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By A. Gullo

Improving criteria of care is a true problem in extensive Care medication. improving scientific functionality, sufferer protection, probability administration and audit represents the cornerstone for elevating the standard of care in ICU sufferers. conversation is the platform from the place to begin to arrive a consensus in a really crowded quarter, a special multidisciplinary and multiprofessional surroundings during which caliber of care and, finally, sufferer survival have to be ameliorated.

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Extra info for Anaesthesia, pain, intensive care and emergency A.P.I.C.E.: proceedings of the 22st postgraduate course in critical medicine: Venice-Mestre, Italy - November 9-11, 2007

Example text

All of this comes down to the important fact that we need more time in order to successfully intervene. We need a window of opportunities. It seems reasonable to assume that tissue and organ pathology starts with changes in tissue biochemistry – even when the primary damage may be physical – as in traumatic brain injury (TBI). We want to avoid the secondary damage whether it is due to ongoing chemical processes in the cells or due to the nature of our pharmacological and surgical interventions.

Maximal POP (POPmax) and minimal POP (POPmin) were determined over the same respiratory cycle. The respiratory variations in POP waveform amplitude were calculated using a formula similar to that proposed to assess DPP: DPOP (%) = 100 x {(POPmax – POPmin)/([POPmax + POPmin]/2)}. Finally, DPOP was evaluated on three consecutive respiratory cycles simultaneously with DPP measurements. We found a fair agreement and a good relationship between DPOP and DPP. Moreover, we found that the threshold DPOP value of 15% allowed discrimination between patients with a DPP >13% and patients with a DPP £ 13% with a sensitivity of 87%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 94%.

Moreover, it has been shown that the respiratory variations in arterial pulse pressure are more predictive of response to volume expansion than the respiratory variations in systolic arterial pressure since systolic arterial pressure not only depends on respiration-induced changes in stroke volume, but also on respiration-induced changes in intrathoracic pressure. The main limitations of these indices are that they are invasive, technically challenging, or not widely available. Arterial catheters, which are mandatory for DPP calculation and monitoring, have been shown to be responsible for infections and thromboses and their use is limited to the operating room.

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