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 than any other discipline thrives and develops thanks to interdisciplinary contact.

APICE 2004 has been organised to provide precise answers to these issues. In particular, considerable emphasis has been given to the reviews regarding the most important aspects - or the most significant clinical developments - in the sectors involving variety of functions: neurological, respiratory and cardiovascular, gastrointestinal, metabolism and perfusion; trauma infections, sepsis and organ failure; perioperative medicine and life support techniques; information technology dedicated to clinical medicine, but also as a means of information and education. The contributing authors are all part of leading research groups at the international level in the various sectors presented in the volume.

This practical and evidence-based workbook offers a series of assessment, implementation and evaluation activities for professionals working in critical care contexts. Designed to improve the quality of care delivery, it looks both at collaboration between professionals and between patients and/or family members. Collaborative Practice in Critical Care Settings: identifies the issues relating to the "current state" of collaboration in critical care through a series of assessment activities; provides a series of interventional activities which can address shortfalls of collaboration previously identified; and offers advice on generating evidence for the effects of any interventions implemented. The activities presented in this book are based on extensive empirical research, ensuring this book takes into account the everyday work environment of professionals in critical care units. It is suitable for practitioners and educators, as well as patient safety leads and managers.

Leading neurocritical care and intensive care specialists from the Neurosciences Critical Care Unit of the Johns Hopkins Hospital have joined forces to spell out concisely for first line health care providers the diverse standards and therapeutic regimens required for the care of critically ill neurological and neurosurgical patients. Their authoritative reference guide takes an algorithmic approach to immediate patient care, incorporating both ancillary investigation to confirm clinical diagnosis and appropriate management guidelines. The book offers comprehensive summaries of the best diagnostic and management practices for a wide range of neurocritical problems, including encephalopathy, intercerebral and subarachnoid hemorrhage, traumatic brain injury postoperative care, ischemic stroke, brain tumors, spinal cord injury, and more. A compact disk accompanies the book for downloading an ebook version to the reader's PC or PDA.
Authoritative and highly practical, the Handbook of Neurocritical Care offers first-line hospital physicians and EMS personnel a comprehensive quick-reference guide to the rapid diagnosis and management of critically ill neurological and neurosurgical patients.

'...provides an excellent introduction to the management of acute illness for all clinical staff, and a solid foundation for those who choose to make ICM a fulfilling life-long career.' From the Foreword by Julian Bion, Professor of Intensive Care Medicine, University of Birmingham Ideal for any medic or health professional embarking upon an intensive care rotation or specialism, this simple bedside handbook provides handy, pragmatic guidance to the day-to-day fundamentals of working in an intensive care unit, often a daunting prospect for the junior doctor, nurse and allied health professional encountering this challenging environment for the first time. Thoroughly updated, the second edition addresses recent and future developments in a variety of areas and is now organised into easy-to-read sections with clearly outlined learning goals. New topics added include sepsis, ARDS, refractory hypoxia, the role of allied health professionals, post ICU syndrome and follow up, and consent and capacity including new DOLS guidance. The book is authored by world-renowned contributors and edited by established consultants in the field of intensive care medicine.

Preface

Introduction

Heino von Prondzynski, Member of the Executive Committee of
F. Hoffmann-La Roche AG and Head of the Diagnostics Division

Winner of the 2002 IFCC-Roche Diagnostics Award

"Apoptosis In Sepsis And Multiple Organ Dysfunction Snydrome"

S. Zeerleder, B. Zwart, W. A. Wuillemin, L. A. Aarden, A. B. J. Groeneveld,
C. Caliez, A. E. M. van Nieuwenhuijze; G. J. van Mierlo, A. J. M. Eerenberg,
B. L??mmle, and C. E Hack

Inflammation ??? Infection ??? Sepsis

Finalists

"Plasma Procalcitonin And C-Reactive Protein In Acute Septic Shock:
Clinical And Biological Correlates"

R. Claeys, S. Vinken, H. Spapen, K. ver Elst, L. Huyghens, F. K. Gorus

National Winners

"4G/5G Promoter Polymorphism In The Plasminogen Activator Inhibitor-1
Gene In Children With Systemic Meningococcaemia"

G. Geishofer, W. Zenz, B. Resch, S. Panzer, G. Endler, D. H??ring,
C. Mannhalter

Hypoxia ??? Ischaemia

Finalist

"Phospholipases A2 Levels And Distribution In Bronchoalveolar Lavage
Fluid Of Patients With Acute Respiratory Distress Syndrome (ARDS):
Application Of A Fluorimetric Method"

E. I. Kitsiouli, G. Nakos, M. E. Lekka

Blood Gases ??? Electrolytes ??? Trace Elements

National Winner

"Magnesium In The ICU"

A. Abraham, A. Bachwani

Cardiology ??? Haemodynamics ??? Stroke

Finalist

"Single-Point Troponin T Measurement On The Day Of Coronary Care
Unit Discharge After Myocardial Infarction Strongly Correlates With
Ejection Fraction And Infarct Size By Nuclear Imaging And With CK-MB
Release"

G. Bonetti, F. Pagani, R. Giubbini, C. Cuccia, M. Panteghini

National Winner

"Soluble Adhesion MoleculesIn Acute Stroke"

A. M. Simundic, V. Basic, E. Topic, V. Demarin, N. Vrkic, B. Kunovic,
M. Stefanovic, A. Begonja

Nephrology

National Winner

"Monitoring Of The Renal Functions During Continuous Renal
Replacement Therapy ??? The Application Of The Analysis Of Cystatin C
And Natriuretic Peptides"

M. Balik, A. Jabor, A. Hendl, M. Kol????, M. Pavlisov??, D. Brestan

Haematology ??? Haemostatis

National Winners

"Serum Levels Of Soluble Transferrin Receptors (sTfR) Correlate Better
With Severity Of Disease Than With Iron Stores In Patients With Malignant
Lymphomas"

J. Bjerner, L. M. Amlie, L. S. Rusten, E. Jakobsen

New Technology ??? Methods

Finalists

"A Rapid And Sensitive Immunoassay For Determination Of S-100 Protein
In A Point-Of-Care Setting"

S. Eriksson, L. Dean, K. Pettersson

National Winner

"A New Approach Of Endotoxin Testing By Using A Monoclonal Antibody
Against Endotoxin (WN1-222/5) And Flow Cytometry"

J. Nolde, F. E. Di Padova, H. Brade H., K. H. Staubach

Organizational Aspects

National Winner

"Improvement Of Critical Care Management In A Healthcare Area By
Implementing Point-Of-Care Testing In Primary Care. A Preliminary
Approach"

M. L. Hortas, I. P??rez-Montaut, M. Redondo, N. Montiel, R. Molina,
C. Gonz??lez

Miscellaneous

National Winners

"Studies On The Potential Effect Of Nitrite"

Y. Tian, C. Wang, S. Song

Index

About Roche and the Roche Diagnostics Division

The goal of the first edition of Interventional Critical Care: A Manual for Advanced Care Practitioners was to fill a knowledge gap of the advanced practice provider (APP) specifically regarding the skills and understanding of critical care procedures in response to the rapidly expanding participation of APPs in critical care. Written by experts in the field, this successor edition adds to the content of the first by expanding upon ultrasonography areas to include more direct hemodynamic evaluations as well as the newer "e"FAST. It also explores the specialty of Urology to include more complex interventions. As billing and coding are necessary, the authors added appropriate CPT codes for each of the appropriate chapters. Most chapters have been completely re-written and updated from the first edition and have different authors - thereby a different perspective and experience level. Interventional Critical Care 2nd Edition serves as a valuable reference for physicians and advanced practice providers in daily practice in the ICU, OR and/or ED setting.

Critically ill and critically injured patients require specialized nutrition support to avoid the complications of progressive malnutrition. There is a paucity of information providing practical solutions to these difficult clinical problems. From Nutrition Support to Pharmacologic Nutrition in the ICU focuses on the theoretical and practical aspects of the management of this high-risk patient population. Each chapter presents a state-of-the-art discussion of nutritional and metabolic issues relevant to this resource-intensive patient population and contains current references, liberal tables and figures, and the personal insights of recognized international leaders in this field.

The coronary circulation is central to sustaining myocardial viability. Unlike the cir culations of most other organs, if the coronary circulation becomes insufficient to sustain myocardial contractile function, overall quality of life rapidly declines and life can abruptly end. In partnership with the cerebral circulation, the coronary circula tion plays a central role in sustaining life. However, unlike the cerebral circulation, whose function is self-sufficient to define life, the coronary circulation determines global blood flow and thus the initial state for the remainder of the body. This unique condition, together with the reality that coronary artery disease primarily affects peo ple in their productive years of life, has allowed physicians and scientists who study the heart to enjoy a privileged position in the field of medical research and clinical practice. Thus, it comes as little surprise that many new and exciting research developments involving the coronary circulation have recently come to the forefront of medical thinking. This reality, coupled with the large number of clinical trials of agents specif ically designed to sustain or improve coronary flow in many disease states, makes the timing of this monograph relevant. The book features papers presented at a recent international symposium, the fourth in a series of meetings on Applied Physiology of the Peripheral Circulation. The papers selected by the editors review the most impor tant advances in the fields of cardiology and the coronary circulation."

Even if in the last years more information on sepsis and new treatments has become available, mortality rate is however high. In fact, the complexity of the several biohumoral factors involved in this process is difficult to understand. Another major problem is the consequent organ failure, which grows in a sequential way and in relation with the lesion gravity and the functional reserves of the patient. The volume presents the most recent results of research in this field.

Critical care medicine is a relatively new specialty. Over the past few decades, we have seen an enormous growth in the number of inten sive care units (ICUs) worldwide. Medical students, residents, fellows, attending physicians, critical care nurses, pharmacists, respiratory ther apists, and other health-care providers (irrespective of their ultimate field of practice) will spend several months or years of their profes sional lives taking care of critically ill or severely injured patients. These clinicians must have special training, experience, and compe tence in managing complex problems in their patients. In addition, they must interpret the data obtained by many kinds of monitoring devices, and they must integrate this information with their knowl edge of the pathophysiology of disease. This handbook was written for every practitioner engaged in criti cal care medicine. We have attempted to present basic and generally accepted clinical information and some important formulas as well as laboratory values and tables that we feel will be useful to the practi tioner of critical care medicine. Chapter 1 provides an introduction to the ICU. Chapters 2 through 18 follow an outline format and are divided by organ system (i. e. , neurologic disorders, cardiovascular dis orders), as well as special topics (i. e. , environmental disorders, trauma, toxicology). In addition, many of these chapters review some useful facts and formulas systematically. Finally, Chapters 19 and 20 supply lists of pharmacologic agents and dosages commonly used in the ICU and laboratory values relevant to the ICU.

This book describes how the integrated approach offered by health services research can improve the quality of care provided to critically ill patients. By focusing on the needs of the patient, health services research links conventional scientific disciplines, systems research, education, and management, with the aim of translating developments in knowledge into sustained change in culture and practice. Intensive care has much to offer in this respect, as it can both benefit from and contribute to the collaborative methodology of health services research. Although the contributions are directed at critical care, the content is relevant to all health care disciplines, including health services administration.

Over two decades an abundance of knowledge has been accumulated focus ing on the understanding of the molecular and cellular pathomechanisms of stressful conditions like systemic inflammation and sepsis. We have learned that there is a clear correlation between the magnitude of the inciting traumatic event and the degree of inflammatory dysbalance. The immunoinflammatory disintegration comprises a simultaneous col lapse of the otherwise very smoothly balanced pro- and antiinflammatory vectors of cytokine regulation. Most recently, we understood that it is predominantly the dysregulation of antiinflammatory mediators that plays a pivotal role for the phenomenon of trauma-induced depression or paralysis of cell-mediated immune responses. The substantial intellectual and logistic investments of numerous investi gators towards understanding the biology of sepsis inevitably lead us towards a rewarding status in terms of reaching spheres of clinical relevance. From the evolutionary collection of a multitude of ex-vivo and in-vivo immuno mechanistic parameters, some were found to represent most significant bio logical markers to support the clinician to characterize better the severity of inflammatory illness and to predict outcome. Chapter one of this book, authored by G. Grass and E.A.M. Neugebauer, analyses elegantly our current knowledge on the assessment of the immuno logical status in terms of risk and prognosis of sepsis.

Infections contracted by patients constitute an important factor in the manage- ment of any hospital unit. For patients with weakened resistance due to trauma, after surgery and in intensive care, infection-related complications have a nega- tive impact on care quality indicators, specifically in terms of protracted hospi- talisation time, increased costs from complications and extended hospitalisation, and increased mortality rate. Effective strategies to prevent and treat infections are a priority in optimising the cost-effectiveness of care. Infection control, diag- nostics and targeted antibiotic therapy require an integrated epidemiological, microbiological and clinical approach. This is indispensable for critically ill patients, especially when the processes of infection and sepsis are supported by micro-organisms which are multidrug-resistant and difficult to root out. The importance of this subject has been demonstrated by a European obser- vational study on the prevalence of hospital infections in patients under intensive care. In this study, the prevalence of infections contracted in a "high-risk" envi- ronment was 21 %, while other studies have observed that the incidence of pneu- monia in patients undergoing artificial ventilation varied between 8% and 54%, with a median of 24%. These figures alone are enough to show the clinical impor- tance of the infective process and the need for continuous interdisciplinary updating and exchanges of experience.

Researchers from many disciplines, with both basic and clinical perspectives, came together in this volume to review and debate issues pertaining to the investigation and control of tissue oxygenation in acute medicine, as well as treatments to improve tissue oxygenation when abnormal. In this latter context, special emphasis is placed on understanding the effect of blood substitutes on the circulation and on the potential roles of this family of compounds in clinical medicine.

SHORTLISTED FOR THE ORWELL PRIZE FOR POLITICAL WRITING Long before the pandemic, care work has been underpaid and its values disregarded. In this remarkable and compassionate book, Madeleine Bunting speaks to those on the front line of the care crisis, struggling to hold together a crumbling infrastructure. A combination of extraordinary first-hand accounts of caring with a history of care and its language, Labours of Love is an impassioned call for change at a time when we need it most.

The interest of researchers, clinicians, practitioners and surgeons in critical care medicine is growing. Clinical pharmacology and new technologies now allow more appropriate therapies, and the commitment of all those involved in this field is of fundamental importance for reaching high interventional standards, in both the prevention and treatment of critical conditions, but also for satisfying the concept of cost-effectiveness in critical care. In this volume advances in critical care medicine are described, including the application of new technologies in the clinical setting, the full integration of computers and informatics, and the continual training of physicians and technicians.

The fifth edition of this popular textbook continues to provide a solid foundation of pharmacological knowledge for all those working in anaesthesia and intensive care. The content has been thoroughly revised to include expanded chapters with clearer figures, ensuring readers are kept abreast of the ever-changing landscape of clinical pharmacology. Conveniently divided into four sections covering the basic principles of pharmacology, core drugs in anaesthetic practice, cardiovascular drugs, and other important drugs and complemented by new diagrams, tables and chemical formulae to facilitate learning. All four chapters on core drugs in anaesthetic practice have been updated along with others exploring applied pharmacokinetic models, antimicrobials, and drugs used in diabetes. An ideal aid to study and practice for junior and trainee anaesthetists and intensive care specialists preparing for exams. Also an invaluable resource for theatre practitioners, ICU nurses and physicians working in areas that demand a solid knowledge of pharmacology.

The management of the critically ill patients has been in the past few years a discipline at the forefront of development which continues to make progress with the support of basic and clinical research. This work is a collection of material that deals with the management of critically ill patients, published on the occasion of the 13th APICE congress in November 1998, which celebrated 40 years of Critical Care Medicine.

An experienced physician knows how to recognize a patient suffering from sepsis, but cannot accurately determine whether the patient will survive. Cardinal elements of the treatment for sepsis include specific antibiotic and vasoactive drugs, enteral and parenteral nutrition, artificial respiration, and optimization of the oxygen transport to tissues. Nonetheless, with a certain frequency, these techniques are insufficient to ensure the recovery of a critically ill patient, especially when it is necessary to overcome functional alterations subsequent to organ and vital-system overload. The key elements in the progression of the sepsis-MODS syndrome are tied to numerous factors. These include: the severity and location of the lesion; the patient's age; the remaining functional reserve; the presence of mediatory which may be stimulatory, inhibitory or both.

Sepsis represents a life threatening condition to ICU patients. The evolution of sepsis to severe sepsis or septic shock may occur in an unpredictable way. In the coming millennium the prevention and management of sepsis and organ dysfunction will present a real challenge for researchers and clinicians.

As more premature infants survive the immediate neonatal period and require prolonged periods of hospitalization, researchers in fetal development and infancy have begun to reassess the strategies for their care. In the past, the focus of neonatal intensive care was to sustain life, with little attention to the quality and implications of survival. Today, however, researchers and clinicians are seeking to enhance the development of these small infants by ameliorating the effects of extreme prematurity and the associated medical and surgical complications. This book reports the work of leading researchers who have begun to use a variety of developmental interventions in the management of small infants in neonatal intensive care units.

The Yearbook compiles the most recent, widespread developments of experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in their field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediattrics, intensive care and emergency medicine. (With approximately 90 contributions.)

Das 4. Heidelberger Symposium uber "Hamostase in der Anasthesiologie" hat es sich zum Ziel gesetzt, fachubergreifend die noch ungelosten Fragen in der Hamostaseologie offenzulegen und auf der Basis einer kritischen Wertung der bekannten Studien klare Handlungsanweisungen fur den praktisch tatigen Arzt zu geben. Die angesprochenen Themen sind haufig in der Klinik auftretende Probleme wie die perioperative Einstellung von Hamophilen, die Betreuung von Patienten mit Massivtransfusion, Protein Z-Mangel, Lungenembolie, Katheterthrombose und Probleme der Gerinnungsanalyse und die Sicherheit von Praparaten mit Gerinnungsfaktoren. Das vorliegende Buch hat es sich zum Ziel gesetzt, den Leser uber die neuen Entwicklungen zu informieren und Anleitungen zum praktischen klinischen Handeln zu geben.

Rontgenthoraxaufnahmen richtig interpretieren

Thoraxaufnahmen, die auf der Intensivstation aufgenommen werden, unterscheiden sich in der Aufnahmetechnik und in den veranderten physiologischen und anatomischen Verhaltnissen von Standard-Thoraxaufnahmen, die am Rasterwandstativ angefertigt werden. Die Interpretation dieser Bilder bereitet selbst erfahrenen Radiologen und Intensivmedizinern haufig Schwierigkeiten.

Der Weg zur korrekten Interpretation: - Rontgen- und Aufnahmetechnik - Strahlenschutz und -belastung - Klinische Problematik und Interpretation von Thoraxaufnahmen auf der Intensivstation.

Neu in der 2. Auflage:

Bildmaterial moderner Aufnahmeverfahren

Indikationsstellung fur CT-Aufnahmen

Vergleich von Projektionsradiographie und Schnittbildradiographie und mogliche Pitfalls

Ein Praxisbuch von Radiologen, Intensivmedizinern und Medizinphysikern zum Lernen und Nachschlagen. Ein Muss fur jeden auf der Intensivstation tatigen Arzt "

Ein vertieftes pathophysiologisches Verstandnis der respiratorischen Insuffizienz und die technischen Entwicklungen der letzten Jahre haben die Beatmung, uber die reine Substitution bei Atmungsausfall durch zentrale oder periphere Atemlahmung hinaus, zu einer Therapie der respiratorischen Insuffizienz und pulmonaler Erkrankungen werden lassen. Es gibt heute ein breites Indikationsspektrum fur vielerlei Beatmungsverfahren, die von einfachen Atemhilfen bis hin zu komplexen, computergesteuerten Beatmungsmustern und zur Lungenersatztherapie reichen. Dieses Buch enthalt neben den pathophysiologischen Grundlagen eine systematische Darstellung der Verfahren und Gerate und gibt Anasthesisten und Intensivmedizinern wertvolle Hinweise fur indikationsgerechte Entscheidungen.