Editorial
Quality
An emphasis on quality of care has always underpinned healthcare, but in recent years quality measurement has come to the fore, as countries around the world seek to provide the best outcomes for patients while facing ever-increasing healthcare costs. In intensive care, despite the heterogeneity of the patient population, great strides have been made in defining and measuring quality in order to improve...
News
Editorial Board Welcomes New Member
Prof. Flavia Machado has recently been welcomed to the Editorial Board of ICU Management & Practice by Editor-in-Chief, Prof. JeanLouis Vincent. Dr. Machado is Professor of Intensive Care and head of the Intensive Care Section of the Anesthesiology, Pain and Intensive Care Department at the Federal University of São Paulo in São Paulo, Brazil. She is one of the founders of the Latin America Sepsis...
Patient Handoff Protocols
Whether they are called handoffs or handovers, it is known from the literature that the transfer of patient information between caregivers at shift changes has the potential for error. Although the U.S. Joint Commission requires healthcare providers to implement a standardised approach to handoff communication as a national patient safety goal, clear instructions and evidence on effective protocols...
New Resource for Children
An activity book for children visiting intensive care units (ICUs) has been published by ICUsteps, the UK intensive care patient and relative support charity. The resource comes with an information sheet for parents and carers to help them support the children, and can be downloaded from the ICUsteps website. Catherine White, Information Manager, ICUsteps, who developed the resource, said:“My son...
Cover Story
Quality in Practice: Towards a Patient-Centred View
Professor Guidet has been a university medical professor since 1997. He is a member of the research unit INSERM U1136 at the National Institute for Health and Medical Research (INSERM), the French public organization entirely dedicated to biological, medical and public health research. Guidet is past President (2008 – 2010) of the French Society for Intensive Care and is currently a member of the...
National ICU Quality Indicators Revisited
The last two decades have seen an accelerated interest in quality management in healthcare in general, and also in intensive care specifically. Often safety has been the main issue, but increasingly a more general approach to quality has emerged, in particular with a focus on quality indicators (QI). It is now more than 15 years since Pronovost and co-workers approached this area systematically and...
Quality Management: The Role of Intensive Care Registries
To initiate, maintain and advance a quality improvement programme in your intensive care unit consumes large amounts of time and energy. There are many advantages for quality management in joining an intensive care registry; the most important is access to precisely defined data for comparative audit. Intensive Care Registries Joint collection of information about intensive care patients, thei
Special Supplement-Advanced Tools for Lung Protection and Nutrition
Introduction
The intensive care unit (ICU) is a complex environment, due to the surroundings, the heterogeneity of patients, caregiver turnover and the at times lengthy patient stays, which lead to increased complexity. The multiple technologies available add another layer of intricacy. However, with the modern tools available to the intensivist, it is now possible to personalize care to meet the heterogeneous...
Protective Ventilation: When and Why to Individualize
ARDS is Heterogeneous Acute respiratory distress syndrome (ARDS) is a heterogeneous entity. Calfee and colleagues’ analysis of the ARMA and ALVEOLI trials (Calfee et al. 2015) differentiated two ARDS subphenotypes, one of which was categorized by more severe inflammation and worse clinical outcomes. Response to positive end-expiratory pressure (PEEP) was different in the two subphenotypes. High PEEP...
Indirect Calorimetry to Measure Energy Requirements: From Consensus to Daily Practice
Why Personalize Nutrition Therapy? The need for personalized nutrition therapy for ICU patients is shown by several observational studies that measured the energy needs of critically ill patients. The 2005 study by Villet and colleagues found that patients with an energy deficit had an increased number of complications, especially infections (Villet et al. 2005). Weijs and colleagues (2014) showed...
Optimising Nutrition With an Integrated Nutrition Module: Myth or Reality?
As a neurointensivist with a strong interest in nutritional support, I was delighted to trial a new integrated nutritional module. We know that nutrition really matters to our ICU patients in the context of first indicators. For example, our research group recently published a paper about two patients with viral meningoencephalitis. Invasive neuromonitoring of brain metabolism showed episodes of severe...
Point-of-View
Current State of Glycaemic Control Practice
Elevated blood glucose is a widely recognised response to critical illness, with most non-diabetic patients exhibiting concentrations outside the normoglycaemic range and a substantial proportion having significantly or hugely elevated blood levels (Farrokhi et al. 2011). It has been 15 years since the publication of the Leuven study abruptly changed the landscape of glycaemic control, highlighting...
Series - Biomarkers
Biomarkers in Heart Failure
Cardiac biomarkers, including natriuretic peptides and troponins, have become widely used in the treatment of heart failure and acute coronary syndrome. As we learn more about the function of these markers, their use has begun to expand. We can now track and utilise natriuretic peptides throughout hospital admission to monitor progress of heart failure therapy. Troponins and natriuretic peptides can...
Matrix
Difficult Intubation in the ICU: Why and How to Prevent and Manage Difficult Intubation?
Severe hypoxaemia and cardiovascular collapse, leading to cardiac arrest, cerebral anoxia and death, are the most frequent complications related to intubation in intensive care units (ICU), associated with difficulty of intubation. To prevent and limit the incidence of difficult intubation, specific risk factors for difficult intubation in the ICU have been identified and pre-oxygenation techniques...
Emergency Intraosseous Access: Novel Diagnostic and Therapeutic Possibilities and Limitations
The intraosseous needle is an essential tool in emergency settings when initial vascular access is difficult to achieve. This paper focuses on possible biochemical analyses on blood from emergency intraosseous needles, suggesting principles of use as well as pointing out advantages and shortcomings. Intraosseous (IO) access has been used since 1922 as a method for delivering fluids and medications...
Pain Assessment and Management for Intensive Care Unit Patients: Seeking Best Practices
This review article focuses on research-based advances in pain assessment practices in intensive care units (ICUs), and stresses clinician consideration of multimodal analgesic techniques for pain management in ICUs. Over the past 30 years, attention devoted to pain experienced by intensive care unit (ICU) patients has evolved from recognising pain as co-existing with ICU illness and treatment
Does Dexmedetomidine Reduce Delirium by Improving Sleep?
Delirium is a common complication in intensive care unit (ICU) patients and its occurrence is associated with worse outcome (Inouye et al. 2014; Abelha et al. 2013). Sleep disturbances are considered one of the important risk factors of delirium development (Flink et al. 2012). Recent evidence shows that dexmedetomidine, either at sedative or non-sedative doses, can improve sleep quality and reduce...
Early Mobilisation in ICU: From Concept to Reality - Four Steps to Change Patient Outcomes
For years, 28-day survival was the holy grail of ICU physicians. As ICU survival continues to improve, a high proportion of these ICU survivors experience significant cognitive, psychological, and physically disabling side effects of their ICU stay. These consequences of critical illness, regardless of their admitting diagnosis, have a dramatic impact on quality of life. Nearly half of these individuals...
Management
What Can Psychologists Do in Intensive Care?
As awareness has grown of the great distress intensive care patients may suffer, units have begun recruiting psychologists to their teams. Intensive care unit psychologists aim to assess and reduce distress for patients, families and staff, to improve outcomes. This paper summarises research on the psychological impact of critical illness, highlights the growth of critical care health psychology as...
Clinical Pharmacist Role in the ICU
We provide an overview of the various facets of pharmacist practice in the intensive care unit (ICU), the current extent to which pharmacists are present in the ICU, along with a discussion on barriers and lessons learned in garnering support for such a role. Caring for critically ill patients in an intensive care unit (ICU) is considered a standard of care in today’s environment. However, the ICU...
Social Media: Blessing or Curse?
Social Media in the “Real” World Social media is all around us, and enables real-time communication with patients, families and with colleagues. There are general social networks (Facebook), professional networks (LinkedIn), blogs (WordPress), microblogs (Tumblr) and media sharing sites for photos, videos and podcasts. The Wall Street fortunes of these companies may wax and wane along with usage, but...
Learning to Lead an ICU: New Course
A course for aspiring and practising intensive care unit (ICU) leaders will take place in Brussels in January 2017. ICU Management & Practice spoke to some of the faculty, which includes Editor-in-Chief, Prof. Jean-Louis Vincent, to find out more. Who is the course for? This course will attract participants from a variety of backgrounds and experience, including young, motivated doctors wh
Interview
Renal Replacement Therapy for Acute Kidney Injury: Questions Remain
Eric Hoste is Professor in Medicine and Head of Clinic at Ghent University Hospital, Belgium. Prof. Hoste’s primary clinical area of interest is clinical critical care nephrology, and he has published more than 190 original papers, review articles and book chapters primarily within this field. He is a Senior Clinical Investigator, Research Foundation-Flanders and a collaborating faculty member of CRISMA...
Country Focus
Brexit's Brutal Blow to the NHS
“I’m sorry. I’m just so sorry.” It’s 8am. Two junior doctors, one English, the other Italian, embrace in tears on the steps outside their hospital. We’ve saved lives together, lost patients together, run cardiac arrests, sought to comfort grieving families, seen patients make miraculous recoveries, witnessed death at its most unforgiving and ugly - all of it together. But as of June 23, 2016, while...
Agenda
Agenda
29 Nov-1 Dec 22nd Postgraduate Refresher on Cardiovascular and Respiratory Physiology Applied to ICM, Brussels, Belgium https://iii.hm/5ep 30 Nov-2 Dec DIVI 2016, Hamburg, Germany https://iii.hm/5er DECEMBER 1-3 8th International Baltic Congress of Anaesthesi