A. Gullo • P.D. Lumb (Eds.) Intensive and Critical Care Medicine Reflections, Recommendations and Perspectives

A. Gullo • P.D. Lumb (Eds.)

Intensive and Critical Care Medicine

Reflections, Recommendations and Perspectives

1 3

A. Gullo • P.D. Lumb (Eds.)

Intensive and Critical Care Medicine

Reflections,Recommendations

and Perspectives

A

G

P

D. L

Department of Perioperative Medicine Department of Anaesthesiology Intensive Care and Emergency Keck School of Medicine at USC Trieste University School of Medicine Los Angeles, CA

Trieste, Italy U.S.A.

Library of Congress Control Number: 2005928163

ISBN 88-470-0349-0 Springer Milan Berlin Heidelberg New York

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Ten Steps to the Top

After the Sydney meeting held in 2001, the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) reinforced its multidiscipli- nary and multi-professional identity.

WFSICCM President Philip D. Lumb from the Keck School of Medicine of the University of Southern California in Los Angeles has, together with the Federation Council, envisaged a new strategy to obtain a more-visible target for its mission.

In the last four years, several goals have been accomplished and the WFSICCM is now well-positioned to succeed in its global mission.

– First, the functions of the Secretariat and Headquarters have been relocated to the United Kingdom. Ms Liz Taylor has been appointed the Council’s Executive Assistant, which represents a significant step towards ensuring the organisation’s administrative integrity. Clearly, this is a winning decision;

– Second, the WF web-site has improved global communications and become a useful tool for effective online decision-making;

– Third, Pathfinder UK has helped to develop a strong marketing plan and to cre- ate a more-visible and proactive presence in the international Critical Care com- munity;

– Fourth, the President has reached all corners of the world, communicating enthusiasm and revealing leadership excellence;

– Fifth, the Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine has reinforced its relationship with the World Federation;

the memorable 2003 congress held in Cancun, Mexico, has represented a key- stone in the growing process of the WF;

– Sixth, Trieste, Italy, has for three times hosted the WF during APICE, the International Congress endorsed by the WF;

– Seventh, Durban, South Africa, has represented an important phase in the expansion process of the WF; an important debate for understanding possible assistance for countries with limited resources has taken place there;

– Eighth, the Council has encouraged new contacts; the dream of establishing the

Mediterranean School of Intensive and Critical Care Medicine is coming true.

Furthermore, Russia and China represent a new target for the WF Council, with scientific contacts and expectations becoming increasingly promising;

– Ninth, last April, in Santos, the WF Council considered the future scenario of the WF after the forthcoming 9

World Congress to be held in Buenos Aires; in the meantime, the capital of tango and the South American atmosphere will be an ideal environment for continuing our dreams;

– Tenth, Education and Standards of Care are the pillars of the WFSICCM; the present book is a celebration of the WF Council’s quadrennial activity and sets out the reflections and perspectives that are necessary for offering care to the highest standards to critically ill patients. We hope we all agree to think about this.

Buenos Aires Antonino Gullo

August 27, 2005 Philip D. Lumb

VI

Table of Contents

Introduction: World Federation 1993-1997

M. Fisher . . . . 1

Consent and Intensive Care: Is It Possible?

L. Berggren . . . . 5

Hepatorenal Syndrome

J. Besso, C. Pru, J. Padron, J. Plaz . . . . 9

HIV/AIDS in Developing Countries

S. Bhagwanjee . . . . 27

Do Not Attempt Resuscitation Order

F.J. de Latorre . . . . 35

Molecular Biology in Critical Care: Is It More Than a Look Only?

G. Domínguez-Cherit, J. Gutiérrez, E. Rivero . . . . 45

Resource Management and Audits in Intensive Care Medicine

A.O. Gallesio . . . . 55

Sepsis and Organ(s) Dysfunction – Key Points, Reflections, and Perspectives

A. Gullo, F. Iscra, F. Rubulotta . . . . 71

How to Evaluate Performance of Adult Intensive Care Units: A 30Year Experience

J.R. Le Gall, E. Azoulay . . . . 97

Research Ethics in Critical Care Medicine

P.D. Lumb . . . . 105

Scoring System and Outcome

R. Moreno, P. Metnitz . . . . 117

Clinical Decision Making for Non-Invasive Ventilation

S. Prayag, A. Jahagirdar . . . . 137

Control of Infections in Intensive Care Units

J. Takezawa . . . . 157

Diagnosis of Pulmonary Embolism

R.G.G. Terzi, M. Mello Moreira . . . . 167

Critical Care Nursing, a WorldWide Perspective

G. Williams . . . . 183

Cost of Care in Critical Illness

T.A. Williams, G.J. Dobbs . . . . 193

Gallery 2002 – 2005 (After Affiliation of APICE to WFSICCM) . . . . 215

Subject Index . . . . 229

VIII Table of Contents

Azoulay E.

Intensive Care Unit, Hôpital Saint Louis, Paris (France)

Berggren L.

Department of Anaesthesiology, Örebro Medical Centre Hospital, Örebro (Sweden)

Besso J.

Department of Intensive Care, Hospital Centro Medico de Caracas (Venezuela)

Bhagwanjee S.

Department of Anaesthesiology, University of Withwatersrand, Johannesburg Hospital, Johannesburg (South Africa)

de Latorre F.J.

Servei de Medicina Intensiva, Hospital Universitari Vall d’Hebron, Barcelona (Spain)

Dobb G.J.

Intensive Care Unit, Royal Perth Hospital and School of Medicine and Pharmacology, University of Western Australia, Perth (Australia)

Dominguez-Cherit G.

Department of Critical Care Medicine, National Institute of Medical Sciences and Nutrition ‘Salvador Zubiran’, Mexico City (Mexico)

Fisher M.

Intensive Care Unit, Royal North Shore Hospital, St. Leonards (Australia)

Gallesio A.O.

Unidad de Terapia Intensiva Adulta, Hospital Italiano, Buenos Aires (Argentina)

Gullo A.

Department of Perioperative Medicine, Intensive Care and

Emergency, School of Anaesthesia and Intensive Care, Trieste University Medical School, Trieste (Italy)

Gutierrez J.

Department of Critical Care Medicine, National Institute of Medical Sciences and Nutrition ‘Salvador Zubiran’, Mexico City (Mexico)

Iscra F.

Department of Perioperative Medicine, Intensive Care and

Emergency, School of Anaesthesia and

List of Contributors

X

Intensive Care, Trieste University Medical School, Trieste (Italy)

Jahagirdar A.

Shree Medical Foundation, Prayag Hospital, Pune (India)

Le Gall J.R.

Intensive Care Unit, Hôpital Saint Louis, Paris (France)

Lumb P.D.

Department of Anaesthesiology, Keck School of Medicine, University of Southern California, Los Angeles (USA)

Mello Moreira M.

Department of Surgery, Faculdade de Ciências Médicas, Universidade Estadual de Campinas UNICAMP, Campinas, São Paulo (Brazil)

Metnitz P.

Department of Anaesthesiology and Intensive Care Medicine, Medical University of Vienna, Vienna (Austria)

Moreno R.

Unidade de Cuidados Intensivos Polivalente, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa, Lisbon (Portugal)

Padron J.

Department of Intensive Care, Hospital Centro Medico de Caracas (Venezuela)

Plaz J.

Department of Intensive Care, Hospital Centro Medico de Caracas (Venezuela)

Prayag S.

Shree Medical Foundation, Prayag Hospital, Pune (India)

Pru C.

Department of Intensive Care, Hospital Centro Medico de Caracas (Venezuela)

Rivero E.

Department of Critical Care Medicine, National Institute of Medical Sciences and Nutrition ‘Salvador Zubiran’, Mexico City (Mexico)

Rubulotta F.

Department of Intensive Care, University Hospital, Leuven (Belgium)

Takezawa J.

Department of Emergency and Intensive Care Medicine, Nagoya University School of Medicine, Nagoya (Japan)

Terzi R.

Department of Surgery, Faculdade de Ciências Médicas, Universidade Estadual de Campinas UNICAMP, Campinas, São Paulo (Brazil)

Williams G.

Direction of Nursing, Maroondah Hospital, Victoria (Australia)

Williams T.A.

Intensive Care Unit, Royal Perth Hospital and School of Medicine and Pharmacology, University of Western Australia, Perth (Australia)

List of Contributors

Abbreviations

A Adenine

ACTH Adrenocorticotropic Hormone

ADE Adverse Drug Effects

AIDS Acquired Immunodeficiency Syndrome

APACHE Acute Physiology and Chronic Health Evaluation APC Antigen Presenting Cell

APS Acute Physiology Score

ARDS Acute Respiratory Distress Syndrome ARF Acute Respiratory Failure

ARV Anti-retroviral

BIPAP Biphasic Positive Air Pressure

C Cytosine

CAM Cell Adhesion Molecules

CAP Community Acquired Pneumonia

CARS Compensatory Anti-Inflammatory Response Syndrome CDC Centers for Disease Control and Prevention

CI Confidence Interval

CMV Cytomegalovirus

COPD Chronic Obstructive Pulmonary Disease CPAP Continuous Positive Airway Pressure

CPI Consumer Price Index

CPR Cardiopulmonary Resuscitation

CR-BIS Catheter-Related Blood Stream Infection CVVH Continuous Veno-Venous Haemofiltration

DD D-Dimer

DHEA Dheydroepiandrosterone

DIC Disseminated Intravascular Coagulation DISC Death-Inducing Signalling Complex

DNA Deoxyribonucleic Acid

DNAR Do Not Attempt Resuscitation

DNR Do Not Resuscitate

DVT Deep Venous Thrombosis EGDT Early Goal Directed Therapy ENAS European-North American Study EPIC European Prospective Infection Control

ER Emergency Room

FGF Fibroplastic Growth Factor FRC Functional Residual Capacity

FVC Forced Vital Capacity

G Guanine

GFR Glomerular Filtration Rate

HIPPA Healthcare Information Portability and Privacy Act

HR Hazard Ratio

HR Heart Rate

HRS Hepatorenal Syndrome

I/R Ischaemic Reperfusion Injury

ICD International Classification of Diseases

ICP Intracranial Pressure

ICU Intensive Care Unit

IPAP Inspiratory Positive Air Pressure IRB Institutional Revue Board

JANIS Japanese Nosocomial Infection Surveillance JCAHO Joint Commission on Accreditation of Heathcare

Organizations

LPS Lipoproteins

MARS Molecular Adsorbent Recirculating System

MI Myocardial Infarction

MODS Multiple Organ Dysfunction Syndrome MPM Mortality Probability Models

MPTP Mitochondrial Permeability Transition mRNA Messenger Ribonucleic Acid

NAC N-acetylcysteine

NAS Nursing Activity Score NIV Non-Invasive Ventilation

NK Natural Killer

NNIS Nosocomial Infection Surveillance

NO Nitrous oxide

NPPV Non-invasive Positive Pressure Ventilation NSAID Nonsteroidal Anti-Inflammatory Drug PaCO2 Partial Arterial Carbon Dioxide Pressure PAD Public Access Defibrillation

PAV Proportional Assist Ventilation

XII Abbreviations

XIII

PCP Pneumocystis Carinii Pneumonia

PE Pulmonary Embolism

PEEP Positive End Expiratory Pressure

PIOPED Prospective Investigators of Pulmonary Embolism Diagnosis PRR Pattern Recognition Receptor

QALY Quality-Adjusted Life-Year

RAAS Renin-Angiotensin-Aldosterone System

RNA Ribonucleic Acid

ROC Receiver Operating Characteristic

ROS Reactive Oxygen Species

RPF Renal Plasma Flow

rRNA Ribosomal Ribonucleic Acid SAPS Simplified Acute Physiology Score SBP Spontaneous Bacterial Peritonitis SCCM Society of Critical Care Medicine SDD Selective Digestive Decontamination SIRS Systemic Inflammatory Response Syndrome SMR Standard Mortality Ration

SNP Single Nucleotide Polymorphism

SNS Sympathetic Nervous System

SOD Superoxide Dismutase

SOFA Sepsis-Related Organ Failure Assessment

SP Standard of Practice

SSI Surgical Site Infection

SUPPORT Study to Understand Prognoses and Preferences for Outcomes and Risk of Treatment

SvO2 Oxygen Venous Saturation

T Thymine

TB Tuberculosis

TEE Trans-oesophageal Echocardiography TIPS Transjugular Intrahepatic Stent-Shunt TISS Therapeutic Intervention Scoring System TLR4 Toll-Like Receptor 4

tRNA Transfer Ribonucleic Acid

UTI Urinary Catheter-related Infection V/Q Ventilation Perfusion Ratio VAP Ventialtor Associated Pneumonia V

/V

phys Physiologic Dead Space

VNTR Variable Number of Tandem Repeats

WFSICCM World Federation of Societies of Intensive and Critical Care Medicine

Abbreviations

Council of the WFSICCM

Lars Berggren (Sweden) José Besso (Venezuela)

Satish Bhagwanjee (South Africa) Geoffrey J. Dobb (Australia), Treasurer Guillermo Domínguez Cherit (Mexico) Antonio Gallesio (Argentina)

Antonino Gullo (Italy)

Francisco J. de Latorre (Spain)

Jean Roger Le Gall (France)

Philip D. Lumb (USA), President

Rui P. J. Moreno (Portugal)

Gilbert Park (United Kingdom)

Fernando Palizas (Argentina)

Shirish Prayag (India)

Jun Takezawa (Japan)

Renato G. G. Terzi (Brazil)

Ged Williams (Australia)

XV

Left to right: A. Gilston (UK) First President WFSICCM, A. Gullo (Italy ), W.C. Shoemaker (USA); Trieste, Welcome Ceremony, APICE 1998

WFSICCM Board in Santos, April 2005 - Left to right, stand: A. Gallesio (Argentina), J.

Besso (Venezuela), A. Gullo (Italy), S. Bhagwanjee (South Africa), J. Takezawa (Japan), S.

Prayag (India), R.P.J. Moreno (Portugal), G. Williams (Australia)

Sit: L. Berggren (Sweden), G. Park (UK), P.D. Lumb (USA), G.J. Dobb (Australia), R.G.G.

Terzi (Brazil), J.R. Le Gall (France)