Intensive+and+ critical+ care+ medicine

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
Department and School of Anesthesia
and Intensive Care
Catania School of Medicine
and University-Hospital
Catania, Italy

José Besso
Department of Critical Care Medicine
Hospital Centro Medico de Caracas
Caracas, Venezuela

Philip D. Lumb
Department of Anesthesiology
Keck Medical School
Los Angeles, CA, USA

Ged F. Williams
World Federation of Critical Care Nurses
C/- Nursing Administration
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
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Preface

The World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) 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 signified 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 multiprofessional 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 nurses 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 understanding 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 personnel, 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 recognized 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 lifethreatening conditions in intensive and critical care and the importance of putting
global strategies in place for surviving during and after natural or man-made disasters 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 participation 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 person full of humanity and devoted to optimizing the standards of care. I like to remember 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 countries; 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 contribution 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 physicians, 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

2

History of Critical Care Medicine:
The Past, the Present and the Future . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Giuseppe Ristagno, Max H. Weil

3

The Mission of the World Federation of Societies of Intensive
and Critical Care Medicine (WFSICCM) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Philip D. Lumb

19

Section II - Professionalism, Ethics and Evidence-Based Practice
3

Professionalism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Antonino Gullo, Paolo Murabito, José Besso

29

4

Ethics of Decision Making in Critical Care . . . . . . . . . . . . . . . . . . . . . . . . . . .
Satish Bhagwanjee

41

5

Evidence-Based Medicine in Critical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Premnath F. Kotur

47

Section III - Clinical Governance
6

Clinical Governance: Definitions and Recommendations . . . . . . . . . . . . . . . .
Georges Offenstadt

61

7

Optimization of Limited Resources and Patient Safety . . . . . . . . . . . . . . . . . .
Antonio O. Gallesio

69

ix


x

Contents

08 Improving Quality of Care in ICUs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Allan Garland

81

09 Scoring Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Rui P. Moreno, Ana C. Diogo, Susana Afonso

93

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

Contents

xi

Section VII - Infections Surveillance, Prevention and Management
19 From Surveillance to Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Mercedes Palomar Martínez, Francisco Álvarez Lerma
20 Antibiotic Policy in Critically Ill Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237
Francisco Álvarez Lerma, Mercedes Palomar Martínez
21 The Physiopathology of Antimicrobial Resistance
on the Intensive Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Nia Taylor, Francisco Abecasis, Hendrick K.F. van Saene
22 Infections in ICU: An Ongoing Challenge . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Hendrick K.F. van Saene, Durk F. Zandstra, Andy J. Petros, Luciano Silvestri,
Angelo R. De Gaudio
23 Selective Decontamination of the Digestive Tract (SDD)
Twenty-five Years of European Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . 273
Luciano Silvestri, Miguel A. de la Cal, Hendrick K.F. van Saene
24 Antifungal Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Simone Rinaldi, Angelo R. De Gaudio

Section VIII - Sepsis, Organ Dysfunction and the Bundles
25 Sepsis: Clinical Approach, Evidence-Based at the Bedside . . . . . . . . . . . . . . . 299
Francisco J. Hurtado, Maria Buroni, Jordan Tenzi
26 Intra-Abdominal Infections: Diagnostic and Surgical Strategies . . . . . . . . . . 315
Gabriele Sganga,Valerio Cozza
27 Surviving Sepsis Campaign and Bundles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Jean-Louis Vincent

Section IX - Trauma

28 The Trauma: Focus on Triage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Frank Plani
29 Damage Control in Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Demetrios Demetriades, Kenji Inaba, Peep Talving


xii

Contents

Section X - Limited Resource Disaster
30 Emergency Mass Critical Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Edgar J. Jimenez
31 Natural Disaster . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
Bin Du, Xiuming Xi, Yan Kang, Li Weng
on behalf of the China Critical Care Clinical Trial Group (CCCCTG)
32 The Needs of Children in Natural or Manmade Disasters . . . . . . . . . . . . . . . 391
Andrew C. Argent, Niranjan “Tex” Kissoon

Section XI - Special Clinical Conditions
33 The Neuroendocrine Response to Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417
Djillali Annane
34 Blood Transfusion and Its Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 435
Edgar Celis-Rodriguez, Konrad Reinhart, Yasser Sakr
35 Pain Management in Neonates and Children . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Marinella Astuto
36 Obstetrics at High Risk . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Ratan Alexander, Annalaura Paratore, Fathima Paruk
37 Intensive Care in the Elderly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 487
Carole Foot, Malcom Fisher

38 Severe Malaria in the ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501
Shirish V. Prayag, Ashwini R. Jahagirdar
39 End-of-Life in the ICU . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Jean-Louis Vincent

Section XII - Environment and Clinical Research
40 Designing Safe Intensive Care Units of the Future . . . . . . . . . . . . . . . . . . . . . 525
Paul Barach, Mary Potter Forbes, Ian Forbes
41 How to Plan and Design a Clinical Research Project . . . . . . . . . . . . . . . . . . . 543
Andrea A. Zin, Antonino Gullo, Walter A. Zin
Subject Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563


List of Contributors

Francisco Abecasis
Department of Medical Microbiology,
University of Liverpool, Liverpool, UK
Susana Afonso
Unidade de Cuidados Intensivos
Polivalente, Hospital de St. António dos
Capuchos, Centro Hospitalar de Lisboa
Central E.P.E., Lisbon, Portugal
Ratan Alexander
Department of Anesthetics, Worcestershire
Royal Hospital, Worcester, UK
Anne W. Alexandrov
UAB Comprehensive Stroke Center,
The University of Alabama at Birmingham,
University Hospital, Birmingham,

AL, USA
Francisco Álvarez Lerma
Servicio de Medicina Intensiva, Hospital
del Mar, Barcelona, Spain
Djillali Annane
Service de Réanimation, Hôpital Raymond
Poincaré (AP-HP), University of Versailles
SQY, Garches, France

Andrew C. Argent
School of Child and Adolescent Health,
University of Cape Town, and Paediatric
Intensive Care, Red Cross War Memorial
Children’s Hospital, Rondebosch, Cape
Town, South Africa
Marinella Astuto
Department of Anesthesia and Intensive
Care, Pediatric Anesthesia and Intensive
Care Section, Catania University Hospital,
Catania, Italy
Paul Barach
Department of Anesthesiology, Utrecht
Medical Center, Utrecht,
The Nederlands
José Besso
Department of Critical Care Medicine,
Hospital Centro Medico de Caracas,
Caracas, Venezuela
Satish Bhagwanjee
Department of Anaesthesiology,

University of the Witwatersrand,
Johannesburg Hospital, Parktown,
Johannesburg, South Africa

xiii


xiv

Gabriela Blanco
Critical Care Medicine, Hospital Centro
Medico de Caracas, Caracas,
Venezuela
Maria Buroni
Intensive Care Medicine Unit. Hospital
Español “Juan J. Crottogini”, ASSE,
Montevideo, Uruguay
Wilson Cañón Montañez
Colombian Committee of Critical Care
Nurses (CECC - ANEC), Nursing
Program, University of Santander,
Bucaramanga, Colombia
Eleonora Carlesso
Dipartimento di Anestesia, Rianimazione e
Terapia del Dolore, Fondazione IRCCS –
Ospedale Maggiore Policlinico,
Mangiagalli, Regina Elena di Milano,
University of Milan, Milan,
Italy
Evelyn Castellanos

Critical Care Medicine, Hospital Centro
Medico de Caracas, Caracas,
Venezuela
Edgar Celis-Rodriguez
Anaesthesia Department and Critical Care
Service, University Hospital Fundación
Santa Fe de Bogotá, Los Andes University,
Bogotá, Colombia
David W.K. Chan
Intensive Care Unit, Prince of Wales
Hospital, Shatin, New Territories,
Hong Kong
Valerio Cozza
Department of Surgery, Istituto Clinica
Chirurgica, Catholic University,
Policlinico A. Gemelli, Rome, Italy

List of Contributors

Angelo Raffaele De Gaudio
Department of Critical Care,
Section of Anesthesiology and Intensive
Care, University of Florence,
Florence, Italy
Miguel A. de la Cal
Intensive Care Unit, Hospital Universitario
de Getafe, Getafe (Madrid), Spain
Demetrios Demetriades
Trauma and Surgical Intensive Care Unit,
University of Southern California,

Los Angeles, CA, USA
Ana Cristina Diogo
Unidade de Cuidados Intensivos
Polivalente, Hospital de St. António dos
Capuchos, Centro Hospitalar de Lisboa
Central E.P.E., Lisbon, Portugal
Bin Du
Medical ICU, Peking Union Medical
College Hospital, Beijing, China
Malcolm Fisher
Intensive Care Unit Royal North Shore
Hospital, St Leonards, Sydney, Australia
Carole Foot
Intensive Care Unit, Royal North Shore
Hospital, St Leonards, Sydney, Australia
Ian Forbes
Health Facilities, DesignInc.; Faculty of
Design Architecture and Building,
University of Technology, Sydney; Injury
Risk Management Research Centre,
University of New South Wales, Sidney,
Australia
Paul R. Fulbrook
The World of Critical Care Nursing;
Australian Catholic University Limited,
Virginia, Queensland, Australia


List of Contributors

Antonio Oscar Gallesio
Department of Intensive Care, Hospital
Italiano de Buenos Aires, Buenos Aires,
Argentina
Allan Garland
Departments of Medicine & Community
Health Sciences, University of Manitoba,
Winnipeg, Manitoba, Canada
Luciano Gattinoni
Dipartimento di Anestesiologia, Terapia
Intensiva e Scienze Dermatologiche; and
Dipartimento di Anestesia, Rianimazione e
Terapia del Dolore, Fondazione IRCCS –
Ospedale Maggiore Policlinico,
Mangiagalli, Regina Elena di Milano,
University of Milan, Milan, Italy
Ruthnorka Gonzalez
Critical Care Medicine, Hospital Centro
Medico de Caracas, Caracas, Venezuela

xv

Ashwini R. Jahagirdar
Critical Care, Jahangir Apollo Hospital,
Pune, India
Edgar J. Jimenez
Universities of Florida, Central Florida
and Florida State University; and Critical
Care and Intermediate Critical Care,
Orlando Regional Medical Center,

Orlando, FL, USA
Yan Kang
ICU, West China Hospital, Chengdu,
Szechuan, China
Niranjan “Tex” Kissoon
Paediatric Intensive Care, Red Cross War
Memorial Children’s Hospital,
Rondebosch, Cape Town, South Africa
Premnath F. Kotur
Anaesthesiology, Jawaharlal Nehru
Medical College, Belgaum, India

Antonino Gullo
Department and School of Anesthesia and
Intensive Care, Catania UniversityHospital, Catania, Italy

Philip D. Lumb
Department of Anesthesiology, Keck
Medical School, Los Angeles, CA, USA

Christiane Hartog
Department of Anesthesiology and
Intensive Care, Jena University Hospital,
Jena, Germany

Flavio M.B. Maciel
Immunology Laboratory, Heart Institute
InCor, University of Sao Paulo, Sao Paulo,
Brazil

Francisco Javier Hurtado
Intensive Care Medicine Unit. Hospital
Español “Juan J. Crottogini”, ASSE; and
Department of Pathophysiology, School of
Medicine, Universidad de la República,
Montevideo, Uruguay

Rui P. Moreno
Unidade de Cuidados Intensivos
Polivalente, Hospital de St. António dos
Capuchos, Centro Hospitalar de Lisboa
Central E.P.E., Lisbon, Portugal

Kenji Inaba
Surgical Critical Care Fellowship
Program, University of Southern
California, Los Angeles, CA, USA

Paolo Murabito
Department and School of Anesthesia and
Intensive Care, Catania UniversityHospital, Catania, Italy


xvi

Rahul Nanchal
Medical Intensive Care Unit, Division of
Pulmonary and Critical Care Medicine,
Medical College of Wisconsin,
Milwaukee, WI, USA

Georges Offenstadt
Medical ICU, Saint-Antoine Hospital,
Paris, France

List of Contributors

Mary Potter Forbes,
Injury Risk Management Research Centre,
University of New South Wales, Sidney,
Australia
Shirish V. Prayag
Critical Care Unit, Shree Medical
Foundation, Pune, India

Mercedes Palomar Martínez
Servicio de Medicina Intensiva, Hospital
Vall d’Hebrón, Barcelona, Spain

Konrad Reinhart
Department of Anaesthesiology and
Intensive Care, Friedrich Schiller
University Hospital, Jena, Germany

Annalaura Paratore
Department of Anaesthesia and Intensive
Care, “Policlinico” University Hospital,
Catania, Italy

Simone Rinaldi
University of Florence, Department of

Critical Care, Section of Anesthesiology
and Intensive Care, Florence, Italy

Fathima Paruk
Department of Anesthesia, University of
Witwatersrand, Johannesburg, South
Africa

Giuseppe Ristagno
Weil Institute of Critical Care Medicine,
Rancho Mirage, CA, USA

Andy J. Petros
Intensive Care Unit, Great Ormond Street
Hospital for Children, London, UK

Yasser Sakr
Department of Anaesthesiology and
Intensive Care, Friedrich Schiller
University Hospital, Jena, Germany

Frank Plani
Flinders University Northern Territory
Clinical School, Royal Darwin Hospital,
Darwin, Australia

Halima M. Salisu- Kabara
Intensive Care Unit, Anaesthesiology
Department, Aminu Kano Teaching
Hospital, Gyadi, Kano, Nigeria

F. Elizabeth Poalillo
Intensive Care Units, Orlando Regional
Medical Center, Orlando, FL, USA

Gabriele Sganga
Department of Surgery, Istituto Clinica
Chirurgica, Catholic University,
Policlinico A. Gemelli, Rome, Italy

Federico Polli
Dipartimento di Anestesia, Rianimazione e
Terapia del Dolore, Fondazione IRCCS –
Ospedale Maggiore Policlinico,
Mangiagalli, Regina Elena di Milano,
University of Milan, Milan, Italy

Luciano Silvestri
Department of Anesthesia and Intensive
Care, Presidio Ospedaliero di Gorizia,
Gorizia, Italy, and
Peep Talving, University of Southern
California, Los Angeles, CA, USA


List of Contributors

xvii

Peep Talving

University of Southern California,
Los Angeles, CA, USA

Li Weng
Medical ICU, Peking Union Medical
College Hospital, Beijing, China

Nia Taylor
Department of Medical Microbiology,
University of Liverpool, Liverpool, UK

Ged F. Williams
World Federation of Critical Care Nurses,
C/- Nursing Administration, Gold Coast
Health, Southport, Queensland,
Australia

Jordan Tenzi
Intensive Care Medicine Unit. Hospital
Español “Juan J. Crottogini”, ASSE,
Montevideo, Uruguay
Hendrick K.F van Saene
School of Clinical Sciences; and
Department of Medical Microbiology,
University of Liverpool, Liverpool, UK
Jean-Louis Vincent
Department of Intensive Care, Erasme
Hospital, Université Libre de Bruxelles,
Brussels, Belgium
Max Harry Weil

Weil Institute of Critical Care Medicine,
Rancho Mirage, CA; Keck School of
Medicine of the University of Southern
California, Los Angeles, CA;
Northwestern University Medical School,
Chicago, IL, USA

Xiuming Xi
ICU, Fuxing Hospital, Capital University
of Medical Sciences, Beijing, China
Durk F. Zandstra
Intensive Care Unit OLVG, Amsterdam,
The Netherlands
Andrea A. Zin
Fernandes Figueira Institute, Oswaldo
Cruz Foundation, Rio de Janeiro, Brazil
Walter A. Zin
Carlos Chagas Filho Institute of
Biophysics, Federal University of Rio de
Janeiro, Rio de Janeiro, Brazil


Abbreviations

AECC
Aes
AGNB
AKI
ALI/ARDS
AMSA

ANCA
ANZICS
APACHE
APFCCN
APRV
APTT
ARDS
ARDS
ASDI
AT-III
AUC
AVPU score
BIS
BMA
BMI
CCNO
CDC
CFU
CG
CI
C-IAIs
Cmax
CME
CNS

American European Consensus Conference
Adverse events
Aerobic Gram-negative bacilli
Acute kidney injury
Acute lung injury/Acute respiratory distress syndrome

Amplitude Spectrum Area
Antineutrophilic cytoplasmic antibodies
Australian and New Zeland Intensive Care Society
Acute physiology and chronic health evaluation
Asia-Pacific Federation of Critical Care Nurses
Airway pressure release ventilation
Activated partial thromboplastin time
Acute respiratory distress syndrome
Adult respiratory distress syndrome
Assurance in intensive care medicine
Antithrombin-III
Area below the curve
Alert, Verbal, Painful, Unresponsive
Bispectral index
Bone marrow aspiration
Body mass index
Critical care nursing organization
Center for Disease Control and Prevention
Colony forming units
Clinical governance
Colonization index
Complicated intra-abdominal infections
Maximum plasma concentration
Continuing medical education
Central nervous system

xix


xx

CoBaTrICE
CPP
CPX
CRBSI
CRED
CRH
CRP
CSE
CSF
CT
CUSP
CVC
CVP
CVVH
DAD
DIC
DO2
DVT
E. Coli
EBBP
EBP
ECG
ECMO
EfCCNa
EMCC
EMS
ESBL
ESICM
EtCO2

FACTT
FCCS
FDA
FDM
FFP
FiO2
FLECI
FSHRF
GABA
GFR
GHRH
GIT
GiViTI
GMC
Gp

Abbreviations

Competency Based Training in Intensive Care in Europe
Cerebral perfusion pressure
Cardiopulmonary exercise
Catheter-related blood stream infection
Center for Research on the Epidemiology of Disasters
Corticotropin-releasing hormone
C-reactive protein
Combined spinal epidural
Cerebrospinal fluid
Computed tomography
Comprehensive Unit-Based Safety Program
Central venous catheter

Central venous pressure
Continuous veno-venous hemodiafiltration
Diffuse alveolar damage
Disseminated intravascular coagulation
Oxygen delivery
Deep venous thrombosis
Escherichia coli
Evidence-based best practices
Evidence-based practice
Electrocardiogram
Extra corporeal membrane oxygenation
European Federation of Critical Care Nursing Associations
Emergency mass critical care
Emergency Medical Services
Extended spectrum beta-lactamase
European Society of Intensive Care Medicine
End-tidal CO2
Fluid and Catheter Treatment Trial
Fundamental critical care support course
Food and Drugs Administration
Fundamentals of disaster management
Fresh frozen plasma
Faction of inspired oxygen
Federación Latinoamericana de Enfermería en Cuidado Intensivo
FSH-releasing factor
Gamma-aminobutyric acid
Glomerular filtration rate
GH-releasing factor
Gastro-intestinal tract
Gruppo italiano per la Valutazione degli interventi in Terapia

Intensiva
General Medical Council
General practitioner


Abbreviations

GRADE
Hb
HCAI
Hct
HES
HFOV
HICS
HIV
HMGB-1
HVA
IAIs
ICD
ICF
ICM
ICNARC
ICP
IFN
IGF-1
IHI
INR
IOM
IPS
IRB

IRR
ISF
ITUs
IUGR
JCAHQ
LABIC
LDH
LHRH
LiDCO
LIS
LMWH
LOS
LP
MAP
MCI
MgSO4
MIC
MIF
MIMMS
MODS
MRI

xxi

Grading of Recommendations, Assessment, Development,
and Evaluation
Hemoglobin
Health care associated infections
Hematocrit
Hydroxyethyl starch

High frequency oscillatory ventilation
Hospital incident command system
Human immunodeficiency virus
High mobility group box
Hazard-vulnerability analysis
Intra-abdominal infections
Intensive care department
Informed consent form
Intensive care medicine
Intensive Care National Audit & Research Centre
Intracranial pressure
Interferon
Insulin-like growth factor receptor
Institute for Healthcare Improvement
International normalized ratio
Institute of Medicine
Infection probability score
Institutional Review Board
Insulin receptor-related receptor
International Sepsis Forum
Intensive therapy units
Intrauterine growth retardation
Joint Commission for Accreditation of Hospitals
Latin American Brain Injury Consortium
Lactate dehydrogenase
LH-releasing hormone
Lithium dilution cardiac output
Lung Injury Score
Low-molecular-weight heparin
Length of stay

Lumbar puncture
Mean arterial blood pressure
Mass casualty incident
Magnesium sulphate
Minimum bacteria inhibiting concentration
Migration inhibiting factors
Major incident medical management and support
Multiple organ dysfunction syndrome
Magnetic resonance imaging


Abbreviations

xxii

MRSA
MV
NANIN
NAS
NCA
NDMS
NHS
NICE
NO
NSAIDs
OPS
PAC
PAOP
PAPR
PCA

PCI
PC-IRV
PCT
PEEP
PET
PfEMP1
PI
PiCCO
PICO
PICU
pK/pD
PNU1
PNU2
PNU3
PPCM
PPE
PPM
PRL
PSA
PtO2
PTSD
QA/QI
QALYs
QI
rhAPC
RIFLE
ROSC
RRT
SAFE
SAPS

Methicillin-resistant Staphilococcus aureus
Mechanical ventilation
National Association of Nurse Intensivists of Nigeria
Neonatal abstinence syndrome
Nurse or parent controlled analgesia
National Disaster Medical System
National Health Service
National Institute for Clinical Excellence
Nitric oxide
Non-steroidal anti-inflammatory drugs
Orthogonal polarization spectral
Pulmonary artery catheter
Pulmonary artery occlusion pressure
Powered air purifier respirator
Patient-controlled analgesia
Percutaneous coronary intervention
Pressure control inverse ration ventilation
Procalcitonin
Positive end-expiratory pressures
Positive emission tomography
Plasmodium falciparum erythrocyte membrane protein 1
Performance improvement
Pulse contour cardiac output
Patient, intervention, comparison, outcome
Pediatric intensive care unit
Pharmacokinetic / pharmacodynamic parameters
Clinically defined pneumonia
Pneumonia with specific laboratory findings
Pneumonia in inmuocompromised patients

Peri-partum cardiomyopathy
Personal protective equipment
Potentially pathogenic micro-organisms
Prolactin
Pressure swing adsorption
Oxygen partial pressure distribution
Post traumatic stress disorder
Quality assurance/Quality improvement
Quality Adjusted Life Years
Quality improvement
Recombinant human activated protein-C
Risk, Injury, Failure, Loss and End stage
Restoration of spontaneous circulation
Renal replacement therapy
Saline versus albumin fluid evaluation
Simplified acute physiology


Abbreviations

SARS
SBI
SCCM
ScvO2
SDD
SICSAG
SIDS
SIRS
SOD
SOFA

SSC
START
SVR
TBI
TNF
TNF-α
TQM
TRALI
TRH
TRTS
TTP
UC
UFH
US
USC
VAP
VAS
VF
VILI
VIP
VO2
VRE
WFCCN
WFSICCM
WHO

xxiii

Severe acute respiratory syndrome
Secondary brain injury

Society of Critical Care Medicine
Central venous oxygen saturation
Selective digestive tract decontamination
Scottish Intensive Care Audit Group
Sudden infant death syndrome
Systemic inflammatory response syndrome
Selective oropharyngeal decontamination
Sequential Organ Failure Assessment score
Surviving Sepsis Campaign
Simple Triage and Rapid Treatment
Aystemic vascular resistance
Traumatic brain injury
Tumor necrosis factor
Tumor necrosis factor alpha
Total Quality Management
Transfusion-related acute lung injury
Thyrotropin-releasing hormone
Triage Revised Trauma Score
Thrombotic thrombocytopenic purpura
Urinary catheter
Unfractioned heparin
Ultrasound
University of Southern California
Ventilator associated pneumonia
Visual analog scale
Ventricular fibrillation
Ventilator induced lung injury
Ventilation, infusion, and pumping
Metabolic oxygen consumption
Vancomycin-resistant enterococci

World Federation of Critical Care Nurses
World Federation of Societies of Intensive and Critical Care
Medicine
World Health Organization


Section I

Introduction and Mission


History of Critical Care Medicine:
The Past, the Present and the Future

1

G. Ristagno, M.H. Weil

Introduction
The term “Critical Care Medicine” was first introduced in the late 1950s at the
University of Southern California (USC) from the concept that immediately lifeendangered patients, the critically ill and injured, may have substantially better
chances of survival if provided with professionally advanced minute-to-minute
objective measurements. Such measurements were largely based on “real time” electronic monitoring of vital signs, hemodynamic and respiratory parameters, and complementary measurements on blood and body fluids. Care was increasingly delegated to a new generation of dedicated physicians, professional nurses, therapists, and
clinical pharmacists in special care units. Since then, progress in the management of
the acutely life-threatened patient has been accelerated by rapid advances in both
monitoring and measurement technologies and the interventions that were triggered
by them. Intubation and mechanical ventilation, hemodialysis, volume repletation
guided by measurement of intravascular pressures and cardiac output, resuscitation
by the routine use of chest compression, defibrillation and pacemaker insertion came
into general use. These individual techniques had progressively evolved over the preceding decades by anesthesiologists in the operating room and postanesthesia recovery units and by cardiologists in the catheterization laboratory. Conventional methods of observation based on physical examination and largely manual measurement

of vital signs at the bedside were therefore increasingly superceded by electronic
techniques of quantitative monitoring and measurements. These methods of monitoring and measurements became not only acceptable practices but were remarkably
rapidly implemented by hospitals and initially at defined in-hospital sites which
were designated intensive care units (ICUs) or in some European countries, intensive

M.H. Weil ( )
Weil Institute of Critical Care Medicine, Rancho Mirage, CA, USA
Antonino Gullo et al. (eds), Intensive and Critical Care Medicine.
© Springer-Verlag Italia 2009

3


4

1

G. Ristagno, M.H.Weil

therapy units (ITUs). In major centers, specialized units were later established in part
contingent on the volume of patients eligible for specialized cardiac, respiratory, surgical, neurological, and later pediatric and neonatal care [1]. A variety of subsidiary
or “step-down” units with less elaborate monitoring for intermediate care expanded
the availability of monitored care to patients at lesser risk [2]. “Critical Care
Medicine” as it became known in the USA, “Intensive Care,” “Intensive Therapy”
and “Reanimation” in some other countries remarkably rapidly became a new in-hospital practice discipline – within literally a decade. Within 25 years the discipline
became a recognized subspecialty in which continuing on-site medical diagnosis and
management of immediately life-threatening diseases and/or injuries was provided
with high priority by advanced specialists recruited from internal medicine, general
surgery, anesthesiology, and pediatrics. These specialists were intended to be physically on site, in part comparable to the well-established uninterrupted loyalty of anesthesiologists to a defined patient during surgical procedures [3]. At present, almost
every medical and surgical practitioner now increasingly relies on critical care

experts for the care of acutely life-threatened patients outside of the operating room
in general or in specialized intensive care units.

When Did Critical Care Medicine Begin?
The beginning of critical care is debated, in part contingent on definitions of site or
locale, the expertise and qualifications of providers, and the evolution of automated
monitors and modern life support technologies. In the 1850s during the Crimean War,
it was the site which defined the pioneering contribution of what became Critical
Care by Florence Nightingale, who is generally viewed as the parent of professional
nursing. Nightingale segregated the most severely battle injured soldiers and bedded
them in close proximity to the nursing station so that they might receive more “intensive nursing care” [4]. Some 70 years later, in 1923, the concept of postoperative
recovery was modeled by Dr. Walter Dandy who organized a neurosurgical postoperative care unit at Johns Hopkins Hospital in Baltimore, enlisting specialized nursing
staff. Professional nurses therefore became the first bedside specialists rendering
critical care under the direction of neurological surgeons. This initial intensive care
also became a model for postoperative recovery units, which provided intensive postoperative management for military causalities during the Second World War [5].
Comparable postanesthesia recovery units evolved for postoperative management of
patients in civilian practices in the 1950s, allowing for better outcomes after more
invasive surgical procedures including cardiac and radical cancer operations. Again,
it was the bedside expertise of specialist nurses, supported by anesthesiologists, who
were later equipped with bedside monitors that triggered timely life support interventions and thereby improved management in the immediate postoperative interval.
Accordingly, there was a transition from site to expertise, both among medical
specialists and especially anesthesiologists, and professional nursing. With respect to
life support technologies, reference is often made to the poliomyelitis epidemics of