The Abdomen

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 programmes guide treatment decisions.

Next, Annika Reintam Blaser and colleagues explain ‏when enteral feeding is feasible for critically ill patients ‏with abdominal conditions: emergency gastrointestinal ‏surgery, open abdomen, abdominal aortic surgery, trauma, ‏abdominal compartment syndrome, severe gastrointestinal ‏bleeding, bowel ischaemia, obstruction and paralysis as ‏well as acute colitis with toxic megacolon. They recommend ‏that enteral nutrition is considered early for most ‏patients following initial management of abdominal crisis. ‏

Acute-on-chronic liver failure does not preclude admission ‏to the intensive care unit (ICU), according to Alexander ‏Wilmer and Philippe Meersseman, who review the ‏latest insights on this serious condition and their potential ‏repercussions on the way intensivists should understand ‏and manage patients with ACLF. Lastly, Manu Malbrain ‏provides some answers to the unanswered questions about ‏intra-abdominal hypertension and abdominal compartment ‏syndrome.

In our Matrix section Shashank Patil advises how pointof- ‏care test devices can be implemented effectively in an ‏emergency department, with great benefit for patient ‏management. Next, Silvia Terraneo and colleagues explore ‏the role of Candida spp. in the respiratory tract, asking whether ‏there is a real causality between Candida spp. and worse ‏outcomes, or whether it is simply a marker of severity. ‏

Simon Bocher and colleagues review recent data on the ‏type of vasopressors to use in sepsis, the timing of infusion, ‏the mean arterial pressure target and alternative approaches. ‏Pieter Depuydt and Lisbeth De Bos discuss controversies ‏regarding ventilator-associated pneumonia diagnosis: ‏whether invasively obtained microbiology improves diagnosis ‏and outcome, ventilator-associated tracheobronchitis ‏as a separate condition and the concept of ventilator-associated ‏events. Alexandre Lima and Michel van Genderen ‏review the latest developments in noninvasive monitoring ‏of peripheral circulation, which they suggest should ‏be central to intensive care clinical practice. Last, Richard ‏Gunderman and LeLand considers the power of touch in ‏healthcare.

In our Management section, Lucy Modra and colleagues ‏from the Women in Intensive Care Network in Australia ‏spell out the startling gender disparity in intensive care ‏medicine leadership and provide suggestions for improvement, ‏so that the sustainability and quality of intensive care ‏leadership is assured. Next, a cri de coeur from Armand Girbes ‏and colleagues, who contend that a jumble of rules, protocols, ‏checklists on both sides of the Atlantic 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.

Intensive care units naturally put all their efforts into ‏treating patients when they are in the ICU. However, rehabilitation ‏after leaving the ICU is a somewhat neglected ‏area and post-intensive care syndrome is a burgeoning ‏area of research. Tara Quasim and Joanne McPeake share ‏their experiences of setting up a peer-supported, selfmanagement ‏programme aimed at empowering patients ‏and relatives after leaving the ICU.

Our interview is with Gernot Marx, 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. University ‏Hospital Aachen has pioneered tele-ICUs, and Marx ‏shares his thoughts on this and on his research into sepsis ‏and fluids.

Our Country Focus is Brazil. Jorge Salluh and Thiago ‏Lisboa describe the challenges and opportunities for critical ‏care in this vast country, where there are active critical ‏care research networks and quality of care initiatives. ‏The ICU Management & Practice team will be at the European ‏Society of Intensive Care Medicine Congress in Milan ‏this month. If you will be attending, make sure to drop ‏by to say hullo and pick up your copy of the journal.

As always, if you would like to get in touch, please email [email protected]