Editorial

The progress towards, and potential of, personalised/ precision medicine in intensive care is the theme for our cover story. We are making progress in moving away from therapies based on poorly characterised patient populations to more personalised treatment of critically ill patients, although true precision medicine, based on individual genes, environment and so on lies some way in the future. Andrew...

News

Acute kidney injury (AKI), a rapid decline in renal function, is highly prevalent in critically ill patients, and is associated with an increased risk of short- and long-term complications that extend beyond the acute phase (Pickkers et al. 2017). AKI is defined and classified by an increase in serum creatinine or a decline in urine output, both late and non-specific markers of the underlying phenomenon....

The Surviving Sepsis Campaign (SSC) (survivingsepsis.org), has released its 2016 guidelines for the management of sepsis and septic shock. The document, published simultaneously in Critical Care Medicine and Intensive Care Medicine, is an update to the 2012 SSC guidelines. The recommendations in the document cannot replace the clinician’s decisionmaking capability when presented with a patient’s unique...

Cover Story

The specialty of intensive care medicine grew out of the realisation that critically ill patients needed more attention and specialised treatment than could be provided on a general ward, and that many of these patients had similar clinical problems and processes, so management would be facilitated if they were grouped together in one place. Since those early days, intensive care medicine has grown...

Multiple failed clinical trials testing immunomodulatory therapies for sepsis argue for a new approach. While precision medicine has been successfully implemented in other fields, testing it in sepsis poses challenges, which this review will discuss, along with potential implementation strategies.Sepsis has an estimated annual incidence of 1.3 million cases and 230,000 deaths (Stoller et al. 2016)....

What is the path forward for treatment of acute respiratory distress syndrome (ARDS)? Is it big trials (favoured by clinical scientists) or further insight into disease physiopathology (favoured by basic scientists)? Or both? Funding resources are limited and the debate is wide open. In the post-genomic era, a new direction is needed. On 20 January 2015, then U.S. President Barack Obama announced the...

Advertorial

Mechanical ventilation has become the established standard therapy for acute respiratory failure in modern intensive-care medicine. Although intensive-care ventilation frequently represents the only option to ensure sufficient pulmonary gas exchange and adequate tissue oxygenation, ventilation therapy can also cause further lung damage and lead to ventilation-induced lung injury (VILI).   While v...

Matrix

  Multidrug resistance (MDR) is increasing worldwide and has been acknowledged as one of the major threats to healthcare by the World Economic Forum and the World Health Organization (World Health Organization 2014). Intensive care unit (ICU) patients seem to be particularly susceptible for acquiring MDR organisms, either just as colonisers, or as pathogens causing invasive infection. This increased...

Treating patients with multidrugresistant (MDR) pathogens is an increasing challenge for intensive care unit (ICU) physicians. In the ICU, compared to other hospital departments, severe infections are most prevalent and antimicrobial use is most abundant. Not surprisingly, antimicrobial resistance (AMR) has emerged primarily in the intensive care setting, where multiple facilitators for the development...

Invasive ventilatory support, one of the most frequently applied strategies in intensive care unit (ICU) patients, is increasingly recognised as a potentially dangerous intervention. Recognition of so–called ventilator– induced lung injury and the broad acceptance of lung–protective ventilation strategies in ICUs worldwide led to noticeable changes in ventilatory management (Putensen et al. 2009; Briel...

EEG measures continuously at the bedside the human brain’s electrical activity. Its main advantages are noninvasiveness, good spatial and temporal resolution, and sensitivity to changes in both brain structure and function. In ICU, seizures are frequent in patients with/without acute brain injury. They are often difficult to recognise, because they are non-convulsive. This provides support in favour...

Evidence shows that sonography of the brain can be used to visualise most of the intracranial structures, allowing estimation of the risk posed by life-threatening conditions, such as raised ICP, intracranial haematoma, hydrocephalus and midline shift.Brain ultrasound is increasingly used in the critical care setting. This technology is noninvasive, associated with low radiation exposure, and available...

Serum albumin is an essential plasma protein, with a variety of homeostatic and predictive roles in health and disease (Figure 1). Hypoalbuminaemia is common in critical illness. Human albumin solution has been administered clinically for more than five decades, but its use has been subject to marked controversy for the last twenty years (Fanali et al. 2012). This has shaped not just day-to-day practice...

Management

Darryl O’Callaghan and Julie Vermeir are survivors of a road trauma that happened in 2010. Their article provides insight into their journey as patient and wife, and the lessons that can be learnt.   Darryl’s Story   There are many courageous souls who have lost their lives attempting to climb Mt Everest. Those who attempt such a climb arrive at the foot of the mountain after many years of prepara

What is human factors? How would you explain to a hospital director why they should hire human factors specialists?   Human Factors (HF) is the study of how people interact physically and psychologically with their environment—this includes the products, tools, procedures and processes they interact with. HF professionals use insights about human limitations, cognitive biases and social interactions...

Advancing Research in the Intensive Care Unit via the Integration of a Nursing ProfessorAdvances in healthcare and management strategies for the critically ill patient continue to evolve at a rate that can become challenging for individual clinicians to keep abreast. It is crucial that medical, nursing and allied health professionals use an evidence-based practice (EBP) approach to support these advances...

The ICU-Hear project delivered by the charity Music in Hospitals™ provides specialised live music sessions for critically ill patients. The initiative started after Helen Ashley Taylor (a former ICU patient) met Sister Natalie Mason, Adult Critical Care Follow up Lead at Manchester Royal Infirmary at a regional support group for former ICU patients. Helen had volunteered for the charity Music in Hospitals...

Interview

Peter Pronovost, MD, PhD, FCCM, is Director, Armstrong Institute for Patient Safety and Quality, Senior Vice President, Patient Safety and Quality and Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Medicine in Baltimore, Maryland, USA. Dr. Pronovost is a leading authority on patient safety and developed a scientifically proven method for reducing central-line associated bl...

Country Focus

Medicine in mainland China has progressed rapidly during the past 20 years along with rapid economic development. Although the number of ICU beds, doctors and nurses has increased, postgraduate professional education is still lacking. This article gives an overview of the history and current state of intensive care in China.   Critical care was recognised as a medical speciality in China less than...

Agenda

April 20176-8ESICM EuroasiaHong Kong, China20-24SG-ANZICS Intensive Care Medicine Forum SingaporeMay 20174-7EuroELSO 2017, Maastricht, the Netherlands10-12Smart Meeting Anesthesia Resuscitation Intensive CareMilan, Italy11-132nd Annual Dubai International Conference on Infectious Diseases and VaccinationDubai, UAE14-17Future of Critical Care - A Brainstorming MeetingLisbon, Portugal18-202nd Europe



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