ICU Management & Practice, Volume 16 - Issue 2, 2016
The publication of the landmark Institute of Medicine report To Err is Human shocked with its estimate that as many as 98,000 people die in U.S hospitals each year due to medical errors (Kohn et al. 2000). Has patient safety improved since the report’s publication? Perhaps not as much as anticipated. A recent paper estimates that medical error is the 3rd leading cause of death in the United States (Maka...
depression, caregivers, post-icu
Caregivers of ICU Survivors at High Risk of Depression
A Canadian study has found that caregivers of ICU survivors experience symptoms of depression up to 1 year after their relative is discharged (Cameron et al. 2016). Factors associated with worse mental health symptoms included younger age and less social support and sense of control over life. Older caregivers caring for a spouse, with a higher income and better social suppo...
critically ill, persistent critical illness, PerCI
Persistent Critical Illness
A study of over 1 million ICU patients has found that just 5 percent of patients account for 33 percent of ICU bed days. The researchers, led by Theodore Iwashyna, MD, Associate Professor of Internal Medicine at the University of Michigan (U-M) Health System and a member of the VA Center for Clinical Management Research and the U-M Institute for Healthcare Policy and Innovation, have identified these patie...
critical care, resuscitation, patient transfer
Dedicated Resuscitation Unit Improves Transfer Times
A critical care resuscitation unit (CCRU) at the University of Maryland Medical Center (UMMC) has significantly improved transfer times for non-trauma critically ill patients, according to a recent study (Scalea et al. 2016). In its first full year of operation, for the subset of adult patients admitted for critical care, transfers increased 64.5 percent compared to a previ...
Patient safety, transport, critical care transport
Safe Transport of Critically Ill Patients
The transport of critically ill patients for diagnostic or therapeutic procedures carries a particular risk and requires therefore a careful risk-benefit assessment. Transport-related risks can be reduced by increased awareness and education, adequate staffing, proper choice and handling of equipment and the use of error-preventive tools like checklists. Intensive Care Units (ICUs) have been developed to...
Patient safety, social media, blogs
Patient Safety and Social Media
Patientsafe represents a group of healthcare staff focused on introducing effective and sustainable healthcare solutions. ICU Management & Practice emailed the team to find out more about their Twitter account and blog. Your Twitter strapline is "Front Line Staff Implementing Effective Safety Solutions” Who’s behind patientsafe? Patientsafe started as a small group of three critical care subspeci...
Vascular access, catheters, guidelines
Making the MAGIC
Guiding Vascular Access Selection for Intensive Care - a Summary of Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) Determining appropriateness for vascular access devices limits the risk of complications in critically ill patients. Michigan Appropriateness Guide to Intravenous Catheters (MAGIC) establishes evidence-based indications as summarised in this paper. Safe and reliable venous...
Bronchoalveolar lavage, ventilator-associated pneumonia, VAP, diagnosis
Treating Complications from Abdominal Surgery
Use of the HALYARD* Mini-BAL Sampling Catheter proved invaluable in the case of a patient experiencing complications from abdominal surgery. Dr. Roberto Oggioni has been director of the Department of Anaesthesia and Intensive Care at S. Giovanni di Dio Hospital since 2012, and wrote up the case with colleague Dr. Margherita Labardi for ICU Management & Practice. Case Report from March 2014 Patient F...
Clostridium difficile, patient safety, quality
A Public Health Threat That Should Be Routinely Included Within Care Quality and Patient Safety Programmes This paper provides an overview of the evidence confirming that CDI independently increases mortality risk in hospitalised patients, and argues for system-wide implementation of specific actions, including care bundles for management (not only infection control) and mandatory surveillance, to improve...
Crew resource management, training
Implementation Challenges of Crew Resource Management
Crew Resource Management (CRM) human factors awareness training is a useable tool in medicine and may fill a void in medical education curricula. Factors impacting CRM implementation into the clinical environment are identified. Human factors (HF) account for the majority of adverse events in highrisk environments, and human factors awareness is therefore essential. Aviation-derived HF awareness training...
Series – Biomarkers
biomarkers, AKI, acute kidney injury
Biomarkers for Acute Kidney Injury
Acute kidney injury (AKI) has been recognised as a major public health problem. It affects >50% of patients in the Intensive Care Unit (ICU) and is associated with serious short- and long-term complications, premature death and high financial healthcare costs (Mehta et al. 2015; Hoste et al. 2015; Lewington et al. 2013). The consensus definition of AKI has emerged from the Risk, Injury, Failure, Loss, E...
biomarkers, AKI, acute kidney injury
Early Diagnosis and Prediction of Acute Kidney Injury
penKid – A Dynamic Inflammation-Independent Biomarker Of Kidney (Dys)function Early recognition and close monitoring of acute kidney injury (AKI) is vital in the ICU, given AKI’s high prevalence and effect on length of stay and risk of re-hospitalisation and death (McCullough et al. 2013). As more becomes known about biomarkers, intensivists need to be well-informed about the benefits of currently avai...
Robots, anaesthesia, anaesthesiology
An Introduction to Robots in Anaesthesia
Technological advancement has made robots an integral part of several fields, including medicine. This article provides an overview of the application of robots to anaesthesia, highlighting recent developments. Pharmacological robots are closed-loop systems, able to precisely titrate the dose of anaesthetic drugs to a preset value, concerning hypnosis, analgesia and neuromuscular block. New evidence shows...
Obesity, perioperative care, respiratory, anaesthesia, analgesia
Perioperative Respiratory Management of Morbidly Obese Patients
Obese patients without other major co-morbidities are categorised as class II according to the American Society of Anesthesiologists (ASA) physical status classification (https://iii.hm/38j). If additional organ dysfunction is present they are categorised as ASA III. These patients are at increased risk for metabolic, cardiovascular and pulmonary complications. Postoperative pulmonary complications (PPCs),...
Cardiac arrest, out-of-hospital, resuscitation
Chain of Survival after Out-of-Hospital Cardiac Arrest
The "Chain of Survival" Concept After Out-of-Hospital Cardiac Arrest To overcome a time-sensitive and severe condition with a low survival rate—out-of-hospital cardiac arrest (OHCA)—the following four links of the “chain of survival” concept were introduced by Newman in the 1980s (Newman 1989): Early access to emergency medical care; Early cardiopulmonary resuscitation; Early defibrillation; and...
Nutrition, muscle impairment, weakness
Potential Nutritional Strategies to Reduce Muscle Wasting in Early Critical Illness
This review will briefly discuss the potential role of nutrition and the schedule of delivery on reducing skeletal muscle wasting in early critical illness. Increasing numbers of patients are surviving critical illness due to treatment advances in the early management of acutely unwell patients. This survival advantage is reflected as an increase in the number of patients experiencing long-term functiona...
Big data, outcome prediction
The Future of ICU Prediction Scores in the Era of 'Big Data'
Fuelled by the growth in electronic medical record (EMR) adoption, the recent boom of Big Data analytics in healthcare affords unprecedented opportunities for developing new prediction scores for patients in the intensive care unit (ICU) and beyond. Based on a review of scientific literature reports, however, Big Data science has added no new scores to clinical practice in recent years. In this article, th...
Video on demand (VOD) is a popular way to keep updated in intensive care. ICU Management & Practice spoke to Prof. Claudio Ronco and Marta Scabardi, from the International Renal Research Institute, Vicenza Italy, about what’s involved with their video subscription channel “Cappuccino with Claudio Ronco.” What’s the idea behind Cappuccino with Claudio Ronco? Marta Scabardi (MS): Dance is my b...
Podcasts are audio files made available regularly to occasional listeners or subscribers (usually a free subscription). The ‘pod’ in the name comes from iPod, and although that device is no longer manufactured, podcasting goes from strength to strength. Listening to a podcast is as simple as clicking a link on a website, or subscribing via an Apple or Android app on to a smartphone or a tablet. You ca...
Resources, healthcare, values
Resource Allocation in Healthcare: Have We Misjudged Societal Values?
Equitable Healthcare With increased emphasis on financial constraint in healthcare, resource allocation discussions are heard more commonly in clinical departments. As agents of the patient, clinicians are faced with struggles to ensure that individual patients can receive costly treatments, despite growing demands for healthcare throughout society. It increasingly seems as though there is a conflict betwe...
Anaesthesiology, Sharon Einav
Anaesthesiology and Critical Care Medicine
Professor Sharon Einav is Chair of the Intensive Care Medicine Subcommittee of the European Society of Anaesthesiology. She is Professor of Intensive Care, Hebrew University Faculty of Medicine, Director of Surgical Intensive Care and Chair of the Resuscitation Committee at Shaare Zedek MedicalCenter, Jerusalem, Israel. Prof. Einav is the Israel country representative for the European Society of Intensive...
Critical Care,Sri Lanka
Critical Care Medicine in Sri Lanka
Sri Lanka is steadily progressing to establish critical care medicine as a separate specialty with fully trained intensivists and nurses playing pivotal roles, as in the developed world. Most general and teaching hospitals of the country already have fully equipped intensive care units. Establishment of an intermediate level diploma qualification for doctors in 2009, and recognition of critical care medi...
JUNE 30-1 July TCS-ECMO Paris, Franceparis-tcsecmo.orgJULY 6-10 Annual International Best of Brussels Symposium on Intensive Care and Emergency MedicinePune, Indiaisccmpune.com 31 SAARC Critical Care Congress Sri Lankahttps://iii.hm/38yAUGUST 10-14 International Conference on Complexity in Acute Illness Pasadena, USAiccai.org 27-31 ESC Rome, Italyescardio.org/ESC201628-2 Sept. World Cong...