Volume 16 - Issue 1, 2016

The use of extracorporeal membrane oxygenation (ECMO) in critical care is growing. From its initial use back in the 1950s in cardiac surgery, it is now an important tool for life-saving organ support, with clear indications for use in neonates and growing use in paediatric ICUs. ECMO for adult patients is also expanding in use (over 400% between 2006 and 2011 in the USA, for example (Sauer et al. 2015)). I...

The updated definitions and clinical criteria for sepsis have been welcomed by Professor Jean-Louis Vincent, ICU Management & Practice’s Editor-in-Chief, who says: “we are finally back to reason – the new recommendations fit the current language.” The new definitions are published in the 23 February issue of JAMA, and aim to facilitate earlier recognition and more timely management of patients...

Acute respiratory distress syndrome (ARDS) seems to be underrecognised, under-treated and associated with a high risk of mortality, according to the results of the ESICM LUNG-SAFE observational study, published in JAMA. Speaking to ICU Management & Practice, John G. Laffey, MD, MA, of the Departments of Anesthesia and Critical Care Medicine, Keenan Research Centre for Biomedical Science, St Michael’s...

Improved Outcomes of Immunocompromised Patients Admitted to the ICU Immunocompromised patients, who include patients with haematological malignancies (HMs), solid tumours, solid-organ transplants, human immunodeficiency virus (HIV) or long-term corticosteroid use, are increasingly admitted to intensive care units (ICUs). Their survival has improved markedly in recent years. For example, most patients with...

The rationale, indications and challenges of extracorporeal lung assist in trauma patients with severe acute respiratory distress syndrome is given on the basis of clinical and scientific experience. Traumatic lung injury is often present in multiple trauma with a wide spectrum of severity. In a large cohort study, patients with multiple trauma were reported to suffer from acute hypoxaemia in 64% of cas...

In-Line Bedside Blood Gas Analysis Enables Rapid Results For Respiratory Support Management Extracorporeal membrane oxygenation (ECMO) is an acute support system used to aid heart and lung function in patients with severe respiratory or cardiac failure. Having its origins in the operating theatre, the use of ECMO has now migrated into the ICU. Since the mortality risk of ICU patients with ECMO, such as tho...

Since its first clinical use in the 1950s, the set-up and management of the heart-lung machine (HLM) has been the responsibility of the perfusionist, who has a documented competency in every facet of extracorporeal technology because of their theoretical and practical training. In contrast, when this technology leaves the operating room to provide longer-term support in terms of ECLS (extracorporeal life s...

The Twinstream® ventilator (Carl Reiner GMBH, Vienna, Austria) is an electricdriven microprocessor-controlled jet ventilator, which allows simultaneous application of two different jet streams (low frequency and high frequency), resulting in a pulsatile Bi-Level Ventilation (p-BLV) mode. ICU Management & Practice spoke to Prof. Dr. Gerfried Zobel about his experiences with the system in the Paediatric...

The aim of the present review is to summarise the current evidence for the use of biomarkers in facilitating therapeutic decision-making by guiding and tailoring the prescription and the duration of antibiotic therapy. The main benefits of this strategy are a potential reduction of antibiotics overuse in critically ill patients. Overuse of antibiotics and its consequences represent a big challenge for hea...

All drugs are inherently dangerous. In critical care we give large numbers of particularly dangerous drugs to very sick people, who have little physiological reserve to cope with additional problems. When patients are admitted to or transferred out of critical care we have to transfer complex information about patients’ medications. The staff prescribing and administering medications are often inexperien...

This review explores current definitions of frailty, methods available to diagnose it, and its application to perioperative and critically ill patients. Frailty is increasingly recognised as a potential contributor to patient outcome during an episode of critical illness. However, there is currently no consensus definition or assessment tool. Two main models exist to conceptualise frailty —the “frail...

The role of the environment in the transmission of healthcare-associated infections (HCAIs) is increasingly recognised, requiring a new approach to the selection of materials for objects frequently touched by healthcare workers, patients and visitors that can serve as reservoirs of infection. There are many technologies and materials on the market, but none are as effective under typical indoor condition...

This article will provide an overview of how to accelerate adoption of bedside ultrasonography, based on experience in a large hospital system. Developing an evidence-based ultrasound training programme and the economic benefits of proven safety practices, such as ultrasound-guided central venous catheterisation (CVC), will be addressed. Every day, more than 1,000 patients die in the United States from...

Intensivists today are faced with a growing deluge of quantitative data, along with demands to implement evidence-based protocols of increasing number and complexity. The tools to support such implementation, including computerised decision support, have, however, seen only incremental development over the past decades. This article will attempt to provide an analysis of the underlying causes and suggest p...

There has been good progress in the last decade to ensure that the patient voice is heard at all levels, including in research and service planning. However there is still more to be done, and this article sets out the case for meaningful intensive care patient and relative involvement and how this can be achieved. Why Involve Former Intensive Care Patients and Relatives? The short answer is because we h...

Nutrition in Critical Care Patients in the critical care setting are at risk of malnutrition (Heyland et al. 2011). The provision of nutrition support (enteral or parenteral) to critically ill patients is vital, but achieving the optimum quantity and balance is a contentious topic. There are two major and contradictory perspectives with respect to how much to feed critically ill patients. The first mainta...

Knowledge about current research evidence is required by clinicians in order to practise safe and effective care. The health librarian occupies a unique position between knowledge resources and knowledge consumers. As such, the librarian is perfectly poised to channel accurate, reliable knowledge into the hands of the healthcare team, who can then confidently apply evidencebased decisions. Traditionally,...

The significance of research or researchers is frequently discussed and debated, so also in the medical research field. Why do we publish? This straightforward question is often difficult to answer, at least in a simple way. As a starter we can list some reasons: We wish to make a difference for the outcome of our patients; We have an obligation to do research because of unanswered questions; We have to do...

Todd Dorman takes office as President of the Society of Critical Care Medicine (SCCM) in February 2016. He is Professor of Anesthesiology and Critical Care Medicine and Vice Chair for Critical Care Services, Department of Anesthesiology/Critical Care Medicine; Senior Associate Dean for Education Coordination; Associate Dean for Continuing Medical Education at Johns Hopkins University School of Medicine. In...

Prof. Ingrid Egerod, RN, MSN, PhD is an active critical care researcher who has focused on the wellbeing and recovery of intensive care patients during admission and recovery. Her particular areas of interest are sedation, mechanical ventilator weaning, patient experiences, family care, ICU diaries, ICU follow-up consultations, ICU environment modifications, as well as symptoms and conditions such as pain,...

The Centre for Research in Intensive Care (CRIC) was established in 2015 to provide support and services for research into intensive care, intervention and treatment (CRIC.nu). CRIC was established to maintain and improve the infrastructure obtained through the large trials conducted in Denmark, the Scandinavian Starch for Severe Sepsis/Septic Shock (6S) (Perners et al. 2012) and Transfusion Requirements i...

April 7-9 12th Emirates Critical Care Conference 2016 (ECCC 2016) Dubai, UAEeccc-dubai.com 14-15 17th Annual Symposium on Patient Blood Management, Haemostasis and Thrombosis Dublin, Ireland nataonline.com14-16German Society of Anaesthesiology and Intensive Care 63rd Annual Meeting 2016 (DAC 2016) Leipzig, Germany dac2016.de18-2116th International Conference on Emergency Medicine (ICEM 2016) Cape Tow...