Volume 17 - Issue 3, 2017

Recovery after critical illness has received increasing attention in recent years, and rightly so. We highlighted neglect of recovery as one of the ten big mistakes in intensive care medicine (Vincent et al. 2014). While survival has improved tremendously, for a long time insufficient attention was given to how patients (and their families and caregivers) were coping after leaving the ICU. Planning for rec...

Increasing evidence implicates autophagy as repair process crucial for recovery from critical illness-induced vital organ failure and muscle weakness. This article summarises recent evidence and highlights potential implications for therapy. Progress in intensive care medicine has resulted in improved survival from acute life-threatening conditions. Still, a considerable number of patients admitted to...

Prof. Henrik Kehlet reflects on the progress of fast-track surgery and the need for multidisciplinary teamwork in optimising perioperative care. You are the “father” of fast-track surgery. What motivated you to develop this concept? It all started when I was a young surgeon and had to perform some major operations. The technical aspects of surgery went well, but patients developed medical complic...

This article will explore the ERAS Programme and provide a unique insight into perspectives and realities of surgical recovery. It will highlight the current evidence versus patients’ perceptions and expectations. Background The Enhanced Recovery After Surgery (ERAS) programme has been implemented in many surgical units around the world over the last two decades with varying degrees of success. This e...

Enhanced recovery after surgery (ERAS) is an evidence-based, multimodal approach to optimising patient outcomes following surgery. The role of physiotherapy within ERAS and intensive care units (ICU) is important. Patients admitted to an ICU following elective major surgery may suffer from physical, psychological and cognitive problems, which can impact their return to function and quality of life. ICU phy...

This article describes recent advances and perspectives in cardiorespiratory monitoring for surgical patients, from prehabilitation to rehabilitation, from smartphones to wearable sensors. There are over 320 million inpatient surgical procedures worldwide (Weiser et al. 2015). We learnt from the recent International Surgical Outcomes (ISOS) Study (ISOS Group 2016) that around 17% of these patients deve...

Reviews the latest evidence evaluating physical rehabilitation in the intensive care unit setting and future directions for the field. Survivors of critical illness frequently experience poor physical outcomes, including persistent impairments in muscle strength, exercise capacity and physical function (Pfoh et al. 2016; Herridge et al. 2011; Dinglas et al. 2017; Fan et al. 2014b). In this article, we...

Optimising nutrition and metabolism post-ICU for recovery of functional lean body mass and quality of life. In-hospital mortality following intensive care unit (ICU) care has consistently declined in recent years (Kaukonen et al. 2014). However, these data reveal many of these ICU “survivors” are not returning home to functional lives after the ICU, but instead to rehabilitation and nursing home se...

We review recent findings on outcomes in adults after mechanical ventilation for one week or more in the intensive care unit, exploring both patients and their family perspectives. Critical illness survivorship carries a burden of physical and neuropsychological disabilities (Griffiths and Jones 1999; Herridge and Cameron 2013). These determine decreased quality of life when compared to the sex- and ag...

This article discusses technological innovations that promote survival and enhance recovery, starting within the ICU with developments in ventilation, sedation, early mobility and ICU design. Post-ICU, the establishment of follow-up services is discussed, as are initiatives for sharing patient information to achieve better continuity of care and the novel concept of teleclinics. Specific issues after ICU...

Based on the patients’ perspective Nutma sheds light on the hidden faces of sepsis, calling for more expertise on sepsis sequelae. She also offers recommendations to improve recovery and outcome. It wasn’t until 2007, after my illness that: “I came to understand the extensive process of recovery after critical illness. Moreover, I came to realise that the need for explanation, support and advice,...

Presents results from a registry detailing information about the management of bleeding patients in the emergency room, operating room or intensive care unit during therapy with direct oral anticoagulants. Background There is a large literature on the efficacy of direct oral anticoagulants (DOAC) to prevent stroke or systemic embolic events in patients with atrial fibrillation or to treat venous th...

Presents the results from a randomised controlled trial which aimed to determine if fibrinogen concentrate infusion reduces intraoperative blood loss in cardiac surgery patients. Background Excessive bleeding is a common complication in cardiac surgery, and may result in the need for red blood cell (RBC) transfusion. Intraoperative bleeding during cardiac surgery is often treated with coagulation fa...

Presents results of the RETIC study that compared treatment of trauma-induced coagulopathy using coagulation factor concentrates or fresh frozen plasma. Background Trauma-induced coagulopathy (TIC) represents a clinical picture resulting from severity of injury, hypoperfusion, blood loss, consumption, dilution and platelet dysfunction. Activation of the protein C system seems to mediate increased...

Current treatment options and challenges - Dr. K. Becke Background An increasing number of diagnostic and treatment procedures are performed outside the operating room. Without sedation even minor procedures such as vaccination can be painful, stressful and lead to severe trauma. Sedation ensures optimal conditions for performing safe and high-quality interventions. Children are at increased r...

Point-of-care ultrasound (POCUS) is now a tool used worldwide, integrating clinical assessment of the critically ill. In this review, we focus on lung, diaphragm and cardiac ultrasound in the management of the mechanically ventilated patient. Ultrasound provides useful information to assess and monitor lung aeration, to set mechanical ventilation and to early identify respiratory complications, such as pne...

In order to make haemodynamic monitoring clinically successful it seems mandatory to have a comprehensive view on the incorporation of the measured variables in a team-adapted strategy. Over the last decades the evolution of haemodynamic monitoring in critically ill patients has not been unequivocal. On the one hand it may be argued that haemodynamic monitoring is an essential part of intensive care me...

Outlines some basic considerations for ICU providers interested in incorporating animals into care programmes. Animals are being introduced into hospital settings in ever-increasing numbers. Emerging literature suggests that incorporating trained animals to assist with medical care and rehabilitation therapies can promote patient engagement, reduce emotional distress and relieve some aspects of physi...

Historical command and control approaches to leadership fail in building relationships and engendering engagement and thus do not enhance performance like modern approaches to leadership. Historically, leadership in medicine was taught and practised in an approach akin to the military paradigm of command and control. It was believed that given the need to respond to emergencies in a coordinated fashio...

Critical care units are home to some of the most sophisticated patient technology within hospitals. In parallel, the field of machine learning is advancing rapidly and increasingly touching our lives. To facilitate the adoption of machine learning approaches in critical care, we must become better at sharing and integrating data. Greater emphasis on collaboration— outside the traditional “multidiscipli...

For a full listing of events visit https://iii.hm/aly OCTOBER 3-5 Critical Care Canada Forum 2017 Toronto, Canada 11-13 ANZICS/ACCCN Annual Scientific Meeting 2017 Broadbeach, Australia 21-25 ANESTHESIOLOGY® 2017 Boston, USA NOVEMBER 2-4 6th Annual Johns Hopkins Critical Care Rehabilitation Conference Baltimore, USA 5-7 European Airway Management Congress 2017 Berlin, Ge...