A. Gullo – författare

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.

Continuing medical education and specialty training procedures represent highly dynamical processes, with a continuously evolving content. The specific teaching methods available (micro-teaching, team teaching, mastery learning, simulation, and e-learning) are essential elements of this process to promote professional updating and teaching at the bedside, aimed at providing an excellent clinical practice. The didactic laboratory is the core of this process: teachers, students and the School must be able to integrate in order to encourage this trend, and following this trend, the Trieste School of Medicine has long recognised the importance of supporting educational aspects and teaching programmes that promote our discipline.

This volume is the result of the co-operation of the Trieste School of Medicine with experts at a national and international level who, in 2005, took part in seminars or micro-teaching sessions held at the Cattinara University Hospital.

In this book are discussed topics of particular importance to critical care cardiovascular diagnosis and management in the perioperative period. Chapter topics are the causes for heart failure; the pathophysiology of heart failure; coronary heart disease and ischemic preconditioning; hypertensive urgencies and emergencies; diagnosis of heart failure; preoperative cardiac risk assessment; hemodynamic monitoring in patients with heart failure; electrocardiography of heart failure - features and arrhythmias; pharmacologic management for patients with heart failure; devices for management of heart failure; pacemaker and internal cardioverter-defibrillator therapies; management of cardiopulmonary arrest; circulatory shock - anaphylactic, cardiogenic, haemorrhagic, septic; prevention and management of cardiac dysfunction during and after cardiac surgery; vasodilator therapy - systemic and pulmonary; and, thromboembolism and anticoagulation. This work represents an important update for anaesthesiologists, cardiologists, cardiac surgeons, emergency care physicians and intensivists caring for patients with acute, life-threatening cardiovascular afflictions.

Developing sectors in the intensive care field - and in critical care medicine in general - require specific levels of competence having a same common denominator: an in-depth knowledge of human pathophysiology. Although this volume presents plenty of topics in constant evolution, as witnessed by the collection of chapters compiled by several researchers, this edition includes, in particular, fields in which decision making at the patient’s bedside prevails over theoretical argumentation. In other words, the first and foremost message this edition wants to provide is for the reader to focus his/her attention on evidence-based medicine.

Improving standards of care is a real challenge in Intensive Care Medicine. Bettering clinical performance, patient safety, risk management and audit represents the cornerstone for raising the quality of care in ICU patients. Communication is the platform from where to start to reach a consensus in an extremely crowded area, a unique multidisciplinary and multiprofessional environment in which quality of care and, ultimately, patient survival need to be ameliorated.