Clinical Governance:Definitions and Recommendations . . . . . . . . . . . . . . . . 61 Georges Offenstadt 7 Optimization of Limited Resources and Patient Safety . . . . . . . . . . . . . . . . . . 69 Antonio O. Gallesio ix x Contents 08 Improving Quality of Care in ICUs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Allan Garland 09 Scoring Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Rui P. Moreno, Ana C. Diogo, Susana Afonso Section IV - Nursing Perspectives 10 Nursing Workforce Management in Intensive Care . . . . . . . . . . . . . . . . . . . . . 107 Ged F. Williams 11 Intensive and Critical Care Nursing Perspectives . . . . . . . . . . . . . . . . . . . . . . 119 Ged F. Williams, Paul R. Fulbrook, Anne W. Alexandrov, Wilson Cañón Montañez, Halima M. Salisu-Kabara, David W.K. Chan Section V - Central Nervous System,Circulation and Kidney 12 Central Nervous System Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Flavio M.B. Maciel 13 Definition,Monitoring,and Management of Shock States . . . . . . . . . . . . . . . 143 Jean-Louis Vincent 14 Plasma Volume Expansion:The Current Controversy . . . . . . . . . . . . . . . . . . 151 Christiane Hartog, Konrad Reinhart 15 Predicting the Success of Defibrillation and Cardiopulmonary Resuscitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Giuseppe Ristagno 16 Acute Renal Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 José Besso, Gabriela Blanco, Ruthnorka Gonzalez Section VI - Respiratory System and Protective Ventilation 17 The Evolution of Imaging in Respiratory Dysfunction Failure . . . . . . . . . . . 195 Luciano Gattinoni, Eleonora Carlesso, Federico Polli 18 ALI,ARDS,and Protective Lung Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Rahul Nanchal, Edgar J. Jimenez, F. Elizabeth Poalillo