Editorial
The Perfect ICU
A disheartening moment in any medical department, particularly in the critical arena, is that of unforeseen human error leading to injury. With teams doing their utmost to ensure the best chances of survival for patients, the inevitability of occasional mistakes occurring in what is an immensely complex system is a distressing concept to shoulder. The emphasis here is that these events should occur rarely;...
Research News
Immune System Tricked to Accept Mismatched Donor Organs
A group of scientists have found a method for deceiving the immune system so that it will accept organs from an incompatible donor, a finding that could help patients avoid a lifetime of medication to prevent rejection of the organ. The procedure involves suppressing the patient’s bone marrow with chemotherapy and radiation before they undergo surgery; a day later they are transplanted with the donor's...
Early Surgery for Refractory Epilepsy Improves Quality of Life
Patients with drug-resistant temporal lobe epilepsy may benefit from surgical intervention soon after failure of two antiepileptic drug (AED) trials, according to results of the Early Randomized Surgical Epilepsy Trial (ERSET). Surgery is usually seen as a last resort, but researchers have concluded that earlier intervention could help epilepsy patients avoid decades of disability. The findings sug...
Management News
Shortage of ICU Beds Leads to Patient Deaths
A lacking supply of ICU beds is leading to preventable deaths, according to a study from France. Dr. Rene Robert of Hopital Jean Bernard in Poitiers, France and colleagues found that out of 1,332 patients referred to ICUs in those hospitals over a three-month period, almost 15% were turned away, at least temporarily, because there were no beds available. They also concluded that those patients that got t...
A Case Study of Patient-Centred Care
The Intensive Care Unit of Tomorrow
The University Medical Center Utrecht (UMC Utrecht) is a 1,042 bed hospital, which admits approximately 30,000 inpatients per year. All academic specialties are present and the hospital provides a core service in heart and lung transplantations, ventricular assist devices, trauma, neurosurgery, oncology, haematology and AIDS patients. In 2004, an independent survey measuring the quality of care and effecti...
Cover Story
Improving handovers by learning from Scuderia Ferrari
Introduction It has been nearly a decade since seminal reports and associated research documenting the surprising frequency of accidental injury in healthcare were published in the UK and around the world (Vincent, Neale and Woloshynowych 2001). Around that time, complex and systemic causes of a sequence of probable accidental deaths at the Bristol Royal Infirmary were emerging, while research at Great Ormo...
The Intensive Care Unit of Tomorrow: A Case Study of Patient-Centred Care
The University Medical Center Utrecht (UMC Utrecht) is a 1,042 bed hospital, which admits approximately 30,000 inpatients per year. All academic specialties are present and the hospital provides a core service in heart and lung transplantations, ventricular assist devices, trauma, neurosurgery, oncology, haematology and AIDS patients. In 2004, an independent survey measuring the quality of care and effect...
New Ambulance Concepts to Improve Care in the ICU?
The Helen Hamlyn Centre for Design at the Royal College of Art in London has a focus on people- centred and inclusive design. From its origins, researching and designing for an ageing population, its work has grown over the past 20 years to encompass better healthcare and better workplaces, because many people now live and work longer despite age-related changes in their abilities. To focus on these increa...
Nutrition
Excellence in Nutrition Therapy
Lessons from the International Nutrition Survey and the Best of the Best Awards Over recent years, nutrition therapy for critically ill patients has gained momentum as an essential part of patient care. Research into this often undervalued intervention has escalated, demonstrating that providing the right amount of nutrition in general, and of specific nutrients in particular diseas...
Intensive Care Dietitian: An Important Contributor to Quality of Care
Many experts have shown that nutritional therapy improves intensive care unit (ICU) outcomes. In particular, the use of early enteral nutrition (EN), as recommended by ESPEN guidelines (2006), is associated with a reduction in mortality in the sickest patients (Artinian et al. 2006). Paradoxically, enteral feeding is most difficult to perform in the sickest patients, and several studies have revealed very...
Series
The Future of Non-Invasive Ventilation
Introduction Non-invasive ventilation (NIV) provides safe and effective assistance to patients with acute respiratory failure (ARF) from various causes (Garpestad et al. 2007). The main reason for applying NIV is to avoid the complications of endotracheal intubation, according to Evans et al. (2000). The ventilator setting generally used to apply NIV is Pressure Support Ventilation (PSV), delivered via an o...
Fluid Overload is Not Only of Cosmetic Concern
Introduction Capillary leak complicates conditions that are characterised by inflammation, infection and resuscitation. It is important to understand the pathophysiologic basis in order to minimise fluid, electrolytes, proteins and other molecules that extravasate from the vascular space into the interstitium. Capillary leak not only contributes to peripheral but also organ oedema, as well as pleural effu...
Decreasing Central Line Associated Bacteraemia in a New Zealand Intensive Care Unit
Putting Evidence into PracticeIntroduction Central venous catheters are commonly used in intensive care units, with studies suggesting that approximately 50% of ICU patients have such lines inserted. Meanwhile, central line infections are responsible for 40-60% of bloodstream infections in intensive care patients, according to New South Wales Health (November 2008). These incidents are known as central lin...
Viewpoints
An Emerging Consensus for Acute Kidney Injury
Acute kidney injury (AKI) is a hot topic in the medical arena, with prominent research and discussion ongoing, prompting amendments to recommended practice. The Acute Kidney Injury Network (AKIN) and Acute Dialysis Quality Initiative (ADQI) and AKI section of the European Society Intensive Care Medicine (ESICM) continue to work on counsel for clinical practice and research, while new guidelines from Kidney...
Matrix
Past and Present Challenges in ICU Management
Introduction Maintaining an intensive care unit (ICU) and providing intensive care for all patients who benefit from it necessitates a high investment in personnel, technology, and material resources within a short time period, and is naturally associated with costs. The complexity of the care processes involved, and the fluctuation in the number of patients needing intensive care at a specific time, make...
Country focus: The Netherlands
Dutch Intensive Care Medicine: Its Start, Professionalism and Future Prospects
The Dutch Society of Intensive Care celebrates its 35th anniversary this year, prompting this overview of developments in intensive care medicine within the Netherlands and the society known as Nederlandse Vereniging voor Intensive Care (NVIC), looking at eras of evolution and innovation, as well as assessing what the future holds. The Emergence of Intensive Care Medicine in the 1950’s and the Role of P...