ICU Management & Practice, ICU Volume 15 - Issue 4 - 2015
Providing seamless emergency care is the ideal for
those of us who work in emergency medicine
and intensive care. In the past, intensive care
units were a closed part of the hospital, and admission
was strictly controlled. This idea is obsolete now. It is
heartening that we are providing more integrated care
between emergency and intensive care. Intensivists need
to go out of the ICU and take action earlier to stabilise
and admit patients — before they are severely affected.
We do this for trauma, and we are doing this for sepsis.
We talk about the “golden hour”, but of course every
minute counts. Can we take action even earlier for more
conditions?
Our Cover Story addresses some of these issues.
Starting with acute ischaemic stroke, Jason Van Schoor,
Vivian Sathianathan and David Brealey argue that, when
compared with other serious ICU diagnoses such as
severe sepsis and long term ventilation, the outcome of
AIS patients on ICU compares well. They suggest that this
comparison should shake the historical reluctance that
surrounds admission of stroke patients to ICU. When
treating patients in cardiac arrest, targeted temperature
management is the key intervention for improving
neurological outcomes after cardiac arrest. Jean Baptiste
Lascarrou and Jean Reignier discuss new data on the
optimal timing and modalities of targeted temperature
management. For burns management, regionalisation of
centres has led to improved outcomes, argue Sam Miotke,
William Mohr and Frederik Endor. They contend that
the complexity of patient care, both in the short- and
long-term, requires a well-prepared interdisciplinary
team. Such implementation has been made possible
by centre regionalisation, which consolidates expert
wound care and critical care management, with benefits
for patient outcomes.
Next, Aristomenis Exadaktylos and Wolf Hautz provide a
snapshot of the pre-hospital emergency system, focusing
on Berne. Michael Reade provides a review of blast
injury, outlining what to expect in civilian versus military
injuries. He observes that mistaken preconceptions of
the medical consequences of blast can lead planners and
managers to allocate resources incorrectly. Civilian blast
injuries are not rare, but most are not due to military
explosives, meaning extrapolation from military texts
is often inappropriate. Last, Anatole Harrois and Jacques
Duranteau focus on the types of fluid available and their
respective indications in the course of trauma resuscitation.
Our series on Infections concludes with an article on the
ICU response to the Middle East Respiratory Syndrome
(MERS) Coronavirus by Hasan Al-Dorzi, Hanan Balkhy
and Yaseen Arabi. They emphasise that prevention of
healthcare-associated transmission should be the main
focus of ICU preparedness.
In the Matrix section, Stuart McGrane, Heidi Smith and
Pratik Pandharipande discuss acute brain dysfunction
during critical illness. They outline risk factors, prevention
and treatment, and reason that delirium monitoring
and management may help decrease development and
duration of delirium in adults and children. Next, Matthew
Kirschen and Peter Le Roux focus on the current experience
with clinically available neuromonitoring techniques in
critically ill patients at risk for neurological compromise,
but without overt acute brain injury.
Although finding evidence has got easier with electronic
databases and the Internet, translating knowledge into
practice can still take time before it has a discernible
effect. aC3KTion Net in Canada is a knowledge translation
network, and Nicole O’Callaghan and John Muscedere
outline its work in quality improvement in our Management
section. Next, we feature an interview with Daren
Heyland, who directs the Canadian Researchers at theEnd of Life Network (CARENET), about the network’s
activities, which includes the development of innovative
resources to prompt discussions about end-of-life care,
both for patients and for health professionals.
It is fair to describe Michael Pinsky as a true leader of
critical care. He is interviewed in this issue about some
of the fundamentals of critical care he has been involved
in over the years as a researcher, practitioner and leader.
New Year, New Name
In 2016 ICU Management changes its title. Since we began
publication in 2000, we have always been the Official
Management and Practice journal of the International Symposium on Intensive Care and Emergency Medicine (ISICEM). To better reflect the contents of the journal, we
will bring practice alongside management to become
ICU Management & Practice.
Not only are we changing title, but the journal will be
even bigger. I thank the Editorial Board for their continuing
support, the many authors from around the world who
write for the journal, and you, the readers. As always, if
you would like to get in touch, please email [email protected]
