La formazione in Anestesia e Rianimazione: Progettazione e sviluppo di un simulatore per emergenza e soccorso

Il mondo della simulazione, nell\u2019ultimo decennio, ha visto specialmente in ambito medico,una nuova primavera. Grazie al fiorire di nuove tecnologie, in grado di rendere sempre pi\uf9 performanti I simulatori, la simulazione ha un ruolo fondamentale nell\u2019addestramento delle figure professionali sanitarie. I simulatori definiti ad alta fedelt\ue0, sono in grado di ricreare fedelmente la fisiopatologia umana ma con una realt\ue0 visiva e tattile non altrettanto elevate. La simulazione ad alta fedelt\ue0 viene realizzata o in ambienti ricreati ad hoc che riproducono reparti ospedaliero, oppure vengono materialmete trasportati nei reparti per simulare nel modo pi\uf9 fedele l\u2019ambiente lavorativo. Tutto ci\uf2 contribuisce a far sviluppare nel personale sanitario quei meccanismi in grado di testare sia la preparazione sotto il profilo strattamente sanitario sia quello di lavoro in team. L\u2019ambiente reale nel quale viene ricreata la simulazione ,purtroppo, viene talvolta inficiato dalla bassa realt\ue0 dal punto di vista visivo del manichino. Pur essendo ad alto contenuto tecnologico appare povero dal punto di vista \u201cvisivo e tattile\u201d. L\u2019utilizzo di una Mixed reality potrebbe essere una buona soluzione per ovviare al problema sopra evidenziato. Grazie a questa tecnologia si pu\uf2 andare ad aumentare il livello di fedelt\ue0 del manichino ricreando un maschera ad hoc umana per questo e rendendo quindi la simulazione pi\uf9 vicino possibile alla realt\ue0. L\u2019obbiettivo che si prefigge questo lavoro \ue8 di creare un software dedicato in grado di implementare la simulazione in ambito medico.The world of simulation, in the last decade, has seen a new spring especially in the medical field. Thanks to the flourishing of new technologies, capable of making simulators ever more performing, simulation plays a fundamental role in the training of healthcare professionals. The simulators defined with high fidelity, are able to faithfully recreate human pathophysiology but with a visual and tactile reality that is not as high. The high-fidelity simulation is carried out either in ad-hoc recreated environments that reproduce hospital wards, or they are physically transported to the wards to simulate the working environment in the most faithful way. All this contributes to the development of mechanisms capable of testing both health and team work preparation in the healthcare staff. The real environment in which the simulation is recreated, unfortunately, is sometimes affected by the low reality from the visual point of view of the manikin. Despite being highly technological, it appears poor from a "visual and tactile" point of view. Using a Mixed reality show could be a good solution to remedy the problem highlighted above. Thanks to this technology it is possible to increase the level of fidelity of the manikin by recreating a human ad hoc mask for this and therefore making the simulation as close as possible to reality.  The goal of this work is to create dedicated software that can implement simulation in the medical field

From cardiac output to blood flow auto-regulation in shock

Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands ofthe tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation ata haemodynamic level and oxygen delivery at a microcirculatory level play a major role. This manuscript aims toreview the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potentialtherapeutic approaches for cardiovascular instability in patients in cardiovascular shock. Despite the recent advancesin haemodynamics, the mechanisms that control the vascular resistance and the venous return are not fully understoodin critically ill patients. The physical properties of the vascular wall, as well as the role of the mean systemicfilling pressure are topics that require further research. However, the haemodynamics do not totally explain thephysiopathology of cellular dysoxia, and several factors such as inflammatory changes at the microcirculatory levelcan modify vascular resistance and tissue perfusion. Cellular vasoactive mediators and endothelial and glucocalixdamage are also involved in microcirculatory impairment. All the levels of the circulatory system must be taken intoaccount. Evaluation of microcirculation may help one to detect under-diagnosed shock, and together with classichaemodynamics, guide one towards the appropriate therapy. Restoration of classic haemodynamic parameters isessential but not sufficient to detect and treat patients in cardiovascular shock.Shock is defined as a state in which the circulation is unable to deliver sufficient oxygen to meet the demands ofthe tissues, resulting in cellular dysoxia and organ failure. In this process, the factors that govern the circulation ata haemodynamic level and oxygen delivery at a microcirculatory level play a major role. This manuscript aims toreview the blood flow regulation from macro- and micro-haemodynamic point of view and to discuss new potentialtherapeutic approaches for cardiovascular instability in patients in cardiovascular shock. Despite the recent advancesin haemodynamics, the mechanisms that control the vascular resistance and the venous return are not fully understoodin critically ill patients. The physical properties of the vascular wall, as well as the role of the mean systemicfilling pressure are topics that require further research. However, the haemodynamics do not totally explain thephysiopathology of cellular dysoxia, and several factors such as inflammatory changes at the microcirculatory levelcan modify vascular resistance and tissue perfusion. Cellular vasoactive mediators and endothelial and glucocalixdamage are also involved in microcirculatory impairment. All the levels of the circulatory system must be taken intoaccount. Evaluation of microcirculation may help one to detect under-diagnosed shock, and together with classichaemodynamics, guide one towards the appropriate therapy. Restoration of classic haemodynamic parameters isessential but not sufficient to detect and treat patients in cardiovascular shock