By K. Hillman (auth.), Antonino Gullo M.D. (eds.)

Developing sectors within the in depth Care box – and in serious Care medication more often than not – require particular degrees of competence having a comparable universal denominator: an in-depth wisdom of human pathophysiology. even if this quantity provides lots of issues in consistent evolution, as witnessed by means of the gathering of chapters compiled by way of numerous researchers, this version comprises, particularly, fields within which decision-making on the patient’s bedside prevails over theoretical argumentation. In different phrases, the 1st and finest message this version desires to supply is for the reader to concentration his/her consciousness on evidence-based medicine.

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Constructing sectors within the in depth Care box – and in severe Care medication normally – require particular degrees of competence having a similar universal denominator: an in-depth wisdom of human pathophysiology. even if this quantity offers lots of subject matters in consistent evolution, as witnessed through the gathering of chapters compiled by means of a number of researchers, this version contains, particularly, fields within which decision-making on the patient’s bedside prevails over theoretical argumentation.

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Extra info for Anaesthesia, Pain, Intensive Care and Emergency A.P.I.C.E.: Proceedings of the 21st Postgraduate Course in Critical Care Medicine Venice-Mestre, Italy — November 10–13, 2006

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Opening of these airways would require relatively high forces, and the shear stresses produced might cause epithelial disruption. Using an ex vivo-lavaged rat lung, Muscedere et al. showed that ventilation with physiological tidal volumes from zero PEEP (ZEEP) resulted in significantly higher histological injury scores in the respiratory and membranous bronchioles than did ventilation from PEEP above the lower inflection point at the static inflation volume–pressure curve of the lung [24]. Because lavaged lungs exhibit marked regional structural inhomogeneity, which would be expected to enhance the shear stresses and relative injury [2], D’Angelo et al.

In the presence of chest wall mechanics altered by abdominal distension, the tidal volume at which compliance starts to decrease is an average of 28% greater in the lung P–V curve than in the respiratory system curve [33]. For the same reason, LIP determined on the lung P–V curve underestimates that determined in the respira- The pressure–volume curve 35 tory system curve by 25–30% [33], since the chest wall adds between 0 and 5 cmH2O to the LIP observed [34]. Effect of intrinsic PEEP Intrinsic PEEP has been reported to produce a fallacious LIP [32, 36].

To check the correct positioning of the catheter, an “occlusion test” can be used [22]. If the ratio between changes in oesophageal pressure and occluded inspiratory pressure is close to 1 this confirms a correct position of the catheter and also indicates that oesophageal pressure closely estimates pleural pressure. Pleural pressures plotted against lung volumes generate the chest wall P–V curve, and the lung P–V curve is constructed by plotting transpulmonary pressures (difference between airway and oesophageal pressure) against lung volumes.

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