Gestione del trauma grave

Descrizione del libro Il titolo del libro \u201cLinee Guida\u2026\u201d \ue8 certamente fuori luogo. Le Linee Guida odierne sono il risultato di processi sistematici di analisi della letteratura e del grado di evidenza di ogni dato. Noi partiamo dal lavoro svolto da altri, gli esperti dei diversi settori, ma siamo alla terza edizione e per almeno due di noi sar\ue0, sicuramente, l\u2019ultima, per cui non ce la siamo sentita di cambiare il titolo in \u201cConsigli e Suggerimenti\u201d come sarebbe stato, forse, pi\uf9 opportuno

Good clinical practice for the use of vasopressor and inotropic drugs in critically ill patients: state-of-the-science and expert consensus

Vasopressors and inotropic agents are widely used in critical care. However, strong evidence supporting their use in critically ill patients is lacking in many clinical scenarios. Thus, the Italian Society of Anesthesia and Intensive Care (SIAARTI) promoted a project aimed to provide indications for good clinical practice on the use of vasopressors and inotropes, and on the management of critically ill patients with shock. A panel of 16 experts in the field of intensive care medicine and hemodynamics has been established. Systematic review of the available literature was performed based on PICO questions. Basing on available evidence, the panel prepared a summary of evidences and then wrote the clinical questions. A modified semi-quantitative RAND/UCLA appropriateness method has been used to determine the appropriateness of specific clinical scenarios. The panel identified 29 clinical questions for the use of vasopressors and inotropes in patients with septic shock and cardiogenic shock. High level of agreement exists among the panel members about appropriateness of inotropes/vasopressors' use in patients with septic shock and cardiogenic shock

Query # 4: Does tranexamic acid administration reduce mortality in trauma?

<p>Results of the CRASH 2 trial [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164090#pone.0164090.ref038" target="_blank">38</a>]. The number of patients is referred to those included in the multivariable model. CI = confidence interval, RR = relative risk, NNTB = number needed to treat for benefit.</p

Query # 3: Does hypofibrinogenemia treatment reduce mortality in trauma?

<p>Reporting of studies included in the revision. The number of patients is referred to those included in the multivariable model. N = number, pts = patients, ctr = centre, OR = odds ratio, CI = confidence interval.</p

Query # 2: Does a fixed blood-plasma transfusion ratio reduce mortality in trauma?

<p>Results of the Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0164090#pone.0164090.ref037" target="_blank">37</a>]: 24-hour and 30-day mortality are reported. RR = relative risk, CI = confidence interval, NNTB = number needed to treat for benefit, NNTH = number needed to treat to be harmed, FFP = fresh frozen plasma, PRBC = packed red blood cells.</p

Query # 1: Does coagulopathy affect mortality in trauma?

<p>Reporting of studies included in the revision. The number of patients is referred to those included in the multivariable model. N = number, pts = patients, ctr = centre, OR = odds ratio, CI = confidence interval, APTT = activated partial thromboplastin time, PT = prothrombin time, INR = international normalized ratio.</p

Prosafe: a european endeavor to improve quality of critical care medicine in seven countries

BACKGROUND: long-lasting shared research databases are an important source of epidemiological information and can promote comparison between different healthcare services. Here we present ProsaFe, an advanced international research network in intensive care medicine, with the focus on assessing and improving the quality of care. the project involved 343 icUs in seven countries. all patients admitted to the icU were eligible for data collection. MetHoDs: the ProsaFe network collected data using the same electronic case report form translated into the corresponding languages. a complex, multidimensional validation system was implemented to ensure maximum data quality. individual and aggregate reports by country, region, and icU type were prepared annually. a web-based data-sharing system allowed participants to autonomously perform different analyses on both own data and the entire database. RESULTS: The final analysis was restricted to 262 general ICUs and 432,223 adult patients, mostly admitted to Italian units, where a research network had been active since 1991. organization of critical care medicine in the seven countries was relatively similar, in terms of staffing, case mix and procedures, suggesting a common understanding of the role of critical care medicine. conversely, icU equipment differed, and patient outcomes showed wide variations among countries. coNclUsioNs: ProsaFe is a permanent, stable, open access, multilingual database for clinical benchmarking, icU self-evaluation and research within and across countries, which offers a unique opportunity to improve the quality of critical care. its entry into routine clinical practice on a voluntary basis is testimony to the success and viability of the endeavor