ICU Management & Practice, ICU Volume 12 - Issue 4 - Winter 2012/2013

The Global ICU

If we look at intensive care in the global context, a myriad of challenges, issues, and also opportunities present themselves, where involvement and commitment from developed and developing nations is increasingly recognised as necessary to reach targeted improvements. From working to enhance intensive care in developing nations and resource-poor settings to responding to endemics there are always lesson...

C. Difficile Researchers Reveal Potential Target to Fight Infections

Researchers have discovered how Clostridium difficile, a common germ in healthcare-associated infections, sends the body's natural defenses into overdrive, actually intensifying illness while fighting infection. The discovery at Virginia Bioinformatics Institute at Virginia Tech in the US, which was recently published in PLOS One, may lead to new drug treatments for C. difficile. The bacterium has be...

West Nile Virus Encephalitis: Recognising and Diagnosing Infection

The increasing spread of West Nile virus (WNV) infection is worrying and requires that all intensivists be ready to recognise and diagnose the disease. Most individuals infected with WNV are asymptomatic, while one-fifth experience a flu-like illness and less than 1% develop neuroinvasive disease. Introduction West Nile virus, the most widely distributed arbovirus, belongs to the genus Flavivirus,...

Valuing Prevention as the New Paradigm in Global Health

Managing Population Immunity for Vaccine Preventable Diseases One lesson from progress towards polio eradication suggests that using models and measurements together to manage population immunity may play a key role in supporting the paradigm shift required to value prevention and realise the full benefits of vaccines (Thompson et al. 2012b). This paper...

Challenges and Changes in Mexico After the Influenza AH1N1 Outbreak

From Standard ICU to Tele Presence with Robotics and Tele-Ultrasound From March to December 2009, the Influenza AH1N1 outbreak was observed in several cities of Mexico, showing deep flaws in the healthcare system and a general lack of knowledge on how to act and react in case of an epidemic. Because of that, thousands of people got infected and high mortality was observed in intensive care units (ICUs...

Challenges in Critical Care in Africa: Perspectives and Solutions

Critical care medicine in Africa is largely an unknown entity in the medical world, though it has recently begun to emerge as a prominent concern, mostly due to increasing research that has highlighted the plight of this sub-specialty in Africa (Adhikari et al., 2010, Riviello et al., 2011). However, the fact that critical care medicine is considered an expensive sub-specialty of medicine in so many aspe...

Improving Obstetrical Critical Care in Developing Nations

A Thematic Review of Challenges and Solutions ringing down maternal morbidity and mortality rates and thereby improving reproductive health services has been a major concern in developing nations for the past few decades. In spite of adopting on the various measures and implementing new strategies, the adversity in maternal health has not been managed entirely. This thematic review is an attempt to briefl...

Pharmaconutrition with Antioxidants in the Critically Ill

Is Selenium Monotherapy the Cornerstone of this Strategy? This article explores the evolving paradigm of pharmaconutrition using antioxidant micronutrients, looking at the available evidence for antioxidant supplementation in the critically ill. In particular it discusses the protective mechanisms of action of selenite in critically ill SIRS patients and how selenium supplementat...

Fluid Management in Critically Ill Patients: A Guided Approach

Critically ill patients are at risk of developing acute cardiovascular insufficiency or shock from any cause, defined as the imbalance between oxygen delivery and tissue oxygen consumption. This state is characterised by cellular dysoxia that, maintained over time, might progress to multi-organ failure and death. In order to prevent these consequences, haemodynamic resuscitation has to be started early an...

Management of Candiduria: Grey Zones Still Exist

Candida species cause a wide spectrum of diseases, of which the prevalence of candiduria varies considerably between nosocomial settings, being most prevalent among patients admitted to the intensive care unit (ICU). However, lacking management and treatment guidelines and the existence of dilemmas have inhibited efforts to curtail cases of candiduria for this vulnerable population. Critically ill p...

A Review of the Evolving Paradigm Shift in Intensive Care Unit Sedation Practices

A Review of the Evolving Paradigm Shift in Intensive Care Unit Sedation Practices

Most mechanical ly vent i lated, cri t ical ly i l l adul ts wi l l require some degree of sedation during their intensive care unit (ICU) stay, an area which has been experiencing significant change in recent years. The goal of this article is to afford a concise, stateof- the-art review of the evolving paradigm shift in ICU sedation practices; current indications for prolonged, uninterrupted, and/or dee...

Therapeutic Hypothermia in the ICU: Indication, Sedation and Prognostication

Mild therapeutic hypothermia (TH) applied for 24 hours in the intensive care unit (ICU) is now recommended in comatose survivors of an outof- hospital cardiac arrest (OHCA), though some uncertainty around indication, clinical management and prognostication still remains. We will probably see this exciting field of intensive care further evolve in the coming years. The aim of this overview is to present s...

Ethics in Simulation for Intensive Care

In this paper we investigate the relationship between simulation and ethical care in the intensive care unit (ICU), primarily analysing the uses of simulation-based training in helping learners to improve their ethical decision-making processes and better react to and reflect upon moral dilemmas. Ethics and simulation-based training can be connected from different perspectives: 1. The whole idea of u...

Collective Global Action in Critical Care: An Interview with Dr. Edgar Jimenez

As President of the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM), as well as Head of the Corporate Division of Critical Care Medicine at Orlando Health Physicians Group, Dr. Edgar Jimenez is an expert in intensive care on many levels. In this interview, Dr. Jimenez tells us about the most significant developments he has led in the global intensive care field, and what i...

Overview of Current Intensive Care Services in Hungary

Introduction The Hungarian Society of Anaesthesiology and Intensive Therapy (MAITT) was founded as a section within the Hungarian Surgical Society in 1958. Since then, anaesthesia became an independent specialty, and in 1978 it was linked with intensive care. There are four medical universities in Hungary, and during the late 1970s all of them established an Anaesthesia and Intensive Care Department, wi...