By A. Gullo

Enhancing criteria of care is a true problem in in depth Care drugs. enhancing scientific functionality, sufferer defense, threat administration and audit represents the cornerstone for elevating the standard of care in ICU sufferers. communique is the platform from the place to begin to arrive a consensus in a very crowded zone, a different multidisciplinary and multiprofessional atmosphere during which caliber of care and, eventually, 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

Sample text

Regional ischaemia after clamping an arcus vessel showed ischaemic metabolism close to the affected region of the intestine while the catheter adjacent to the normal intestine showed no signs of ischaemia. Intraperitoneal microdialysis (IPM) was then carried out in a pilot study in humans after abdominal surgery confirming the ability of microdialysis to detect intestinal ischaemia [29]. Subsequent studies have shown that a normal postoperative course results in a decreasing lactate/pyruvate ratio, while complications such as peritonitis, bowel ischaemia and urinary fistula are preceded by two to four days of increasing lactate/pyruvate ratio as an early marker of an impending complication [30].

Another valuable feature of the lactate/pyruvate ratio is that increases in lactate due to an increase in cell metabolism are not misinterpreted as a sign of ischaemia as long as the lactate/pyruvate ratio remains the same. Furthermore, the lactate/ pyruvate ratio tells us whether a decrease (or increase) in tissue oxygen has a real effect on cell metabolism. e. the change in cell metabolism that may or may not follow a change in tissue oxygen. Once there is an increase in the lactate/pyruvate ratio we want to know if this is damaging to the cells.

7-11 kDa). This has become possible when using microdialysis catheters with large pore membranes and a molecular cut-off of 100,000 Da or higher [12, 13]. Furthermore, microdialysis emerges as a truly unique tool for monitoring the free fraction of drugs in catheters placed in tissues and organs or in the blood using intravenous microdialysis catheters. It becomes possible to evaluate the penetration of drugs over the blood brain barrier both when it is intact and when it is damaged [14] and the extent to which antibiotics, for example, reach an infected organ.

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