Editorial
Pre-ICU
What happens before patients arrive in the ICU? We know that status pre-ICU is associated with outcomes after patients leave the ICU. We also know that we want patients to come to the ICU only if it is needed. This ties in to having an adequate emergency medicine system and innovative techniques in trauma as well as monitoring hospital patients at risk of clinical deterioration. Our cover story...
Cover Story
Rapid response teams
This article reviews the RRT system concept and provides an update on the current state of such systems, their challenges, their performance, the evidence supporting their usefulness and their evolution. Rapid Response Teams (RRTs) are the key components of Rapid Response Systems. RRT-based rescue systems were developed in response to evidence that many deteriorating hospital patients...
Is pre-hospital coagulation management in trauma feasible?
Coagulation management remains a formidable challenge in severely bleeding trauma patients. A strong rationale suggests starting treatment of trauma-induced coagulopathy in the pre-hospital phase. The burden of trauma is increasing worldwide, particularly in less well-resourced nations. There are an estimated 5 million deaths per year, more than TB, malaria and HIV combined. Trauma particularly...
Pre-ICU health organisation in Norway
Presents the main principles of the Norwegian acute healthcare system. Norway is a rather small country with a population of about 5.3 million. More than half of these inhabitants are located in and around the larger cities, with about a million in the capital region of Oslo. Hence, significant parts of the country are rural, with fjords and high mountains, combined with winter darkness...
Emergency pre-hospital care challenges: Greece
The ongoing economic crisis in Greece and inflow of refugees has led to changes to the pre-hospital emergency medicine services. Greece is a country of 10.1 million inhabitants, half of whom live in six cities: Athens, Thessaloniki, Heraklion, Patra, Larissa and Ioannina. In recent years the country drew media attention because of the financial crisis and the inflow of refugees, which often...
Point-of-View
The Accelerate Pheno™ system in clinical practice: fast and accurate turnaround for critical results
Our clinical experiences of using the Accelerate Pheno™ system have greatly benefited patient care, providing earlier diagnostic certainty. Two complex sepsis cases are discussed, where the impact of rapid identification, with antibiotic sensitivities, of the causative organism from blood cultures is described. At Hampshire Hospitals NHS Foundation Trust, we endeavour to be ahead of the...
Matrix
Point-of care ultrasonography in critical care
A brief overview of point-of-care ultrasound (POCUS) in the ICU: for the already converted, a reminder of how POCUS has changed ICU practice; for the ultrasound naïve, an aperitif to leave the reader with interest in this evolving paradigm shift of patient care. As intensivists, we have all faced this scenario: a 28-year-old woman, 35 weeks pregnant, presenting to the emergency department...
Liver support in the intensive care unit: mechanism of action and science
The idea of liver assist is extremely attractive for patients with liver failure, as the liver possesses huge capacity to regenerate. The hypothesis behind the use of extracorporeal liver assist is to enhance the regenerative environment by removing or replacing toxic molecules while the liver can regenerate. Extracorporeal liver assist devices are either based on the principles of blood purification...
Management of bleeding in visceral surgery and liver transplantation
The implementation of patient blood management programmes led to reduced blood product usage. However, haemorrhage secondary to major surgery remains a major cause of potentially preventable death. Considering the heterogeneity of procedures and technical approaches, it is not surprising that the bleeding risk stratification for visceral surgery is not clearly defined. However, there is agreement...
Immediate-type hypersensitivity reactions in the ICU
For the ICU patient, correct and timely diagnosis of drug hypersensitivity is required to administer emergency epinephrine treatment, and retrospective allergological investigation is needed to identify the culprit drug and safe alternatives. For ICU departments, epidemiological data regarding the incidence of drug-induced immediate-type hypersensitivity are scarce and the impact on patients’ outcome...
Results of antimicrobial stewardship programme implementation in multidisciplinary hospital
The interventional single-centre with historical control study was conducted in a 600-bed multidisciplinary hospital to evaluate 4 years’ results of an antimicrobial stewardship programme. We found a significant reduction in average duration of courses of antimicrobial therapy, length of stay of patients with infection in ICU, mortality in patients with bacteraemia, the rate of extended-spectrum...
Management
The role of speech and language therapy in critical care
The role of speech and language therapists (SLTs) in critical care can be unclear so this article sets out the scope of practice to increase awareness of the value of SLTs as part of the wider multidisciplinary team. Speech and language therapists (SLT) are trained to deliver specialist clinical services to adults with a broad range of disorders, including hearing impairment, motor speech...
Making the case for social work practice in the care of critically ill ICU patients
The role of the ICU social worker End-of-life issues occur frequently in the intensive care unit (ICU). The specific training and skills received by social workers provides them with the necessary tools to collaborate with the interdisciplinary team and provide holistic care to the patient and family. Research has shown that there is great variation in the level of participation of the social...
Interview
Emirates Critical Care conference: where east meets west
Professor Hussain Al Rahma is Head of the Emergency and Critical Care Services Directorate at Al Zahra Hospital in Dubai, UAE. He is Chairman of the Emirates Critical Care Conference, President of the International Pan-Arab Critical Care Medicine Society and President of the Emirates Intensive Care Society. Dr. Al Rahma studied medicine at King Edward Medical Centre in Lahore, Pakistan and completed...
Country Focus
Distributing a life source in Africa
Lifebank has developed crucial infrastructure in Nigeria, enabling the efficient transportation and storage of blood, saving thousands of lives. HealthManagement editor Marianna Keen spoke to CEO and founder Temie Giwa-Tubosun about her journey. To what degree has the blood shortage in Nigeria been tackled so far, due to the work of LifeBank? It’s a very small degree to be perfectly honest....
News
Lighter emergency breathing tubes associated with higher survival after OHCA
When paramedics used a new, more flexible laryngeal breathing tube to give oxygen to patients who had had an out-of-hospital cardiac arrest, these patients survived longer than patients who received oxygen via the traditional endotracheal tube, according to the results of a large randomised controlled trial conducted in the USA. The results from the Pragmatic Airway Resuscitation Trial (...
Bioengineering approach to artificial tracheas
A new paper reports an approach to growing tracheas by coaxing cells to form three distinct tissue types after assembling them into a tube structure. The research, led by Eben Alsberg, professor in Biomedical Engineering and Orthopaedic Surgery and director of the Alsberg Stem Cell & Engineered Novel Therapeutics (ASCENT) Lab at Case Western Reserve University, is published in Advanced Scie...
Study: Aortic grafts are feasible to rebuild windpipe and airway
A French study of patients with lung cancer or end-stage tracheal lesions has successfully used cryopreserved human aortic grafts to rebuild the windpipe and airway sections removed because of disease. The study is published in JAMA, to concide with its presentation at the American Thoracic Society 2018 conference. The study, Airway and/or Pulmonary Vessels Transplantation (TRACHBRONCAR) [...
Study: Air pollution associated with ARDS hospitalisation in over 65s
A comparison of hospital admissions of patients over 65 and air pollution in the USA has found an association between exposure to pollutants and admission for acute respiratory distress syndrome (ARDS). The study was presented at the annual meeting of the American Thoracic Society. The researchers analysed data by zip code from nearly 30 million Medicare patients (65 years and over) discharged...
European Society of Intensive Care Medicine Diversity Task Force
In March the European Society of Intensive Care Medicine (ESICM) ( esicm.org ) announced its Diversity Task Force (pictured), which will draft a policy paper and code of conduct related to gender, gender identity, age, sexual orientation, race, culture, socioeconomic status and multi professionalism. ESICM is the first major international medical society to publicly announce the formation of such a...
Addressing the gender gap in critical care
A “persistent and pervasive” gender gap in academic critical care medicine is highlighted in a recent article in Critical Care Medicine by Geeta Mehta, MD, of the Department of Medicine and Interdepartmental Division of Critical Care Medicine, Sinai Health System, University of Toronto, Canada and colleagues from Canada and the UK (Mehta et al. 2018). The paper is the latest in a number of reports...
Have you answered these surveys on intensive care medicine?
Three surveys seeking information from ICUs around the world are currently open for data collection. ICU inter-professional rounding practices This online survey, supported by the World Federation of Societies of Intensive and Critical Care Medicine, is led by Dr. Andre Amaral, Sunnybrook Research Institute, Toronto, Canada. It is open to intensivists, trainees and ICU nurses. The
I-I-I Blog
Highlights from the I-I-I Blog
(I expert, I question, I answer) Have you got something to say? Visit https://healthmanagement.org/c/icu/list/blog or contact [email protected] Rana Awdish Director of the Pulmonary Hypertension Program, Henry Ford Hospital; Medical Director of Care Experience, Henry Ford Health System; Faculty member, Wayne State University School of Medicine, Detroit, USA; Author...
Agenda
Upcoming events/ courses/ congresses
JUNE 4-8 NeuroIntensive Care: Update 2018 Como, Italy https://iii.hm/jxj 8-11 41st Annual Conference on Shock Coronado, USA https://iii.hm/jxk 9-13 9th World Congress of the World Federation of Pediatric Intensive and Critical Care Societies Singapore https://iii.hm/jxl 10-12 The Future of Critical Care - Brainstorming Meeting Edinburgh, UK https://iii.hm/jxm...