Editorial
After ICU
One of the most positive components of our roles in intensive care is that on any given day we are privy to real-life dramas wherein patients, who often enter our units with low scores and little hope of survival; endure, fight, recover and ultimately move to the wards or leave hospital. These stories are inspiring, and rewarding, and they remind us why we have chosen the field of critical care medicine....
News
In Memoriam
If ever a doctor deserved the title of “Father of Critical Care Medicine”, it is Dr. Max Harry Weil, MD, PhD, ScD (Hon). Concerned by the lack of close monitoring of critically ill patients, in 1958 Dr. Weil developed the famous Shock Unit at the University of Southern California. He was always an innovator, full of new ideas, and passionate about his subject. His contributions to critical care medicin...
Research News
Statins Reduce Deaths From Infection and Respiratory Illness,
Data Eight Years on From Trial Suggests The death rate among patients prescribed a statin in a major trial that ended in 2003 is still lower than those given a placebo, even though most participants in both groups have been taking statins ever since. ASCOT, the Anglo-Scandinavian Cardiac Outcomes Trial, was stopped early because the statin was so effective at preventing heart attacks and strokes, but a new...
Cover Story
After ICU
Introduction Intensive care medicine is quite a recent medical discipline born around 1950. At the beginning, the medical world held an illusion that new highly sophisticated techniques would allow for the recovery of every single patient. A half century later, the discipline has grown up and there is a realisation that while many more lives can be saved and obviously fewer patients die, the many patients...
Implementing a Diary Programme in Your ICU
Patients recovering from serious illness have been shown to be at risk for developing Post Traumatic Stress Disorder (PTSD). Studies show that around 1 in 10 patients with an ICU stay of 48 hours or more develop PTSD (Jones et al. 2007). Since the 1980s, it has been known that patients don’t tend to remember much from their time in ICU and as doctors and nurses we thought that was good. If patients a...
Improving Long-Term Recovery after Critical Illness in the UK
Background Critical Illness Critical illness is any form of illness that represents an immediate threat to life.The major purpose of Intensive Care Units (ICUs) is to treat patients with potentially reversible forms of critical illness. Until recently, the major focus in ICU research has been on survival, usually short-term survival, and with modern day ICU treatment around 80% of critically ill patients...
Helmet Non-Invasive Ventilation
Introduction Non-Invasive Ventilation (NIV), the provision of ventilator assistance using techniques that do not bypass the upper airway, is widely used in the management of selected patients with acute respiratory failure (ARF). The main theoretical advantage of NIV is avoiding the side effects and complications related to endotracheal intubation (Pingleton 1988). NIV interfaces are devices that c...
Series
A Change Management Perspective on a Novel Meta-Analysis:
The first step in any practice change initiative involves an 'appraisal' of the research evidence to understand its inherent potential to change practice. As an example, a novel meta-analysis of early enteral nutrition in trauma is assessed. Introduction Up to 30% of all hospitalised patients receive care that is inconsistent with current best research evidence (Buchan 2004). Evidence-practice gaps c...
Impact of Pharmacokinetics of Antibiotics in ICU Clinical Practice
Introduction The efficacy of a drug is mainly dependent on its ability to achieve an effective concentration in the target tissue. However the risk of toxicity limits the dose that can be administered. Critically ill patients often have increased cardiac output, capillary leak, modification of proteins serum levels and binding properties. Additionally increased renal and hepatic clearance or, on th...
Long-Term Outcome After Abdominal Compartment Syndrome
Introduction The past two decades have witnessed a tremendous evolution in our understanding and management of patients with Intra- Abdominal Hypertension (IAH) or Abdominal Compartment Syndrome (ACS). Improved diagnosis and institution of both medical and surgical management strategies have significantly increased survival, improved long-term functional outcome, and decreased hospital resource utilisatio...
Matrix
Avoiding Disasters
A Tool for Estimating the Needs of Healthcare Resorces at Sporting and Other Public Events Co-authors Amir Khorram-Manesh, MD, PhD Annika H.E. Hedelin, RN Per Örtenwall, MD, PhD Sporting events have the potential to turn into major incidents. Thus, as part of the planning for such events, there should be an estimation of the needs for medical teams and healthcare resources based on a simple calculating m...
Viewpoints
We Need to Connect
For this "After ICU" edition of ICU Management, Managing Editor Sherry Scharff sat down with Jean-Daniel Chiche to discuss a range of engaging topics including the allure of intensive care medicine as a specialty, the need to push away from the "hero" culture and the importance of being human. What Brought You to the Field of Intensive Care? When I first entered the ICU as a medical student, I was immed...
Interview
Overview of Irish Healthcare System
Ireland is one of a small number of countries where the delivery of Health and Social care services comes under the auspices of one government department. The range of services delivered ranges from neurosurgery at one end of the spectrum to child and family welfare services on the other end. Services are usually categorised by acute care, primary care, continuing care and community care services - such...
Intensive Care Medicine in Ireland
Still in the throes of economic turmoil and famous for political disputes, there are many reasons why one might wonder how Ireland's Intensive care Medicine (ICM) system could be accurately summarised while the country remains in such a state of flux. The division of this island into Northern Ireland and the Republic has never prevented close cooperation within the ICM community, however. Although two heal...