Antonino Gullo – Författare

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.

These are the proceedings of the 14th Postgraduate Course in Critical Care Medicine. Critical care medicine is an interdisciplinary area of medicine drawing upon the specialties of anaesthesiology, internal medicine and surgery, and relying upon the essential contributions and support from basic research. Advances in critical care medicine depend on the application of new technologies to the clinic, the full integration of computers and informatics, the continual training of physicians and technicians, and the consideration of ethical issues in the clinical setting. Within this complex panorama of complementary approaches and viewpoints, it is apparent that critical care medicine is one of the best examples of evidence-based medicine.

Intensive care is a rapidly changing area of medicine, and after four years from the 2nd edition the volume editors and authors have deemed necessary to update it. In the recent years, in fact, five new randomised controlled trials and five new meta-analyses demonstrate that selective decontamination of the digestive tract [SDD] is an antimicrobial prophylaxis to prevent severe infections of not only lower airways but also of blood. Additionally, SDD has been shown to reduce inflammation including multiple organ failure and mortality. An intriguing observation is the evidence that SDD using parenteral and enteral antimicrobials reduces rather than increases antimicrobial resistance. Moreover, a new chapter on microcirculation had been added. The volume will be an invaluable tool for all those requiring in depth knowledge in the ever expanding field of infection control.

Advances in intensive and critical care medicine occur rapidly. Considering that cerebral, respiratory, cardiovascular, renal and metabolic dysfunctions occurring during serious illnesses or syndromes represent risk factors for patient survival, the final goal remains multifaceted: to improve standards and quality of care;

Per governo clinico si intende la capacità di gestione del sistema sanitario, caratterizzato, come noto, da una notevole complessità. Gli obiettivi di questa gestione si articolano su numerosi fronti di sviluppo, tra cui il miglioramento delle prestazioni assistenziali, la riduzione degli errori in medicina, la garanzia della sicurezza per i pazienti, l’appropriatezza nel decision making in tema di salute, il controllo del livello di competenza del personale, fino al controllo delle risorse disponibili e dei costi di gestione.Questo volume affronta gli aspetti che gravitano attorno al governo clinico e alla sua introduzione in settori cardine quali l’anestesia e la medicina del malato critico. Dopo una prima sezione dedicata alle good practices, al professionalismo e al ruolo dell’errore in medicina, la trattazione affronta nel dettaglio numerose questioni di grande rilevanza nel perioperatorio: etica e deontologia, costi, procedure e audit, organizzazione del team, monitoraggio del dolore in età pediatrica, fino a importanti considerazioni sul punto di vista del paziente. Completano il volume una sezione sul ruolo della ricerca clinica e un glossario. Caratterizzato da una particolare completezza e varietà di argomenti, questo testo vuole offrire ai diversi professionisti e operatori del settore indicazioni utili ed efficaci su come articolare l’organizzazione del sistema sanitario moderno.

Resuscitation is a two-stage process comprising the achievement/maintenance of spontaneous circulation and post-resuscitation management. The approach is complex and multifaceted and entails the integration of new physiological insights, pharmacological options, and technological advances. The purpose of this volume, written by top experts in the field, is to promote, share, and disseminate new advances in resuscitation and post-resuscitation care. The issues addressed are wide ranging and of great topical interest or controversy. They include priorities of intervention, quality of resuscitation, use of mechanical supports, new defibrillation strategies, prevention of organ damage, strategies in cases of sudden cardiac death, new pharmacological treatments, and post-resuscitation care, including temperature management and prediction and improvement of outcome after cardiac arrest. Particular attention is devoted to up-to-date evidence from the most recent experimental and clinical trials on resuscitation science and to gold standard evidence-based resuscitation and post-resuscitation treatments and interventions. In addition, organizational models and integrated care systems for trauma are considered, and critical care education and the process of guideline development are reviewed.

Resuscitation

Peri- and postoperative managements as well as treatment of surgical infections and of pain, new and old artificial ventilation strategies are some of the most relevant topics the volume deal with in this new edition.