Editorial

Goal-directed therapy (GDT) continues to be a subject of controversy in intensive care medicine, especially after the results of recent trials exploring its effectiveness. Our cover story this issue looks at two aspects of GDT. Azriel Perel addresses some of the remaining questions about the practice of perioperative goal-directed therapy. Despite evidence supporting its routine use, it has not been...

News

Sepsis Care Faster, Reduced Mortality Suggested Harnessing vital signs information in the electronic health record (EHR) to develop an automated early warning and response system for sepsis led to a marked increase in sepsis identification and care, transfer to the ICU, and an indication of fewer deaths due to sepsis. A study assessing the tool, developed by Penn Medicine experts, is available online...

Highlights of the State of the Art Meeting 2014 Would you want to be admitted to hospital on a Sunday? As the NHS implements its drive to a full 7-day service, many in intensive care will say “we’re there already!” On Day 1 of the conference, Professor Julian Bion will outline a project examining (in the light of the higher mortality rate associated with weekend admission) the cost-effectiveness of...

Cover Story

Some Remaining QuestionsWhat is Perioperative Goal-Directed Therapy? Perioperative mortality of patients undergoing high-risk surgery has been steadily declining over recent years. And yet this reduced mortality rate is still considered to be higher than anticipated (Pearse et al. 2012). Newer approaches aimed at improving perioperative outcome and reducing its associated costs have been recently proposed....

Early goal-directed therapy (EGDT) is a therapeutic strategy based on haemodynamic monitoring and pre-defined goals. The roots of this approach come from observational studies in non-cardiac surgery that showed that poor post-operative outcomes and higher mortality were associated with decreased oxygen delivery in the perioperative period (Clowes et al. 1960; Shoemaker 1972).   Following those studies...

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Fluids

Asserting the existence of a state of permanent controversy is a staple during presentations on the topic of resuscitation fluids. Clinical audiences recognise a cliché when they hear it, and may disengage. This is unfortunate, since there has been a steady crescendo in the quality and quantity of clinical fluid science in the last two decades. In particular, our understanding of which fluid to use...

Matrix

Antimicrobial management in the intensive care unit (ICU) represents an ongoing challenge for critical care clinicians. The goal of this review is to focus on strategies aimed at optimising antimicrobial use within intensive care units.   Antimicrobial management in the intensive care unit (ICU) represents an ongoing challenge for critical care clinicians. In the ICU setting broad-spectrum antibiotic...

Key Messages 1. We need to Identify high risk patients early on during their hospital admission. 2. Recognise anticoagulant prophylaxis may not be suitable for all patients therefore consider other interventions to protect against VTE. 3. Focus on sustained education of healthcare professionals to increase   Venous thromboembolism (VTE) is commonly encountered and difficult to manage in critical care....

By taking the Hippocratic Oath, physicians commit to practising their art according to the current best scientific knowledge. For that purpose, all physicians need full access to the best knowledge (see Figure 1). The necessary steps include continuous innovation in healthcare, followed by appropriate translation of innovative care into routine practice and eventually reassessment of remaining gaps...

Management

While prognosis of elderly patients in intensive care is often seen as poor, this is largely due to deficits that can be described with the vocabulary of frailty and its measures. Using the Clinical Frailty Scale as a tool to assess patients referred to intensive care might facilitate discussions about treatment aims, and identify patients who are likely to require enhanced support for re-enablement...

Is there a correlation between health and economic growth? Can the healthcare sector be an answer to the current weak economic growth in the leading industrial nations?   So far, the economic development of the industrialised nations has been disappointing during the 21st century. And the situation would be even worse, had the administrations not helped the economy by taking on enormous debt and had...

Interview

Professor Bertrand Guidet is Director, Medical Intensive Care, St. Antoine Hospital, Paris, France andMedical Director, APHP Hospitals, East Paris.You have a long-standing interest in ICU care and elderly patients. What prompted your interest? We should not consider the ICU as a unique unit. It is part of the hospital and there is treatment before and after ICU. This is true for all ICU patients,...

Country Focus: Turkey

The history of intensive care (IC) in Turkey has followed a somewhat similar pattern to other European countries (see Figure 1). The first intensive care unit (ICU) was founded in a state hospital in Istanbul in 1959. The first attempts to institute intensive care in several cities were performed almost exclusively by anaesthesiologists. In 1977 those pioneer anaesthesiologists attended their first...

In Turkey intensive care was not a separate specialty for years, and was managed mainly as a subspecialty of anaesthesiology. In 2009 a new regulation was announced by the Ministry of Health (MoH) in which intensive care medicine (ICM) was recognised as a supraspecialty. Regarding this regulation, ICM education has a duration of three years after primary specialty training in anaesthesiology, pulmonology,...

Agenda

DECEMBER   3-5 International Sepsis Forum, New ChallengesParis, France www.internationalsepsisforum.com 4-5 Airway for Anaesthesiologists 2014Copenhagen, Denmarkwww.airwaymanagement.dk 7-10 Update on Antibiotic Therapy in the ICURome, Italywww.intensive.org 8-10 Intensive Care Society State of the Art Meeting


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