By C. Parsloe (auth.), Prof. Antonino Gullo M.D. (eds.)
The curiosity of researchers, clinicians, practitioners and surgeons in severe care medication is starting to be. scientific pharmacology and new applied sciences now enable extra applicable cures, and the dedication of all these excited about this box is of basic value for attaining excessive interventional criteria, in either the prevention and therapy of serious stipulations, but in addition for pleasing the concept that of cost-effectiveness in severe care. during this quantity advances in severe care drugs are defined, together with the applying of recent applied sciences within the scientific environment, the complete integration of desktops and informatics, and the continuous education of physicians and technicians.
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Extra info for Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.: Proceedings of the 15th Postgraduate Course in Critical Care Medicine Trieste, Italy — November 17–21, 2000
The introduction of technology must be congruous with the overall level of existing development. It must be a consistent effort and certainly not a haphazard intermittent collage. We should seriously consider that "high tech" may have no place at all in areas without sufficient infrastructure. In fact, a sociological definition of under development could be the lack of supportive infrastructure. Under many circumstances "low tech" is the appropriate answer. Even "no tech" is far superior to "Wrong Tech".
In spite of this, Nelson et al.  verified that a hematocrit lower than 28% was more related to ischemic events in patients with previous peripheral vascular disease. In our studies , hematocrit ranged from 21 to 23%, and in a recent clinical report  where dogs were submitted to massive volume expansion (32 mllkg) with physiological saline or 4 mllkg with hypertonic saline this same range was observed. Poli de Figueiredo et al.  studyed the effects of hemodilution during descending thoracic aortic cross-clamping and lower torso reperfusion and established 20% as the target hematocrit.
Both solutions were similar in volume replacement and effects on oncotic pressure and coagulation. Van der Linden et al.  compared the same solutions and found no differences in hemodynamic and oxygenation parameters. Nevertheless, Mortelmans et al.  observed that gelatine required infusion of extra volume, approximately 30% of the volume originally needed, due to its more-pronounced extravasation, and that the HES group presented a higher blood loss. Baron et al. 2 m1 of colloid for each 1 m1 of blood withdrawn and performed an additional infusion of 500 ml of colloids after hemodilution .