Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)
Abstract The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has developed a good clinical practice to address the challenges of treating critically ill patients in resource-limited austere environments, exacerbated by recent pandemics, natural disasters, and con...
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| Format: | Article |
| Language: | English |
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BMC
2024-11-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
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| Online Access: | https://doi.org/10.1186/s44158-024-00209-8 |
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| author | Mattia Bixio Luca Carenzo Giuseppe Accurso Roberto Balagna Simone Bazurro Giovanni Chiarini Andrea Cortegiani Loredana Faraldi Costantino Fontana Emilio Giannarzia Antonino Giarratano Enrico Molineris Santi Maurizio Raineri Paolo Marin |
| author_facet | Mattia Bixio Luca Carenzo Giuseppe Accurso Roberto Balagna Simone Bazurro Giovanni Chiarini Andrea Cortegiani Loredana Faraldi Costantino Fontana Emilio Giannarzia Antonino Giarratano Enrico Molineris Santi Maurizio Raineri Paolo Marin |
| author_sort | Mattia Bixio |
| collection | DOAJ |
| description | Abstract The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has developed a good clinical practice to address the challenges of treating critically ill patients in resource-limited austere environments, exacerbated by recent pandemics, natural disasters, and conflicts. The methodological approach was based on a literature review and a modified Delphi method, which involved blind voting and consensus evaluation using a Likert scale. This process was conducted over two rounds of online voting. The document covers six critical topics: the overall impact of austere conditions on critical care, airway management, analgesia, bleeding control, vascular access, and medical devices and equipment. In these settings, it is vital to apply basic care techniques flexibly, focusing on immediate bleeding control, airway management, and hypothermia treatment to reduce mortality. For airway management, rapid sequence intubation with ketamine for sedation and muscle relaxation is suggested. Effective pain management involves a multimodal approach, including patient-controlled analgesia by quickly acting safe drugs, with an emphasis on ethical palliative care when other options are unavailable. Regarding hemorrhage, military-derived protocols like Tactical Combat Casualty Care significantly reduced mortality and influenced the development of civilian bleeding control devices. Establishing venous access is crucial, with intraosseous access as a swift option and central venous access for complex cases, ensuring aseptic conditions. Lastly, selecting medical equipment that matches the specific logistical and medical needs is essential, maintaining monitoring standards and considering advanced diagnostic tools like point-of-care ultrasounds. Finally, effective communication tools for coordination and telemedicine are also vital. |
| format | Article |
| id | doaj-art-60f569b5f33b4b7a95875fb72d8a4fc1 |
| institution | Kabale University |
| issn | 2731-3786 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj-art-60f569b5f33b4b7a95875fb72d8a4fc12024-11-10T12:46:59ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862024-11-014111410.1186/s44158-024-00209-8Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI)Mattia Bixio0Luca Carenzo1Giuseppe Accurso2Roberto Balagna3Simone Bazurro4Giovanni Chiarini5Andrea Cortegiani6Loredana Faraldi7Costantino Fontana8Emilio Giannarzia9Antonino Giarratano10Enrico Molineris11Santi Maurizio Raineri12Paolo Marin13UO Anestesia E Rianimazione, IRCCS Ospedale Policlinico San MartinoDepartment of Anesthesia and Intensive Care Medicine, IRCCS Humanitas Research HospitalUOC Anestesia Rianimazione E Terapia Intensiva, AOU Policlinico Paolo GiacconeAnestesia e Rianimazione 2U.O. Anestesia E RianimazioneAnestesia E Rianimazione, Spedali Civili Di BresciaUOC Anestesia Rianimazione E Terapia Intensiva, AOU Policlinico Paolo GiacconeServizio Anestesia E Rianimazione 1, ASST Grande Ospedale Metropolitano NiguardaAnestesia E Terapia Intensiva, Policlinico MilitareCentro Ospedaliero Militare, Marina MilitareUOC Anestesia Rianimazione E Terapia Intensiva, AOU Policlinico Paolo GiacconeAnestesia E RianimazioneUOC Anestesia Rianimazione E Terapia Intensiva, AOU Policlinico Paolo GiacconeU.O. Anestesia E RianimazioneAbstract The Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) has developed a good clinical practice to address the challenges of treating critically ill patients in resource-limited austere environments, exacerbated by recent pandemics, natural disasters, and conflicts. The methodological approach was based on a literature review and a modified Delphi method, which involved blind voting and consensus evaluation using a Likert scale. This process was conducted over two rounds of online voting. The document covers six critical topics: the overall impact of austere conditions on critical care, airway management, analgesia, bleeding control, vascular access, and medical devices and equipment. In these settings, it is vital to apply basic care techniques flexibly, focusing on immediate bleeding control, airway management, and hypothermia treatment to reduce mortality. For airway management, rapid sequence intubation with ketamine for sedation and muscle relaxation is suggested. Effective pain management involves a multimodal approach, including patient-controlled analgesia by quickly acting safe drugs, with an emphasis on ethical palliative care when other options are unavailable. Regarding hemorrhage, military-derived protocols like Tactical Combat Casualty Care significantly reduced mortality and influenced the development of civilian bleeding control devices. Establishing venous access is crucial, with intraosseous access as a swift option and central venous access for complex cases, ensuring aseptic conditions. Lastly, selecting medical equipment that matches the specific logistical and medical needs is essential, maintaining monitoring standards and considering advanced diagnostic tools like point-of-care ultrasounds. Finally, effective communication tools for coordination and telemedicine are also vital.https://doi.org/10.1186/s44158-024-00209-8AustereHostileSIAARTICritically ill patientCritical careAnesthesia |
| spellingShingle | Mattia Bixio Luca Carenzo Giuseppe Accurso Roberto Balagna Simone Bazurro Giovanni Chiarini Andrea Cortegiani Loredana Faraldi Costantino Fontana Emilio Giannarzia Antonino Giarratano Enrico Molineris Santi Maurizio Raineri Paolo Marin Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) Journal of Anesthesia, Analgesia and Critical Care Austere Hostile SIAARTI Critically ill patient Critical care Anesthesia |
| title | Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) |
| title_full | Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) |
| title_fullStr | Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) |
| title_full_unstemmed | Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) |
| title_short | Management of critically ill patients in austere environments: good clinical practice by the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) |
| title_sort | management of critically ill patients in austere environments good clinical practice by the italian society of anesthesia analgesia resuscitation and intensive care siaarti |
| topic | Austere Hostile SIAARTI Critically ill patient Critical care Anesthesia |
| url | https://doi.org/10.1186/s44158-024-00209-8 |
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