Springer-Verlag Italia SrI.

A. Gullo (Ed.) Anaesthesia, Pain, Intensive Care and Emergency Medicine - A.P.I.C.E.

Proceedings of the

17th Postgraduate Course in Critical Care Medicine Trieste, Italy - November 15-19,2002

Volume I

Springer

Prof. ANTONINO GULLO, M.D. Head, Department of Perioperative Medicine Intensive Care and Emergency Trieste University School of Medicine Trieste, Italy

© Springer-Verlag Italia 2003 Originally published by Springer-Verlag Italia, Milano in 2003

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Table of Contents

Vol. I

EMERGENCY MEDICINE

Chest pain F. SCHIRALDI, L. DAMIANo, AND F. PALADINO................................................. 3

Advanced Life Support in the management of cardiac arrest: European Resuscitation Council guidelines 2000 L. BOSSAERT, J. NOLAN, AND F. DE LATORRE. . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . .. 11

Hyperosmolar syndrome F. SCHIRALDI, G. ESPOSITo, AND G. RUGGIERO. . . . . . . . . . . . . . . . • . • . . . . . . . . . • . • . . .. 33

Hypertonic solutions: when, how, how long, how much? J.O.c. AULER JR, L.F. POLl DE FIGUEIREDO, AND M. ROCHA e SILVA

Efficacy of non invasive positive pressure ventilation (BIPAP) in acute cardiogenic pulmonary oedema

41

S. PRAYAG, S TALEKAR, AND S JOG. . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . .. 57

Emergency treatment of acute stroke P.D. SCHELLINGER, T. STEINER, AND W. HACKE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 69

Early management of severely burned patients A. LUZZANI, E. POLATI, AND I. SALVETTI. . . . . . . . . . . . . . . . • . . . • . . . . . . . . . . . . . . . . . . . 85

SPECIAL CONDITIONS IN CRITICAL CARE

Sedation and analgesia in the critically ill - Principles and practice S. ANwAR, AND G. PARK. . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . .. 103

Organophosphorus poisoning S. PRAYAG ............................................................... 113

Physostigritine in the postoperative period J. RUPREHT ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . .. 121

Physostigmine use in intensive care K. LEENDERTSE, AND J. RUPREHT .. " .............. , .. '" ...................... 129

VI Table of Contents

Blood redistribution during central neural blocks: influence of leg bandaging and

other mechanical methods D. STIFANIC, AND V. PAVER-ERZEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 137

Management of the post-operative critically ill patient 1. BESSO, E. RIVERO. AND A. BOLIVAR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 145

HIV infection in critical care G. DOMINGUEZ-CHERIT, D. BORUNDA, AND 1. SIERRA .............................. 165 Anaesthesia for TURP: regional vs. general C. MELLONI, F. SFOGLIAFERRI, AND S. PISTOCCHI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 197

BRAIN

GLOBAL AND FOCAL MONITORING IN ACUTE CEREBRAL DAMAGE

The role of jugular 02 difference A. BACHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 223

Intracranial and cerebral perfusion pressure management in traumatic brain injury J. MYBURGH .............................................................. 237

Essential cerebral monitoring when resources are limited W. VIDETTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 253

Therapeutic hypothermia C.K. SPISS, U.M. ILLIEVICH, AND A. BACHER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 263

ADEQUACY OF CEREBRAL PERFUSION IN THE EARLY PHASES AFTER ACUTE

DAMAGE

Strategies to maintain cerebral perfusion pressure during rescue and transport W. VIDETTA, AND G. DOMENICONI. ............................................ 275

The systemic and cerebrovascular effects of inotropes and vasopressors 1. MYBURGH. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 283

Awake craniotomy

M. KLIMEK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 301

Fast-track neuroanaesthesia M. KLIMEK .............................................................. 313

Table of Contents VII

LUNG

Interaction between ventilation and pulmonary circulation

G. HEDENSTIERNA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 329

Acute Respiratory Distress Syndrome: strategies to improve gas exchange

D. CHIUMELLO, P. PELOSI, AND D. D'ONOFRIO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 339

Mechanical ventilation and the kidney

H. BURCHARDI, AND G. KACZMARCZYK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 367

Capnography and Pulse oximetry

U. LUCANGELO, G. DEGRASSI, AND M.L. CHIEREGO ............................... 377

Oximetry spectral analysis and sleep disordered breathing

P.V ROMERO, AND C. ZAMARR6N ............................................. 401

Post-occlusion rapid drop in pressure

W.A. ZIN ................................................................ 417

Relaxed expiration

G.L. CHELUCCI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 427

Dynamic hyperinflation

W.A. ZIN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 439

Bronchodilation in COPD

G.L. TANTUCCI ........................................................... 449

High Frequency Oscillation in ARDS

R.M. KACMAREK. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 459

Statics of normal lung

J. MILlc-EMILl, AND A. KOUTSOUKOU .......................................... 467

Definition of spectrum of ALI

C.S. VALENTE BARBAS, C. HOELZ, AND VL. CAPELOZZI. ........................... 477

Primary and secondary ARDS

P. Rocco. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 483

Effect of PEEP on gas exchange in ARDS

A. KOUTSOUKOU, CH. Roussos, ANDJ. MILlC-EMILI .............................. 501

Experimental evidence for the use of corticosteroids in ARDS P. Rocco ................................................................ 513

Evidence of biological efficacy for prolonged corticosteroid treatment

in unresolving ARDS

G.U. MEDURI, E. GOLDEN, AND S. RATNAKANT ................................... 531

VIII Table of Contents

Effects of nitric oxide in haemodynamics and gas exchange in ARDS

K. LEWANDOWSKI, M. LEWANDOWSKI, AND KJ. FALKE ............................. 547

Lung function, dyspnea and exercise tolerance in stable COPD patients

1. MILIC-EMILI, AND C. TANTUCCI ............................................. 559

Alveolar recruitment strategy improves arterial oxygenation in severe

ARDS patients

A. GALLESIO, E. SAN ROMAN, AND S. GIANNASI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 569

Ventilator-associated pneumonia

V. PAVONI, G. GRITTI, R. ALVISI .............................................. 585

Surgical treatment of end stage emphysema

E. COHEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 595

Discontinuing mechanical ventilation: the role of a "Respiratory Acute

Care Unit"

L.M. BIGATELLO, AND E. GETTINGS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 605

Table of Contents IX

Vol. II

PERIOPERATIVE MEDICINE

CARDIOVASCULAR FUNCTION ASSESSMENT

Principles of haemodynamic monitoring

S. MAGDER ...•..•.............................•....................•.... 619

Cardiovascular integrated monitoring

J.O.c. AULER JR, L.F. POLl DE FIGUEIREDO, AND M. REZENDE LOPES. . • . . . • . . . . . . . . . .. 635

Blood measurements of the oxygen transport in clinical practice M. GIRARDIS, L. RINALDI, AND S. BUSANI. . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . • . . .. 649

The importance of information on volemia during the perioperative period: new vs. old technique

M. GlRARDIS, A. ROBERTI, AND A. PASETTO ...•........•........................ 655

Assessment of pre-load

V. PIRIOU, B. GOSlOLI, AND D. JACQUES •......•....•........................... 661

Left ventricular dysfunction in complicated CABG R. SALLUSTI, J.O.C. AULER JR, AND L.M. SA MALBOUISSON . . . . . . . . . . . . . . . . . . . . • . . .. 679

Reperfusion arrhythmias: prevention and management J.L. AlLEE .....................•.... , .•.•................................ 709

Myocardial ischaemia and cardiac function

P. FOEX .........................•......................................• 725

Transmural myocardial infarction. Focus on current strategies of myocardial

reperfusion

G. SINAGRA, G. SABBADINI, AND A. PERKAN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 737

Does technological evolution justify the use of Swan-Ganz catheters

in perioperative haemodynamic monitoring?

R. MUCHADA. . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . .. 759

Comparison of haemodynamic monitoring techniques B. ALLARIA, M. FAVARO, AND M. RESTA . . . . . . . . . . . . . . . . . . . • . . . . . . . . . . . . . . . . . . .. 771

Thoracic impedance tracing in perioperative haemodynamic monitoring

M. FAVARO, B. ALLARIA, AND M. RESTA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 791

x Table of Contents

Clinical experience on TED G. GALIMBERTI, A. AGOSTI, R. MUCHADA ....................................... 813

MECHANISMS OF ACTION OF GENERAL ANAESTHETICS

Clinical governance of perioperative medicine R. ULLRICH, AND M. ZIMPFER. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 827

Molecular mechanisms of general anaesthesia N.P. FRANKS. AND W.R. LIEB .................................•............... 835

2P Domain K+ Channels: Novel Targets for Volatile General Anaesthetics E. HONORE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 843

Sites of anaesthetic action on ligand-gated ion channels R.A. HARRIS, M.P. MASCIA, AND I.A. LOBO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 857

Effects of opioids analgesics on the action of general anaesthetics P. GIUSTI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 863

Mapping cerebral metabolic and blood flow effects of general anaesthetics U. FREO, and C. ORI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 877

Recent advances in mechanisms of action of general anaesthetics from genetically engineered animal models G. HOMANICS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 891

POSTOPERATIVE ACUTE PAIN MANAGEMENT

Organization and clinical experience G. GALIMBERTI, S. NADALIN, AND E. CORSI .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 903

Techniques Y. LEYKIN , A.M. MALISANO, AND G. ZANETIE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 919

Recovery room: clinical experience Y. LEYKIN, S. MILESI, AND S. FURLAN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 937

CHALLENGES AND CONTROVERSIES IN OBSTETRIC ANAESTHESIA

Caudal anaesthesia: does it have a place today? P. BUSON!. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 957

Informed consent in obstetrics G. CAPOGNA, AND M. CAMORCIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 965

Table of Contents XI

Anaesthesia in pregnant women with neurological disease G. LYONS ................................................................ 971

Cardiac disease in pregnancy R. ALEXANDER, AND T. THOMAS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 979

Life-threatening complications in peripartum G. CAPOGNA, AND M. CAMORCIA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 995

TRAUMA OPERATIVE PROCEDURES (TOP)

Trauma - the integrate system of care G. GORDINI,ANDM. MENARINI .............................................. 1005

Triage in critical care K. HILLMAN, A. FLABOURIS, AND M. PARR ..................................... 1013

Scoop and run vs. stay and play: strategies in pre-hospital care C. DEAKIN .............................................................. 1019

Early assessment of multiple trauma C. DEAKIN .............................................................. 1027

Scoring system in trauma A. SUTCLIFFE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1037

SEPSIS AND MODS

SIRS, sepsis and MODS G. BERLOT, A. TOMASINI,ANDM. VIVIANI ..................................... 1047

Grading severity of sepsis J-L VINCENT, D. PERES-BOTA, F. FERREIRA ..................................... 1057

Sepsis and the role of the human host M.E. HARTMAN, AND D.C. ANGUS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1065

Toll-like receptors in sepsis: where do we stand? L. DEL SORBO, AND H. ZHANG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1075

Early goal-directed therapy prevents organ failure and mortality in severe sepsis and septic shock E. RIVERS, B. NGUYEN, AND S. HAVSTAD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1089

The neural and humoral response to acute neurological illness is the mechanism of consequent new organ failures P. ANDREWS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11 05

XII Table of Contents

Indications of CRRT in sepsis C. TETrA, V. D'INTINI, AND F. GASTALDON , , , , , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1119

Advances on membrane biology for CRRT C. TETTA, A. BRENDOLAN, AND V D'INTINI. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1127

Timing of CRRT in sepsis H. BURCHARDI ........................................................... 1139

Consumption coagulopathy M.L. CHIEREGO, AND A. GULLO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1147

Step (or leap) into the future. What is new in 2000 and beyond? An emphasis on

endocrine failure A.E. BAUE .............................................................. 1167

CONTINUING MEDICAL EDUCATION IN CRITICAL CARE

Critical care in South Asia S. PRAYAG .............................................................. 1193

Critical care in South America 1. BESSO, AND A. MARTINELLI ............................................... 120]

QUANTITATING CAREGIVER WORKLOAD IN THE ICU

Methods of quantifying workload: How ICU nurses' quantitative workload can be

studied A. DE RIJK .............................................................. 1213

QUALITY OF CARE IN THE ICU

Modulation of the innate immune response during respiratory tract infections MJ. SCHULTZ, T. VAN DER POLL, AND 1. KESECIOGLU . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1231

Quality management in intensive care G. WILLIAMS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1239

Auditing D.REIsMIRANDA ........................................................ 1251

ETHICS AND LAW IN CRITICAL CARE

Withholding and withdrawing treatment K.D. ROONEY, AND N.A. PACE .............................................. 1263

Table of Contents XIII

Case studies of legal intervention in end-of-Iife care in the ICU A. LEFEBVRE. . . • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1273

INDEX

Authors Index

Agosti A. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Alexander R. Department of Anaesthesia, Worcestershire Royal Hospital, Worcester (U.K.)

Allaria B. Department of Intensive Care, National Institute for Cancer Research, Milan (Italy)

Alvisi R. Department of Surgical Anaesthesiological and Radiological Sciences, Section of Anaesthesiology and Intensive Care, University of Ferrara, Ferrara (Italy)

Andrews P.J.D. Intensive Care Unit, Western General Hospital, Edinburgh (U.K.)

Angus D.C. The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (U.S.A.)

AnwarS. The John Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge (U.K.)

AtIee J.L. Department of Anesthesiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin (U.S.A.)

Auler J.O.C. Jr. Anaesthesia and ICU Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo (Brazil)

Bacher A. Department of Anaesthesiology and General Intensive Care, University of Vienna, Vienna (Austria)

BaueA.E. Professor of Surgery Emeritus, St. Louis University School of Medicine, Vice-President for the Medical Center Emeritus, St. Louis University Medical Center, Fishers Island, New York (U.S.A.)

Berlot G. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Besso J. ICU and Fellowship Training Program in Critical Care Medicine, Hospital Centro Medico de Caracas, Caracas (Venezuela)

XVI Authors Index

Bigatello L.M. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (U.S.A.)

Bolivar A. Division of Critical Care Medicine, Hospital Centro Medico de Caracas, Caracas (Venezuela)

BorundaD. Department of Anaesthesia, National Institute of Medical Sciences and Nutrition "Salvador Zubiran" (Mexico)

Bossaert L. European Resuscitation Council Secretariat, Antwerp (Belgium)

Brendolan A. Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Vicenza (Italy)

Burchardi H. Centre for Anaesthesiology and Intensive Care, Georg-August University, Gottingen (Germany)

Busani S. Department of Anaesthesia and Intensive Care, Modena University General Hospital, Modena (Italy)

Busoni P. Department of Anaesthesia and Intensive Care, "A Meyer" Paediatric Hospital, Florence, (Italy)

CamorciaM. Department of Anaesthesia, Fatebenefratelli General Hospital, Rome, (Italy)

Capelozzi V.L. University of Sao Paulo General Hospital, Sao Paulo (Brazil)

CapognaG. Department of Anaesthesia, Fatebenefratelli General Hospital, Rome, (Italy)

Chelucci G.L. Department of Respiratory Pathophysiology, Florence University, Florence, (Italy)

Chierego M.L. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Chiumello D. Department of Anaesthesia and Intensive Care, Milan University General Hospital, Milan (Italy)

CohenE. Thoracic Anesthesia, The Mount Sinai School of Medicine, New York, New York (U.S.A.)

Corsi E. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Authors Index

D'Intini V. Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Vicenza (Italy)

D'Onofrio D. Department of Biological Sciences, University of Insubria General Hospital, "Macchi" Foundation, Varese (Italy)

DamianoL. Department of Emergency, "S. Paolo Hospital", Naples (Italy)

de Latorre F.J. Department of Intensive Care, University Hospital Vall d'Hebron, Barcelona (Spain)

de RijkA.

XVII

Dept. Health Organisation, Policy and Economics, Faculty of Health Sciences Maastricht University, Maastricht (The Netherlands)

DeakinC.D. Shackleton Department of Anaesthetics, Southampton General Hospital, Southampton (U.K.)

Degrassi G. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Del Sorbo L. Department of Anaesthesia, University of Toronto, Toronto, Ontario (Canada)

Domeniconi G. Intensive Care Unit, National Hospital "Prof. A. Posadas", Buenos Aires (Argentina)

Dominguez-Cherit G. Department of Critical Care, National Institute of Medical Sciences and Nutrition "Salvador Zubiran" (Mexico)

Esposito G. Department of Emergency, "S. Paolo Hospital", Naples (Italy)

FalkeK.J. Clinic for Anaesthesiology and operative Intensive Care, Rudolf Virchow University Clinic, Berlin (Germany)

FavaroM. Department of Intensive Care, National Institute for Cancer Research, Milan (Italy)

Ferreira F. Department of Intensive Care, Erasme University Hospital, Free University of Brussels (Belgium)

Flabouris A. Intensive Care Unit, University of New South Wales, Liverpool Health Service, Sydney (Australia)

FoexP. Department of Anaesthetics, Oxford Radcliffe NHS Trust, Oxford (U.K.)

XVIII Authors Index

FranksN.P. Biophysics Section, Department of Biological Sciences, The Blackett Laboratory, Imperial College of Science, Technology and Medicine, London (U.K.)

Freo U. Department of Pharmacology and Anaesthesiology, University of Padua, Padua (Italy)

Furlan S. 2nd Department of Anaesthesia and Reanimation, "S. Maria degli Angeli" Hospital, Pordenone (Italy)

Galimberti G. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Gallesio A. Adult Intensive Care Service, Hospital Italiano of Buenos Aires (Argentina)

Gettings E. Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (U.S.A.)

Giannasi S. Adult Intensive Care Service, Hospital Italiano of Buenos Aires (Argentina)

Girardis M. Department of Anaesthesia and Intensive Care, Modena University General Hospital, Modena (Italy)

Giusti P. Dept. of Pharmacology and Anaesthesiology, University of Padua, Padua (Italy)

Golden E. Baptist Memorial Hospitals, Memphis, Tennessee (U.S.A.)

Gordini G. Department of Anaesthesia and Intensive Care, Maggiore Hospital, Bologna (Italy)

Gostoli B. Department of Anaesthesia and Intensive Care, Louis Pradel Hospital, Lyon (France)

Gritti G. Department of Anaesthesia and Intensive Care, Padua University Hospital, Padua (Italy)

GulloA. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

HackeW. Department of Neurology, University Heidelberg, Heidelberg (Germany)

Harris R.A. Waggoner Center for Alcohol and Addiction Research, Section of Neurobiology and Institute for Cellular and Molecular Biology, University of Texas at Austin, Austin, Texas (U.S.A.)

Authors Index

Hartman M.E. The CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute illness) Laboratory, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania (U.S.A.)

Havstad S.

XIX

Henry Ford Health Systems, Case Western Reserve University, Detroit, Michigan (U.S.A.)

Hedenstierna G. Department of Medical Sciences, Clinical Physiology, University Hospital, Uppsala (Sweden)

Hillman K. Department of Intensive Care, University of New South Wales, Sydney (Australia)

Hoelz C. University of Sao Paulo General Hospital, Sao Paulo (Brazil)

Homanics G.E. University of Pittsburgh, Departments of Anesthesiology and Pharmacology, Pittsburgh, Pennsylvania (U.S.A.)

Honore E. Institute of Molecular and Cellular Pharmacology, CNRS-UMR, Sophia Antipolis, Valbonne (France)

Illievich U.M. Department of Anaesthesiology and General Intensive Care, University of Vienna (Austria)

Jacques D. Department of Medical Intensive Care, Lyon Sud Jules Courmont Hospital, Pierre Benite (France)

JogS. Critical Care Centre, Shree Medical Foundation, Prayag Hospital, Deccan Gymkhana. Pune (India)

Kacmarek R.M. Department of Anesthesia, Harvard Medical School, and Respiratory Care, Massachusetts General Hospital, Boston, Massachusetts (U.S.A.)

Kaczmarczyk G. Centre for Anaesthesiology and Intensive Care, Georg-August University, Gottingen (Germany)

Kesecioglu J. Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht (The Netherlands)

KlimekM. Sub-department "Central location", Department of Anaesthesiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam (The Netherlands)

Koutsoukou A. Critical Care Department, Evangelismos General Hospital, Medical School, University of Athens (Greece)

xx Authors Index

Leendertse K. Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam (The Netherlands)

LefebvreA. Kugler Kandestin, Montreal, Quebec (Canada)

Lewandowski K. Clinic for Anaesthesiology and operative Intensive Care, Rudolf Virchow University Clinic, Berlin (Germany)

Lewandowski M. Clinic for Anaesthesiology and operative Intensive Care, Rudolf Virchow University Clinic, Berlin (Germany)

Leykin Y. 2nd Department of Anaesthesia and Reanimation, "S. Maria degli Angeli" Hospital, Pordenone (Italy)

Lieb W.R. Biophysics Section, Department of Biological Sciences, The Blackett Laboratory, Imperial College of Science, Technology and Medicine, London (U.K.)

Lobo I.A. Waggoner Center for Alcohol and Addiction Research, Section of Neurobiology and Institute for Cellular and Molecular Biology, University of Texas at Austin, Austin, Texas (U.S.A.)

Lucangelo U. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

LuzzaniA. Department of Anaesthesia and Intensive Care "A", Borgo Trento City Hospital, Verona (Italy)

LyonsG. Obstetric Anaesthesia, St. James' University Hospital, Leeds (U.K.)

MagderS. Division of Critical Care, McGill University Health Centre, Montreal, Quebec (Canada)

Malisano A.M. 2nd Department of Anaesthesia and Reanimation, "S. Maria degli Angeli" Hospital, Pordenone (Italy)

Martinelli A. Division of Critical Care Medicine, Hospital Centro Medico de Caracas, Caracas (Venezuela)

Mascia M.P. National Research Centre, Centre of Neuropharmacology, c/o Department of Experimental Biology, University of Cagliari, Cagliari (Italy)

MeduriG.U. University of Tennessee Health Science Center, Division of Pulmonary and Critical Care Medicine, The Memphis Lung Research Program, Memphis, Tennessee (U.S.A.)

Authors Index

Melloni C. Department of Anaesthesia and Intensive Care, Faenza Hospital, Faenza (Italy)

MenariniM. Department of Anaesthesia and Intensive Care, Maggiore Hospital, Bologna (Italy)

Milesi S. 2nd Department of Anaesthesia and Reanimation, "S. Maria degli Angeli" Hospital, Pordenone (Italy)

Milic-Emili J.

XXI

Meakins-Christie Laboratories, McGill University, Montreal, Quebec (Canada)

Muchada R. Department of Anaesthesia and Intensive Care, "Eugene Andre" Hospital, Lyon (France)

Myburgh J.A. Department of Intensive Care, St George Hospital, Sydney (Australia)

Nadalin S. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

NguyenB. Henry Ford Health Systems, Case Western Reserve University, Detroit, Michigan (U.S.A.)

Nolan J. Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath (U.K.)

Ori C. Department of Pharmacology and Anaesthesiology, University of Padua, Padua (Italy)

PaceN.A. Consultant Anaesthetist, Western Infirmary, Glasgow, Scotland (U.K.)

Paladino F. Department of Emergency, "S. Paolo Hospital", Naples (Italy)

ParkG. The John Farman Intensive Care Unit, Addenbrooke's Hospital, Cambridge (U.K.)

ParrM. Intensive Care Unit, University of New South Wales, Liverpool Health Service, Sydney (Australia)

Pasetto A. Department of Anaesthesia and Intensive Care, Modena University General Hospital, Modena (Italy)

Paver-Eden V. Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre, Ljubljana (Slovenia)

Pavoni V. Department of Anaesthesia and Intensive Care, Padua University Hospital, Padua (Italy)

XXII Authors Index

Pelosi P. Department of Biological Sciences, University of Insubria General Hospital, "Macchi" Foundation, Varese (Italy)

Peres-Bota D. Department of Intensive Care, Erasme University Hospital, Free University of Brussels (Belgium)

PerkanA. Cardiology Unit, "Maggiore" Hospital, Trieste (Italy)

Piriou V. Department of Anaesthesia and Intensive Care, Louis Pradel Hospital, Lyon (France)

Pistocchi S. Faenza Hospital, Faenza (Italy)

Polati E. Department of Anaesthesia and Intensive Care "A", Borgo Trento City Hospital, Verona (Italy)

Poli de Figueiredo L.F. Department of Cardiopneumology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo (Brazil)

Prayag S. Critical Care Centre, Shree Medical Foundation, Prayag Hospital, Deccan Gymkhana, Pune (India)

Ratnakant S. University of Tennessee Health Science Center, Division of Pulmonary and Critical Care Medicine, The Memphis Lung Research Program, Memphis, Tennessee (U.S.A.)

Reis Miranda D. Health Services Research Unit, University Hospital of Groningen, Groningen (The Netherlands)

RestaM. Department of Intensive Care, National Institute for Cancer Research, Milan (Italy)

Rezende Lopes M. Anaesthesia and ICU Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo (Brazil)

Rinaldi L. Department of Anaesthesia and Intensive Care, Modena University General Hospital, Modena (Italy)

RiveroE. Division of Critical Care Medicine, Hospital Centro Medico de Caracas, Caracas (Venezuela)

Rivers E. Henry Ford Health Systems, Case Western Reserve University, Detroit, Michigan (U.S.A.)

Roberti A. Department of Anaesthesia and Intensive Care, Modena University General Hospital, Modena (Italy)

Authors Index XXIII

Rocco P.R.M. Laboratory of Respiration Physiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)

Rocha e Silva M. Department of Cardiopneumology, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo (Brazil)

RomeroP.v. Lung Function Test Laboratory, Division of Respiratory Medicine, Bellvitge Hospital, Barcelona (Spain)

RoncoC. Department of Nephrology, Dialysis and Transplantation, St Bortolo Hospital, Vicenza (Italy)

RooneyK.D. Specialist Registrar in Intensive Care Medicine, Western Infirmary, Glasgow, Scotland (U.K.)

Roussos Ch. Critical Care Department, Evangelismos General Hospital, Medical School, University of Athens (Greece)

Ruggiero G. Department of Emergency, "S. Paolo Hospital", Naples (Italy)

RuprehtJ. Department of Anaesthesiology, Erasmus Medical Centre, Rotterdam (The Netherlands)

Sa Malbouisson L.M. Anaesthesia and ICU Department, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo (Brazil)

Sabbadini G. Department of Geriatrics, "Maggiore" Hospital, Trieste (Italy)

Sallusti R. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Salvetti I. Department of Anaesthesia and Intensive Care "A", Borgo Trento City Hospital, Verona (Italy)

San Roman E. Adult Intensive Care Service, Hospital Italiano of Buenos Aires (Argentina)

Schellinger P.D. Department of Neurology, University Heidelberg, Heidelberg (Germany)

Schiraldi F. Department of Emergency, "S. Paolo Hospital", Naples (Italy)

Schultz M.J. Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam (The Netherlands)

XXIV Authors Index

Sfogliaferri F. Parma University, Parma (Italy)

SierraJ. Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition "Salvador Zubiran" (Mexico)

Sinagra G.F. Cardiology Unit, "Maggiore" Hospital, Trieste (Italy)

Spiss C.K. Department of Anaesthesiology and General Intensive Care, University of Vienna (Austria)

Steiner T. Department of Neurology, University Heidelberg, Heidelberg (Germany)

StifanicD. Clinical Department of Anaesthesiology and Intensive Therapy, University Medical Centre, Ljubljana (Slovenia)

Sutcliffe A.J. Department of Anaesthesia and Intensive Care, Queen Elizabeth Hospital, Birmingham (U.K.)

TaiekarS. Critical Care Centre, Shree Medical Foundation, Prayag Hospital, Deccan Gymkhana, Pune (India)

Tantucci C. Department of Respiratory Diseases, University of Brescia, Brescia (Italy)

Tetta C. Clinical and Laboratory Research Department, Belleo SpA, Mirandola (Italy)

ThomasT. Department of Anaesthesia, Worcestershire Royal Hospital, Worcester (U.K.)

TomasiniA. Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

Ullrich R. Department of Anaesthesiology and General Intensive Care, University of Vienna, Vienna (Austria)

Valente Barbas C.S. University of Sao Paulo General Hospital, Sao Paulo (Brazil)

van der Poll T. Department of Infectious Diseases, Tropical Medicine and AIDS, Laboratory of Experimental Internal Medicine, Academic Medical Center, Amsterdam (The Netherlands)

Videtta w. Intensive Care Unit, National Hospital "Prof. A. Posadas", Buenos Aires (Argentina)

Vincent J.-L. Department of Intensive Care, Erasme University Hospital, Free University of Brussels (Belgium)

Authors Index xxv

VhianiM. Department of Peri operative Medicine, Intensive Care and Emergency, Trieste University School of Medicine, Trieste (Italy)

WilliamsG. Nursing Services, Alice Springs Hospital, Alice Springs (Australia)

ZamarronC. Sleep Unit, Division of Respiratory Medicine, University Hospital, Santiago de Compostela (Spain)

ZanetteG. 2nd Department of Anaesthesia and Reanimation, "S. Maria degli Angeli" Hospital, Pordenone (Italy)

ZhangH. Critical Care Program, St. Michael's Hospital, Toronto, Ontario (Canada)

ZimpferM. Department of Anaesthesiology and General Intensive Care, University of Vienna, Vienna (Austria)

ZinW.A. Laboratory of Respiration Physiology, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro (Brazil)

Abbreviations

ABG, arterial blood gas

ACE, angiotensin-converting enzyme

ACLS, advanced cardiac life support

ACM, alveolo-capillary membrane

ACTH, adrenocorticotropic hormone

ACV, assist-control ventilation

ADARPEF, Association Des Anesthesistes

Reanimateurs Pediatriques d'Expression

Franc;aise

ADH, antidiuretic hormone

AFB, atrial fibrillation

AFT, atrial flutter

Am, apnoea-hypopnoea index

AIS, abbreviated injury score

ALF, advanced life support

ALI, acute lung injury

ALS, amyotrophic lateral sclerosis

AM, alveolar macrophages

AMI, acute myocardial infarction

ANP, atrial natriuretic peptide

AOC, anaesthetic preconditioning

AP, anatomical profile

AP-l, activator protein-l

APACHE, acute physiological and chronic

health evaluation

APRV, airway pressure release ventilation

ARDS, acute respiratory distress syndrome

ARF, acute renal failure

ARF, acute respiratory failure

ASA, American Society of Anaesthesiologists

ASCOT, a severity score of trauma

BAL, bronchoalveolar lavage

BiPAP, bilevel positive airway pressure

BMI, body mass index

BOLD, blood oxygenation level-dependent

contrast

BOOP, bronchiolitis obliterants organizing

pneumonia

BUN, blood urea nitrogen

BV, blood volume

CABG, coronary artery bypass grafting

CAO, chronic airway obstruction

CAS, central anticholinergic syndrome

CBF, cerebral blood flow

CBG, corticosteroid binding globulin

CBP, CREB-binding protein

CBV, central blood volume

CBV, circulating blood volume

CC, closing capacity

Cdyn, dynamic compliance

CFI, cardiac function index

CMR02, cerebral metabolic rate for oxygen

CMV, conventional mechanic ventilation

CMV, cytomegalovirus

CNS, central nervous system

CO, cardiac output

COLD, chronic obstructive lung disease

COMT, catechol-O-methyltransferase

COPD, chronic obstructive pulmonary disease

COX, cyclooxygenase

CPAP, continuous positive airway pressure

CPB, cardiopulmonary bypass

CPFA, coupled plasma filtration absorption

CPM, central pontine myelinolysis

CPP, cerebral perfusion pressure

CPP, coronary perfusion pressure

CPR, cardiopulmonary resuscitation

CPU, Chest Pain Units

CRH, corticotrophin releasing hormone

CRRT, continuous renal replacement therapy

CT, computed tomography

CVC, central venous catheter

CVP, central venous pressure

CVR, cerebrovascular resistance

CVVH, continuous veno-venous haemofiltra­

tion

XXVIII

CVVHDF, continuous veno-venous haemo-

diafiltration

DAD, diffuse alveolar damage

DFMO, difluoromethylomithine

DH, dynamic hyperinflation

DIAS, desmoplase in acute ischaemic stroke

DIC, disseminated intravascular coagulation

DNR, do not resuscitate

EDA, end diastolic area

EDAI, end diastolic area indexed

EDRF, endothelium-derived relaxing factor

EDV, end diastolic volume

EELV, end-expiratory lung volume

EF, ejection fraction

EFL, expiratory flow limitation

EL, elastance of the lung

EMD, electromechanical dissociation

EPIC, European prevalence of infection in

Intensive Care

ERC, European Resuscitation Council

Est,rs, static elastance of the respiratory sy-

stem

ET, endotracheal tube

EVLW, extra vascular lung water

EW, elastance of the chest wall

FDA, Food and Drug Administration

FEPIMCTI, Federaci6n Panamericana e Ibe-

rica de Sociedades de Medicina Crftica y

Terapfa Intensiva

FFT, fast fourier transform

Fi02, fractional concentration of inspired o­

xygen

FL, flow limitation

fMRI, functional magnetic resonance ima-

ging

FRC, functional residual capacity

FVC, forced vital capacity

GABA, ?-aminobutyric acid

GC, glucocorticoid

GFR, glomerular filtration rate

Abbreviations

GI, gastrointestinal

GISIS, Gruppo Italiano di Studio sulle Infe­

zioni Severe

GM-CSF, granulocyte-macrophage colony

stimulating factor

GR, glucocorticoid receptor

GREs, glucocorticoid-responsive elements

GRa, glucocorticoid receptor a

HAART, highly active antiretroviral therapy

Hb, haemoglobin concentration

HES, hydroxyethyl starch

HF, haemofiltration

HFJV, high frequency jet ventilation

HFO, high frequency oscillation

HFPPV, high frequency positive pressure

ventilation

HIR, host inflammatory response

HIV, human immunodeficiency virus

HMCAS, hyperdense middle cerebral artery

sign

HPA, hypothalamic-pituitary-adrenal

HR, heart rate

HRCT, high resolution computed tomo­

graphy

HRQL, health-related quality 0 life

HSD, 6% dextran-70 to the 7.5% NaCI solu-

tion

HSP 70, heat shock protein 70

HSS, 6% hetastarch to the 7.5% NaCI solution

HVHF, high volume haemofiltration

IIR, ischaemia-reperfusion

IC, index of contractility

IC, inspiratory capacity

ICAM-l, intracellular adhesion molecule-l

ICG, indocyanine green

ICH, intracerebral haemorrhage

ICP, infection control practitioners

ICP, intracranial pressure

ICU, Intensive Care Unit

IDU, injection drug users

Abbreviations

llCCM, Indian Journal of Critical care Medi-

cine

IL-I, interleukin-l

IL-IO, interleukin-lO

IL-Ira, IL-l receptor antagonist

ILCOR, International Liaison Committee on

Resuscitation

IMV, intermittent mandatory ventilation

iNOS, inducible nitric oxide

IPC, ischaemic preconditioning

ISCCM, Indian Society of Critical Care Me-

dicine

ISS, injury severity score

ITVB, intrathoracic blood volume

IVDG, initial volume of distribution of gluco­

se

IVRT, isovolumic relaxation time

KISS, Krankenhaus - Infection - Surveillance

System

LDH, lactate dehydrogenase

LGI, lactate-glucose index

LIS, lung injury score

LOI, lactate-oxygen index

LOS, length of stay

LPS, lipopolysaccharide

LVEDA, left ventricular end-diastolic area

LVEDV, left ventricular end-diastolic volume

LVSW, left ventricular stroke work

MAC, minimum alveolar concentration

MAP, mean arterial pressure

MCA, middle cerebral artery

MD, medical director

MEFV, maximal flow-volume curve

MI, myocardial infarction

MIP, maximum inspiratory pressure

MODS, multiple organ dysfunction syndrome

MOF, multiple organ failure

MP, methylprednisolone

MPT, methylprednisolone treatment

MTS, methanethiosulfonate

XXIX

MV, mechanical ventilation

NAECC, North American-European Consen-

sus Conference

NEP, negative expiratory pressure

NETT, National Emphysema Treatment Trail

NF -?B, nuclear factor-?B

NICO, non-invasive cardiac output

NIH, National Institutes of Health

NIHSS, National Institutes of Health Stroke

Scale

NIPPV, non invasive positive pressure venti-

lation

NISS, new injury severity score

NMDA, N-methyl-D-aspartate

NNIS, National Nosocomial Infection Sur-

veillance System

NO, nitric oxide

NSAIDs, non-steroidal analgesic drugs

NTE, neurotoxic esterase

ODI, oxygen desaturation indexes

OM, organization and management

OP, organophosphates

OPIM, other potentially infectious materials

OSA, obstructive sleep apnoea

PA, peak amplitude

PAC, pulmonary artery catheter

PAF, platelet activating factor

PAG, periaqueductal grey region

PAl-I, plasminogen activator inhibitor 1

PAOP, pulmonary artery occlusion pressure

Paw, airway pressure

PCA, patient-controlled analgesia

PCCO, pulsed contour cardiac output

PCP, Pneumocystis carinii pneumonia

PCR, polymerase chain reaction

PCWP, pulmonary capillary wedge pressure

PDDG, pulse dye densitometry with indocya-

nine green

PEA, pulseless electrical activity

PEEP, positive end-expiratory pressure

xxx

PEEPi, intrinsic positive end-expiratory pres-

sure

PEP, pre-ejection period

PGI2, aerosolised prostacyclin

PGL, persistens generalized lymphadeno­

pathy

PIRO, predisposing factor, infection, respon-

se and organ dysfunction

PKC, protein kinase C

PLA2, phospholipase A2

PLC, phospholipase C

PMN, polymorphonuclear cells

PNMT, phenethanolarnine-N-methyltransfe­

rase

POCD, postoperative consciousness distur-

bance

PONY, postoperative nausea and vomiting

PPCM, peripartum cardiomyopathy

Pra, right atrial pressure

PROWESS, protein C worldwide evaluation

in severe sepsis

PSG, polysornnography

PSV, pressure support ventilation

PTCA, percutaneous coronary angioplasty

PV, pressure volume

PVF, pulmonary venous flow

PVR, pulmonary vascular resistance

RACU, Respiratory Acute Care Unit

RAP, right atrial pressure

Raw, airway resistance

Rawm, mean airway resistance

rCBF, regional cerebral blood flow

rCMRglc, regional cerebral metabolic rates

for glucose

RCV, red cells volume

rhAPC, recombinant human activated protein

C RM, recruitment manoeuvres

ROSC, return of spontaneous circulation

RTS, revised trauma score

Abbreviations

RV, residual volume

RVEDV, right ventricular end-diastolic volume

RVEF, right ventricular ejection fraction

RVSW, right ventricular stroke work

SA, surgical auditors

SAB, sub-arachnoid block

SAH, subarachnoid haemorrhage

SBT, spontaneous breathing trials

SG, Swan-Ganz

sICAM-l, soluble intracellular adhesion mo-

lecule-I

SICU, surgical ICU

SIRS, systemic inflammatory response score

SLPI, secretory leukocyte protease inhibitor

SPECT, single photon emission computed to-

mography

SPY, systolic pressure variation

SRC-l, steroid receptor coactivator-l

SSI, surgical site infections

SSS, Scandinavian Score Scale

sTNFRl, soluble TNF receptor I

SV, stroke volume

SV02, mixed venous oxygen saturation

SVR, systemic vascular resistance

SVV, stroke volume variation

TAT, thrombin-antithrombin

TCDB, Traumatic Coma Data Bank

TCP, tri cresyl phosphate

TEE, transesophageal echocardiography

TFPI, tissue factor pathway inhibitor

ThD, thermodilution

TLC, total lung capacity

TLV, total lung volume

TNF a, tumour necrosis factor-a

TOCP, tri orthocresyl phosphate

TP, transpulmonary pressure

t-PA, tissue-type plasminogen activator

TPV, total pulmonary volume

TRISS, trauma and injury severity score

TS, trauma score

Abbreviations

TURP, trans urethral resection of prostate

YAP, ventilator associated pneumonia

VF, ventricular fibrillation

VILI, ventilator-induced lung injury

Vr, relaxation volume

Vrec, alveolar recruited volume

VT, tidal volume

VT, ventricular tachycardia

Vtmax, maximal tidal volume during exercise

WOB, work of breathing

WP, wedge pressure

WUR, work utilization ratio

ZEEP, zero end-expiratory pressure

XXXI

~down, minimal value of systolic pressure

~PP, difference between the systolic and the

diastolic pressure

~up, augmentation of LV stroke volume

~t, time constant