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 1st
Edition
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A. Gullo (Editor)
Anaesthesia, Pain, Intensive Care
and Emergency
A.P.I.C.E.
Proceedings of the
22nd Postgraduate Course in Critical Care Medicine
Venice-Mestre, Italy – November 9-11, 2007
Springer
ANTONINO GULLO, M.D.
Head, Department of Anaesthesia and Intensive Care
Head, Postgraduated School of Anaesthesia and Intensive Care
Catania University Hospital
Catania, Italy
Library of Congress Control Number: 2007939172
ISBN 978-88-470-0772-7 Springer Milan Berlin Heidelberg New York
e-ISBN 978-88-470-0773-4 Springer Milan Berlin Heidelberg New York
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Table of Contents
ADVANCES ON CRITICAL CARE
Chapter 1 - Organization of the Rapid Response System
P. DIGIACOMO, M.A. DEVITA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Chapter 2 - Transoesophageal Echocardiography: Clinical Assessment,
Techniques and Procedures in Critical Care and ICU
F. GUARRACINO, C. CARIELLO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Chapter 3 - Use of Pulse Oximeter Waveform as a Non Invasive Functional
Haemodynamic Monitoring Technique
M. CANNESSON, J.-J. LEHOT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Chapter 4 - Continuous Monitoring of Organ Chemistry – a Paradigm Shift
in Management of Intensive Care
U. UNGERSTEDT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Chapter 5 - General Anaesthesia and the Developing Brain
V. JEVTOVIC-TODOROVIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
AIRWAY
Chapter 6 - Airway Management: The Essential
G. FROVA, M. SORBELLO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Chapter 7 - Best Method to Establish the Grade of Difficult Airway.
Clinical Assessment, Techniques and Procedures in Critical Care and ICU
F. PETRINI, L. MOGGIA, G. MERLI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Chapter 8 - Out-Of-Hospital Airway Management: Knowledge and Equipment
S. RUSSO, C. EICH, A. TIMMERMANN . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
VI
Chapter 9 - Practical Aspects to Manage Extubation of the Difficult Airway
M. SORBELLO, G. MORELLO, A. GUARINO . . . . . . . . . . . . . . . . . . . . . . . . 81
TRAUMA
Chapter 10 - Head Injury Treatment in 2007
M.G. ABATE, F. SALA, G. CITERIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Chapter 11 - Penetrating Injuries to the Neck: Operation, Observation
or Angiointervention
D. DEMETRIADES, J. DUBOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
OBSTETRICS
Chapter 12 - Clinical Decision Making in Obstetric Patients
R. ALEXANDER, A. PARATORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Chapter 13 - Organization of Obstetric Services
R. ALEXANDER, A. SAXENA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
PAEDIATRIC ANAESTHESIA
Chapter 14 - Clinical Decision Making in Paediatric Anaesthesia
P. BUSONI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
Chapter 15 - Perioperative Care in Paediatrics: Organization
I. SALVO, A. CAMPORESI, E. ZOIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Chapter 16 - Techniques and Drugs in Paediatrics: TIVA and TCI
M. ASTUTO, N. DISMA, E. SANALITRO . . . . . . . . . . . . . . . . . . . . . . . . . . 175
Chapter 17 - Depth of Anaesthesia Monitoring in Children
N. DISMA, S. PELLEGRINO, M. ASTUTO . . . . . . . . . . . . . . . . . . . . . . . . . . 185
CARDIAC ARREST
Chapter 18 - New Aspects of Basic Cardiopulmonary Resuscitation Research:
From Clinically Relevant Animal Models to Cells
G. RISTAGNO, T. WANG, W. TANG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
VII
Chapter 19 - Warning Symptoms of Sudden Cardiac Death
G. BERLOT, A. VERGOLINI, C. CALDERAN . . . . . . . . . . . . . . . . . . . . . . . . 213
Chapter 20 - Vasopressors During Cardiac Arrest
G. CAMMARATA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
INFECTIONS, SEPSIS, ORGAN DYSFUNCTION
Chapter 21 - Candida Infection in Critically Ill Patients
P.H.J. VAN DER VOORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Chapter 22 - Predisposition to Sepsis
J.C. MARSHALL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Chapter 23 - SOFA Score: A Keystone for Grading Multiple Organ Dysfunction
J.-L. VINCENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255
PERIOPERATIVE CARE
Chapter 24 - Operating Theatres: Organization, Costs and Audit
M. KLIMEK, M. VAN HOUDENHOVEN, T.H. OTTENS . . . . . . . . . . . . . . . . . . . 263
Chapter 25 - Use and Misuse of Preoperative Cardiac Testing
for Noncardiac Surgery
H.-J. PRIEBE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269
Chapter 26 - Perioperative Beta-Blockade: Myths and Realities
G. HOWARD-ALPE, P. FOËX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Chapter 27 - Management of Hypoxia During One Lung Ventilation
J.B. BRODSKY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291
Chapter 28 - Regional Anaesthesia for Thoracic Surgery
J.B. BRODSKY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Chapter 29 - Why the Obese Patient is at Risk for Perioperative Complications
J.B. BRODSKY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305
Chapter 30 - Perioperative Care in Neurosurgery – Intraoperative Monitoring
C. ORI, M. MUNARI, S. VOLPIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
VIII
Chapter 31 - Incidents Provoked Specifically by Certain Drugs Used
in Anaesthesia
M. KLIMEK, T.H. OTTENS, F. GRÜNE . . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Chapter 32 - Side Effects Induced by Anaesthetic Manipulation
or by Surgical Operation
Y. LEYKIN, N. NOAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333
QUALITY OF CARE IN THE ICU
Chapter 33 - Quality Management in the ICU: Understanding the Process
and Improving the Art
P. MURABITO, F. RUBULOTTA, A. GULLO . . . . . . . . . . . . . . . . . . . . . . . . . 345
List of Contributors
Abate M.G. Camporesi A.
UO Neuroanestesia e Neurorianimazione, Paediatric Anaesthesia and Intensive
Dipartimento di Medicina Perioperatoria Care, Children Hospital “Vittore Buzzi”,
e Terapie Intensive, H San Gerardo, Mon- Milan (Italy)
za (Italy), and Division of Anaesthesia,
University of Cambridge, Addenbrooke’s Cannesson M.
Hospital, Cambridge (UK) Department of Anaesthesiology, Hôpital
Louis Pradel, Bron (France)
Alexander R.
Department of Anaesthetics, Worcester- Cariello C.
shire Royal Hospital, Worcester (UK) Department of Cardiothoracic Anaesthe-
sia and Intensive Care, Azienda Ospeda-
Astuto M. liera Universitaria Pisana, Pisa (Italy)
Department of Anaesthesia and Intensive
Care, “Policlinico” University Hospital, Citerio G.
Catania (Italy) UO Neuroanestesia e Neurorianimazione,
Dipartimento di Medicina Perioperatoria
Berlot G. e Terapie Intensive, H San Gerardo, Mon-
Department of Perioperative Medicine, za (Italy)
Intensive Care and Emergency, Trieste
University Medical School, Trieste (Italy) Demetriades D.
Division of Trauma and Surgical Critical
Brodsky J.B. Care, Department of Surgery, University
Department of Anesthesia, Stanford Uni- of Southern California, Los Angeles (USA)
versity School of Medicine, Stanford, CA
(USA) DeVita M.A.
Department of Critical Care Medicine,
Busoni P. University of Pittsburgh (USA)
Department of Anaesthesia and Intensive
Care, A. Meyer Hospital, Florence (Italy) DiGiacomo P.
Department of Critical Care Medicine,
Calderan C. University of Pittsburgh (USA)
Department of Perioperative Medicine,
Intensive Care and Emergency, Trieste Disma N.
University Medical School, Trieste (Italy) Department of Anaesthesia and Intensive
Care, “Policlinico” University Hospital,
Cammarata G. Catania (Italy)
Department of Anaesthesia and Intensive
Care, University of Catania, Cannizzaro DuBose J.
(Italy) Division of Trauma and Surgical Critical
Care, Department of Surgery, University
of Southern California, Los Angeles (USA)
X
Eich C. Marshall J.C.
Department of Anaesthesiology, Emer- Department of Surgery, and the Interde-
gency and Intensive Care Medicine, Uni- partmental Division of Critical Care Medi-
versity of Göttingen (Germany) cine, University of Toronto, Li Ka Shing
Knowledge Institute, St. Michael’s Hospi-
Foëx P. tal, Toronto, Ontario (Canada)
Nuffield Department of Anaesthetics, Uni-
versity of Oxford (UK) Merli G.
Centro Cardiologico Monzino, Milan
Frova G. (Italy)
Emergency Department of Anaesthesia
and ICU, Civili Hospital, Brescia (Italy) Moggia L.
Anaesthesiology and Intensive Care, Uni-
Grüne F. versity G. D’Annunzio Chieti-Pescara,
Department of Anaesthesiology, Erasmus Chieti (Italy)
University Medical Centre, Rotterdam
(The Netherlands) Morello G.
Department of Anaesthesia and Intensive
Guarino A. Care, “Policlinico” University Hospital,
Anaesthesia and Intensive Care, PO “Villa Catania (Italy)
Scassi”, Genoa (Italy)
Munari M.
Guarracino F. Department of Pharmacology and
Department of Cardiothoracic Anaesthe- Anaesthesiology, Anaesthesia and Inten-
sia and Intensive Care, Azienda Ospeda- sive Care Unit, University of Padua,
liera Universitaria Pisana, Pisa (Italy) Padua (Italy)
Gullo A. Murabito P.
Department of Anaesthesia and Intensive Department of Anaesthesia and Intensive
Care, “Policlinico” University Hospital, Care, “Policlinico” University Hospital,
Catania (Italy) Catania (Italy)
Howard-Alpe G. Noal N.
Nuffield Department of Anaesthetics, Uni- Department of Anaesthesia, S.M. degli
versity of Oxford (UK) Angeli Hospital, Pordenone (Italy)
Jevtovic-Todorovic V. Ori C.
Departments of Anesthesiology and Neu- Department of Pharmacology and
roscience, University of Virginia Health Anaesthesiology, Anaesthesia and Inten-
System, Charlottesville (USA) sive Care Unit, University of Padua,
Padua (Italy)
Klimek M.
Department of Anaesthesiology, Erasmus Ottens T.H.
University Medical Centre, Rotterdam Department of Anaesthesiology, Erasmus
(The Netherlands) University Medical Centre, Rotterdam
(The Netherlands)
Lehot J.-J.
Department of Anaesthesiology, Hôpital Paratore A.
Louis Pradel, Bron (France) Department of Anaesthesia and Intensive
Care, “Policlinico” University Hospital,
Leykin Y. Catania (Italy)
Department of Anaesthesia, S.M. degli
Angeli Hospital, Pordenone (Italy)
XI
Pellegrino S. Tang W.
Department of Anaesthesia and Intensive Weil Institute of Critical Care Medicine,
Care, “Policlinico” University Hospital, Rancho Mirage, CA (USA) and Keck
Catania (Italy) School of Medicine, University of South-
ern California, Los Angeles, CA (USA)
Petrini F.
Anaesthesiology and Intensive Care, Uni- Timmermann A.
versity G. D’Annunzio Chieti-Pescara, Department of Anaesthesiology, Emer-
Chieti (Italy) gency and Intensive Care Medicine, Uni-
versity of Göttingen (Germany)
Priebe H.-J.
Department of Anaesthesia, University Ungerstedt U.
Hospital, Freiburg (Germany) Dept of Physiology and Pharmacology,
Karolinska Institutet, Stockholm (Swe-
Ristagno G. den)
Weil Institute of Critical Care Medicine,
Rancho Mirage, CA (USA) and Depart- van der Voort P.H.J.
ment of Perioperative Medicine, Intensive Department of Intensive Care, Onze Lieve
Care and Emergency, Trieste University Vrouwe Gasthuis, Amsterdam
Medical School, Trieste (Italy) (The Netherlands)
Rubulotta F. van Houdenhoven M.
Department of Anaesthesia and Intensive Director Beatrix-Hospital, Gorinchem
Care, “Policlinico” University Hospital, (The Netherlands)
Catania (Italy)
Vergolini A.
Russo S. Department of Perioperative Medicine,
Department of Anaesthesiology, Emer- Intensive Care and Emergency, Trieste
gency and Intensive Care Medicine, Uni- University Medical School, Trieste (Italy)
versity of Göttingen (Germany)
Vincent J.-L.
Sala F. Department of Intensive Care, Erasme
UO Neuroanestesia e Neurorianimazione, Hospital, Free University of Brussels (Bel-
Dipartimento di Medicina Perioperatoria gium)
e Terapie Intensive, H San Gerardo, Mon-
za (Italy) Volpin S.
Department of Pharmacology and
Salvo I. Anaesthesiology, Anaesthesia and Inten-
Paediatric Anaesthesia and Intensive sive Care Unit, University of Padua,
Care, Children Hospital “Vittore Buzzi”, Padua (Italy)
Milan (Italy)
Wang T.
Sanalitro E. Weil Institute of Critical Care Medicine,
Department of Anaesthesia and Intensive Rancho Mirage, CA (USA)
Care, “Policlinico” University Hospital,
Catania (Italy) Zoia E.
Paediatric Anaesthesia and Intensive
Saxena A. Care, Children Hospital “Vittore Buzzi”,
Department of Anaesthesia, Worcester- Milan (Italy)
shire Royal Hospital, Worcester (UK)
Sorbello M.
Department of Anaesthesia and Intensive
Care, “Policlinico” University Hospital,
Catania (Italy)
List of Abbrevations
a-MNE a-Methylnorepinephrine
A wave Atrial Peak Velocity
A Adenine
ABP Arterial Blood Pressure
ABS Analgesia-Based Sedation
AC Alternating Current
ACC American College of Cardiology
ACE Angiotensin-Converting Enzyme
ACLS Advanced Cardiac Life Support
ACS Abdominal Compartment Syndrome
ACS Acute Coronary Syndrome
ACUITY Acute Catheterization and Urgent Intervention Triage Strategy
AE Accidental Extubation
AECOPD Acute Exacerbation of COPD
AGNB Aerobic Gram Negative Bacteria
AHA American Heart Association
AHRQ Federal Agency Healthcare Research and Quality
ALI Acute Lung Injury
Am Late Diastole
AMAF Airway Management Assessment Forms
APACHE Acute Physiology Chronic Health Evaluation
AR Aortic Regurgitation
ARDS Acute Respiratory Distress Syndrome
ARF Acute Renal Failure
ATLS Advanced Trauma Life Support
AVDO2 Arteriovenous Oxygen Content Difference
BAEP Brainstem Auditory Evoked Potentials
XIV
BBB Blood-Brain Barrier
BDNF Brain-Derived Neurotrophic Factor
BGA Blood Gas Analysis
BIS Bispectral Index
BMI Body Mass Index
BV Blood Volume
C Cytosine
CABG Coronary Artery Bypass Grafting
CAS Central Anticholinergic Syndrome
CBF Cerebral Blood Flow
CBV Cerebral Blood Volume
CCI Controlled Cortical Impact
CCI Corrected Colonisation Index
CCT Critical Care Outreach Teams
CFD Colour Flow Doppler
CI Cardiac Index
CI Confidence Interval
CMRO2 Cerebral Metabolic Rate of Oxygen
CNS Central Nervous System
COPD Chronic Obstructive Pulmonary Disease
CPA Cardiopulmonary Arrest
CPAP Continuous Positive Airway Pressure
CPK Creatine Phosphokinase
CPP Cerebral Perfusion Pressure
CPR Cardiopulmonary Resuscitation
CQI Continuous Quality Improvement
CRRT Continuous Renal Replacement Therapy
CSA Compressed Spectral Arrays
CSHT Context-Sensitive Half Time
CSI Cerebral State Index
CV-CI Cannot Ventilate – Cannot Intubate
CVP Central Venous Pressure
D wave Diastolic Wave Velocity
DAM Difficult Airway Management
XV
DC Decompressive Craniectomy
DISC Death-Inducing Signalling Complex
DMV Difficult Mask Ventilation
DNA Deoxyribonucleic Acid
DSA Density Modulated Spectral Arrays
DSE Dobutamine Stress-Echocardiogram
DT Deceleration Time
E wave Early Filling Peak Velocity
EBM Evidence Based Medicine
ED Emergency Department
EEG Electroencephalogram
EF Ejection Fraction
EGD Extra Glottic Devices
EGDT Early Goal-Directed Therapy
EGR1 Early Growth Response Factor-1
Em Early Diastole
EMS Emergency Medical Service
EORs Estimated Odds Ratios
EPs Evoked Potentials
ER Emergency Room
ERV Expiratory Reserve Volume
ETC Esophageal-Tracheal-Combitube
ETI Endotracheal Intubations
FE Failed Extubation
FRC Functional Residual Capacity
FV Flow Velocity
G Guanine
GA General Anaesthesia
GCS Glasgow Coma Scale
GEB Gum Elastic Bougie
GERD Gastroesophageal Reflux Disease
GOS Glasgow Outcome Scale
GSW Gunshot Wounds
HBS Hypnotic-Based Sedation
XVI
HELP Head Elevated Laryngoscopy Position
HFV High Frequency Ventilation
HICP High Intracranial Pressure
HPV Hypoxic Pulmonary Vasoconstriction
HS Hypertonic Saline
IAP Intra-Abdominal Pressure
IBW Ideal Body Weight
ICN Intercostals Nerve
ICP Intracranial Pressure
ICU Intensive Care Unit
IE Infective Endocarditis
IHCA In-Hospital Cardiac Arrest
IHI Institute for Healthcare Improvement
IIT Intensive Insulin Therapy
ILMA Intubating Laryngeal Mask Airway™
IOM Institute of Medicine
IOM Intraoperative Monitoring
IPM Intraperitoneal Microdialysis
IRAK-M IL-1 Receptor-Associated Kinase
JCAHO Joint Commission on Accreditation of Healthcare Organizations
LAD Left Anterior Descending Coronary
LAP Left Atrium Pressure
LBW Lean Body Weight
LEMON Look - [e] Mallampati class – Obstruction - and Neck mobility
LMA Laryngeal Mask Airway
LOS Length of Stay
LT Laryngeal Tube™
LV Left Ventricle
LVEDAI Left Ventricular End Diastolic Area Index
LVEDP Left Ventricular End-Diastolic Pressure
MABP Mean Arterial Blood Pressure
MaVS Metaprolol after Vascular Surgery
MCA Middle Cerebral Artery
MDPE Median Performance Error
XVII
MEP Motor Evoked Potentials
MET Medical Emergency Team
MET Metabolic Equivalent Task
MI Myocardial Infarction
MOANS Mask seal poor - Obesity - Aged - No teeth – Stiff
MODS Multiple Organ Dysfunction Score
MPM Mortality Probability Models
MR Mitral Regurgitation
MSCs Mesenchymal Stem Cells
NAS Nursing Activities Score
NF-kappa B Nuclear Factor Kappa B
NFR Not-For-Resuscitation
NGF Nerve Growth Factor
NIMV Non Invasive Mechanical Ventilation
NIPV Non-Invasive Positive Ventilation
NIRS Near-Infrared Spectroscopy
NIV Non Invasive Ventilation
NMBD Neuromuscolar Blocking Drugs
NNT Numbers Need to Treat
NO Nitric Oxide
NSAID Nonsteroidal Anti-Inflammatory Drugs
NSTEACS Non-ST-segment Elevation Acute Coronary Syndromes
NSTEMI Non-ST-segment Elevation Myocardial Infarction
NT Neurotrophic Factor
OAA/S Observer’s Assessment of Alertness/Sedation Scale
OHCA Out-of-Hospital Cardiac Arrest
OHS Obesity Hypoventilation Syndrome
OLV One-Lung Ventilation
OR Operation Room
OSA Obstructive Sleep Apnoea
PaCO2 Arterial Carbon Dioxide Tension
PACU Post Anaesthesia Care Units
PAOP Pulmonary Artery Occlusion Pressure
PAP Pulmonary Artery Pressure
XVIII
PBEF Pre-B-cell colony-Enhancing Factor
PbrO2 Brain Tissue Oxygen Tension
PBS Phosphate Buffer Solution
PCI Percutaneous Coronary Intervention
PCWP Pulmonary Capillary Wedge Pressure
PD Pharmacodynamic
PEA Pulseless Electrical Activity
PEEP Positive End-Expiratory Pressure
PIC Pulmonary Infection Control
PICU Paediatric Intensive Care Unit
PIRO Predisposition, Infection, Response, Organ dysfunction
PK Pharmacokinetic
PNI Penetrating Neck Injuries
POBBLE Perioperative Beta-Blockade
POISE PeriOperative ISchemic Evaluation
PONV Postoperative Nausea and Vomiting
POP Pulse Oximeter Plethysmographic
PPM Potential Pathogenic Microorganisms
PR Rules Rate
PRIS Propofol Infusion Syndrome
PSV Pressure Support Ventilation
PVB Paravertebral Block
PvO2 Mixed Venous O2 Tension
PVR Pulmonary Vascular Resistance
RCRI Revised Cardiac Risk Index
RCT Randomised Controlled Trial
RML Rhabdomyolysis
ROC Receiver Operating Characteristic
ROSC Return of Spontaneous Circulation
RR Relative Risk
RR Respiratory Rate
RRS Rapid Response System
RRT Rapid Response Team
RSI Rapid Sequence Intubation
XIX
RTP Reverse-Trendelenburg Position
RV Right Ventricle
RWMA Regional Wall Motion Abnormalities
S wave Systolic Wave Velocity
SAH Subarachnoid Haemorrhage
SAM Systolic Anterior Motion
SAPS Simplified Acute Physiology Score
SBP Systolic Blood Pressure
SCCM Society of Critical Care Medicine
SCD Sudden Cardiac Death
ScvO2 Central Venous Oxygen Saturation
SDD Systemic Digestive Decontamination
SEF Spectral Edge Frequency
SEPs Somatosensory Evoked Potentials
SjO2 Jugular Venous Oxygen Saturation
SjvO2 Jugular Venous Bulb Oxygen Saturation
Sm Systolic Velocity Signal
SMR Standardised Mortality Ratio
SNP Single Nucleotide Polymorphism
SOFA Sequential Organ Failure Assessment
SV Stroke Volume
T Thymine
TBI Traumatic Brain Injury
TBW Total Body Weight
TCD Transcranial Doppler
TCI Target Controlled Infusion
TDA Traumatic Disruption of the thoracic Aorta
TEE Transoesophageal Echocardiography
TENS Transcutaneous Electric Nerve Stimulation
TISS Therapeutic Intervention Scoring System
TIVA Total Intravenous Anaesthesia
TLR Toll-Like Receptor
TLV Two-Lung Ventilation
TNF Tumour Necrosis Factor
