Editorial

In medicine the benefits of treatment are always weighed against possible harms. In these times of budgetary constraints financial considerations also come even more into focus. Costeffectiveness in medicine works at many levels. In clinical trials the cost of quality-adjusted life years (QALYs) may be one of the outcomes measured. At a department or hospital level, directors need to consider the...

News

The findings of a new study examining the ratio of nurse practitioners (NPs) and physician assistants (PAs) to patients may help hospital administrators better determine appropriate staffing levels in ICUs. Published in the American Journal of Critical Care (AJCC), “Patient-to-Provider Ratios for Nurse Practitioners and Physician Assistants in Critical Care Settings: Results From a National Survey” is...

A study published in JAMA has shown that drinking a non-toxic strain of Clostridium difficile bacteria could help reduce the incidence of recurrent infection caused by the toxic strains of the bacteria. C. difficile is the most common cause of healthcare-associated infection in U.S. hospitals, and recurrence occurs in 25 to 30 percent of patients. Toxic strains of C. difficile bacteria cause diarrhoea,...

Cover Story

The Economic ImpactWe studied the economic impact of omitting routine chest radiographs (CXR) in a university ICU. Additionally, we performed a prospective observational micro-costing exercise to identify the current costs of radiodiagnostic pathways, and compared the CXR cost calculation between a university hospital and a regional hospital ICU. Anteroposterior chest radiographs (CXRs) are often obtained...

Ultrasound Guidance Improves the Safety and Success of Needle Procedures The European Prevalence of Infection in Intensive Care study reported that 78% of critically ill patients had a central line inserted, while several million central venous catheters (CVCs) a year are placed in American hospitals (Gibbs, 2006). Since this common procedure can have serious risks, including accidental puncture and...

Matrix

The use of lactate measurements in critically ill patients has steadily increased to a level where in some cases it may be considered lactate monitoring. In this brief review we discuss the central metabolic role of lactate in animal metabolism, and address important misconceptions as well as why lactate is mainly a marker of stress and how this translates into its unique diagnostic utility in many...

Sepsis is a recognised clinical spectrum of infection that often results in catastrophic physiologic and metabolic abnormalities. This article aims to identify the derangements associated with sepsis and to review the evidence-based literature. The tenets of early sepsis management include diagnosis, risk stratification (elevated serum lactate or hypotension), assessment of haemodynamic response after...

Implementation at Hospital Alemán in ArgentinaThe acute condition of hospital patients and the use of higher risk medication increases the consequences that counterfeit and illegitimate pharmaceutical products can have on them. Delivering the right and genuine product to the right patient is crucial. In our globalised economy, the risks of harming the patient can stem from counterfeited medicines....

Point-of-View

The RADICAL multicentre observational study was performed to compare PCR/ESI-MS to standard microbiology in critically ill patients.Dr. David Brealey, Consultant Intensivist at University College Hospital, London, was one of the investigators in the UK arm of this trial, and explains more about the challenges of diagnosing infections in the ICU and the potential of rapid pathogen testing PCR/ESI-M...

Management

The Educational Challenge in Anaesthesia and Intensive Care Historically, medical education has focused on the autonomy of healthcare providers, who are expected to take care for a patient on their own. Consequently, issues related to teamwork, multidisciplinary and multi-professional interactions have not been explicitly and formally included in medical curricula. In addition, the hierarchical or...

The Most Dangerous Procedure in the Hospital?Communication is central to the human experience of illness, and therefore central to medical decision-making. Being an expert clinician now means being a skilled communicator. Fortunately, communication skills can be learnt, mastered and measured. Communication Matters Communication is increasingly recognised as medicine’s most important non-technical skill....

The use of simulation-based training provides safe and effective procedures for the practice and acquisition of clinical skills needed for patient care. Medical education is required for the learning and training period in order to ensure patient safety especially in ICU. Artificial respiration education and proper setting of mechanical ventilation modes is primordial before application to the patient....

Interview

Interview With Professor Paul E. PepePaul E. Pepe, MD, MPH, is Professor with Tenure in Internal Medicine, Surgery, Pediatrics, Public Health &Emergency Medicine (EM) at UT Southwestern and the City of Dallas Director of Medical Emergency Services for Public Safety, Public Health & Homeland Security. Up until this spring, he served for more than a decade as the jurisdictional Medical Director for...

Country Focus

The Past, The Present and the FutureHistory of Critical Care in Korea and the Korean Society of Critical Care MedicineThe first intensive care unit (ICU) in Korea was established in 1968 with six beds in a university hospital in Seoul, and the number has since expanded to 220 ICUs taking care of 3197 patients (data from a one-day survey in 2009). As in other countries, such as Dr. Peter Safar in the...

12th Congress of World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) This year, the 12th Congress of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM Seoul 2015 Congress), in collaboration with the World Federation of Critical Care Nurses (WFCCN) and the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS) will be...

Agenda

Interview With Professor Jean-Louis Vincent, WFSICCM PresidentWhat have been the highlights of your term of office? With modern communication means, it is easier to interact all over the world, to know each other better, and learn from each other. We have started the organisation of large trials, inviting the entire word to contribute – the ICON study has been a great success! We have put several task...

Social Media and Critical Care (smacc)’s third meeting takes place in Chicago from 23-26 June. ICU Management spoke to one of the smacc founders, Dr. Roger Harris, to find out more. What is the background to smacc? Oliver Flower and I started our website www. intensivecarenetwork.com, and began collaborating with a similar site run by Chris Nickson and Mike Cadogan www.lifeinthefastlane.com. We began...

June23-26 SMACC Chicago Social Media and Critical Care Chicago, USA www.smacc.net.au 24-26 SESAM 2015 Belfast, Ireland www.sesambelfast2015.com July 8-12 ISCCM: 3rd Annual international Best of Brussels symposium on intensive Care and Emergency Medicine Pune, India www.isccmpune.com 16-18 Paediatric Continuous Renal Replacement therapy London, UK www.pcrrtconferences.com August 14-16 Annual scientific...



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