Editorial

Managing the abdomen and its complications in the intensive care unit is the subject of our Cover Story. First, Jan de Waele considers the ‏data on new antibiotics for complicated intra-abdominal ‏infections. While these, singly and in combination, show‏ promise, he cautions that recent studies have certain shortcomings from a critical care perspective, and recommends that local antibiotic stewardship...

News

Three objective criteria could identify out-of hospital  ‏cardiac arrest (OHCA) patients with ‏zero chance of survival, who can be considered ‏for organ donation. Prof. Xavier Jouven, Georges ‏Pompidou European Hospital, Paris, and ‏colleagues, analysed data from two registries and ‏a clinical trial, and found that there is essentially ‏no chance of survival in patients whose OHCA ‏is not witnessed by...

A multicentre trial investigating early use ‏of vasopressin compared to norepinephrine ‏to treat septic shock found no reduction ‏in the number of kidney failure-free days. The ‏results of the VAsopressin vs. Noradrenaline as ‏Initial therapy in Septic sHock (VANISH) trial ‏are published in JAMA (Gordon et al. 2016). ‏   Patients who had septic shock requiring ‏vasopressors despite fluid resuscit...

Cover Story

Recently a number of new antibiotics or combinations for complicated ‏intra-abdominal infections have been introduced. Here we ‏review the currently available data of these new drugs and discuss ‏how they can be used in critically ill patients with complicated intraabdominal ‏infections.   Complicated intra-abdominal infections ‏(cIAI) remain one of the most challenging ‏infections in the intensive...

The enteral route is commonly accepted as the first choice for providing ‏nutrition to patients in the ICU with stable haemodynamics and a functional ‏gastrointestinal (GI) tract. However, there is wide uncertainty ‏regarding safe enteral nutrition in patients with critical pathology in the ‏abdomen. In the current review we address different abdominal conditions ‏in critically ill patients where...

Most patients with liver cirrhosis ‏remain in a compensated stage for ‏more than 10 years, regardless of ‏the aetiology of the liver disease. The progression ‏to decompensated cirrhosis is defined by ‏the occurrence of a major complication such ‏as ascites, variceal bleeding and/or hepatic ‏encephalopathy. From here on most patients ‏will not die because of a progressive, irreversible ‏decrease in...

Knowledge of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) is crucial for successful treatment of critically ill patients, whether medical or surgical, young or old (Kirkpatrick et al. 2013). Today we understand that IAH and ACS are frequent causes of increased morbidity and mortality (De Waele et al. 2016). More importantly, we now also know that IAH and ACS have correctable...

Point-of-View

Many patients presenting to the hospital ‏emergency department do not need ‏to stay overnight. Ambulatory emergency ‏care (AEC) may optimise identification ‏and management of such patients by delivering ‏streamlined, efficient patient care within ‏one working day. This may improve clinical ‏outcomes, patient experience and lower costs.   At James Paget University Hospital, the acute ‏medicine unit...

Matrix

Use of point-of-care test devices in the emergency department has ‏shown significant benefits in patient management. A proper governance ‏policy will ensure credible, effective and safe practice.   Emergency Department (ED) practices have ‏evolved, modified and developed pathways ‏over the years to recognise and initiate ‏appropriate early treatment for acutely unwell ‏patients. One of the major c...

A Real Causality With Worse Outcomes or Just a Marker of Severity? Candida spp. is the most common cause of intensive care unit (ICU) invasive fungal infections worldwide.The isolation of Candida spp. from respiratory tract secretions of non-immunocompromised, mechanically ventilated patients varies between 20% and 55%, but it might represent colonisation rather than infection.Candida spp. colonis...

In this update review on vasoactive drugs in sepsis, we focus on the ‏most recent data regarding the type of vasopressors that should be ‏used, the timing of infusion, the mean arterial pressure target and ‏the alternative approaches.   Sepsis and especially septic shock is associated ‏with arterial vasodilation refractory to ‏fluid challenge. The use of vasoactive drugs ‏is strongly recommended by...

Ventilator-associated pneumonia is a ‏major complication of mechanical ‏ventilation and represents the most ‏common reason for antibiotic prescription in ‏ventilated patients. Incidence ranges from 1.2 ‏to 8.5 cases per 1000 ventilator days or 9 to ‏27% cases per mechanically ventilated patient; ‏attributable mortality rates vary between 0% ‏and 70% (Chastre and Fagon 2002; Melsen et ‏al. 2013). The...

Even though systemic haemodynamic variables may be normalised, ‏there could be regions with inadequate regional oxygenation at the tissue ‏level. The most recent developments of noninvasive monitoring of the ‏peripheral circulation have helped physicians to early identify patients ‏at high risk for tissue hypoperfusion, organ failure and poor outcome. ‏   Why Might Clinical Assessment of Periphera...

In contemporary healthcare, touch— ‏contact between a doctor’s hand and a ‏patient—appears to be on its way out. ‏The expanding role of CT and MRI imaging ‏is decreasing reliance on touch as a way of ‏making diagnoses. Pressures to move patients ‏through the system more quickly leave health ‏professionals with fewer opportunities to make ‏contact. Our experience suggests that when ‏doctors spend fewer...

Management

There is a significant gender imbalance in positions of leadership in intensive care medicine. This complex problem requires action to ensure high quality and sustainable leadership for our specialty in the future.   Despite an increasing proportion of ‏women in the medical specialty ‏workforce, there are few female doctors ‏in positions of leadership in intensive care ‏medicine (ICM). This articl...

A New Model for ICU Rehabilitation It is now well established that many patients ‏and caregivers suffer physical, psychological ‏and social problems in the years ‏and months following critical care discharge ‏(Herridge et al. 2011). Similar to many centres, ‏our intensive care unit (ICU) had no follow-up ‏service available to support patients through this ‏difficult recovery period (Griffiths et al....

We argue that a jumble of rules, protocols, checklists has emerged, ‏which jeopardises not only the pivotal relationship between doctor and ‏patient, but also the quality and costs of care, and the quality of future ‏healthcare workers. It must be emphasised that the introduction of ‏protocols and checklists in clinical medicine has improved care at some ‏points and in some places, and it has similarly...

Interview

Professor Gernot Marx is Director of the Department of Intensive Care  ‏Medicine and Intermediate Care, University Hospital Aachen, and ‏Professor of Anaesthesiology and Operative Intensive Care Medicine at ‏RWTH Aachen University, Aachen, Germany. Dr. Marx is a member of ‏the Intensive Care Medicine Scientific Subcommittee of the European ‏Society of Anaesthesiology.   The first tele-ICU service

Country Focus

Brazil is the largest country in South America, and ranks fifth in the  ‏list of the most populous countries, with a population of approximately ‏209 million people (84% urban). It is a large country with ‏many challenges that affect the healthcare sector, such as economic ‏inequalities, and the demographic transition with an ageing population ‏(>10% older than 60%), the result of diminishing birth...

Agenda

OCTOBER12-15 19th Asia Pacific Conference on Critical Care Medicine 2016Bangkok, Thailandhttps://iii.hm/5ds13-14   Sepsis Unplugged ConferenceBrighton, UKhttps://iii.hm/5dt15-18  American Association for Respiratory Care CongressSan Antonio, USAhttps://iii.hm/5du20-2241st ANZICS/ACCCN Intensive Care ASMPerth, Australiahttps://iii.hm/5dw21-22 International Conference of Acu



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