Issues

Volume 19 - Issue 1, 2019

Thu, 14 Mar 2019

Volume 19 - Issue 1, 2019

In this Issue

  • Table of contents
  • Editorial Board
  • Download pdf (print optimised)
  • Download pdf (screen optimised)

Editorial

  • Innovation

    The burden of critical illness is a major concern in healthcare. This burden is expected to continue to increase as our population ages. Our cover story Innovation highlights the growing problem of critical illness and the need to develop improved practices and implement new and advanced solutions to meet the expected challenges. Our contributors envision the ICU of the future and discuss the changing need...

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News

  • Sleep index, wakefulness can predict patient ability to breathe on their own

    According to new research, critically ill patients can be more successfully weaned from a mechanical ventilator if they have higher levels of wakefulness and if both their right and left brains experience the same depth of sleep. The article titled "Sleep and Pathological Wakefulness at Time of Liberation from Mechanical Ventilation" is published in the American Journal of Respiratory and Critical Care Med...

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  • Acute pain estimation, postoperative pain resolution, opioid cessation, and recovery

    Acute postoperative pain is associated with persistent postsurgical pain (PPSP). The incidence of PPSP ranges from 10 to 50% while severe, chronic pain after surgery is reported by 2 to 10% of patients. Both the severity and duration of postoperative pain are influenced by other factors including pre-existing pain. A secondary analysis of the Stanford Accelerated Recovery Trial (START), a randomised, doub...

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  • Trends in epidemiology and antimicrobial resistance in intensive care units

    The intensive care unit has a unique environment, mainly because it treats severe and critically ill patients who require special care. Critical care patients often require high-risk surgeries, and there is also a frequent need for invasive devices such as central or peripheral venous catheters, urinary catheters or tracheal tubes, among others. This makes these patients more susceptible to hospital-acquir...

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  • Results of the ABATE infection trial

    According to results of the ABATE infection trial, daily bathing with an antiseptic soap, plus nasal ointment for patients with prior antibiotic-resistant bacteria reduced hospital-acquired infections among patients with central venous catheters and other devices. The ABATE infection trial included 340,000 patients from 53 hospitals. The study was led by researchers from the Harvard Pilgrim Health Care In...

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Special Supplement - Pain Management in the ICU

  • How to manage sedation analgesia for patient-centred care in the ICU

    Managing sedation analgesia for patient-centred care in the ICU Pain management and sedation are closely linked in the intensive care unit. In the past, clinicians were using sedative agents too liberally, often with benzodiazepines. And several issues were observed in the ICU, including the problems of delirium, weakness and prolonged ICU course. In recent years, attempts have been made to decrease th...

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  • Sedation and Analgesia

    How to manage sedation analgesia for patient-centred care in the ICU. In the concept of patient-centered care, sedation and analgesia have high importance. Intensive care is sometimes invasive and very painful. Patients in the ICU are seriously ill and often suffer from anxiety, agitation, and pain. There is sometimes a need to use deep and prolonged sedation, but that can cause other issues which need t...

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  • Pain management through multimodal analgesia in the ICU

    Overview and focus on regional anaesthesia Opioid dependency is a serious problem in the ICU. Opioids are effective at providing pain relief because they reduce the perception of the pain signal. At the same time, opioids are associated with respiratory depression, cough suppression, confusion, and drowsiness. In addition, there is a risk of abuse and dependence with opioid drugs. Despite these risks a...

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  • Concluding remarks

    Reducing sedation and managing and treating pain are important objectives for clinicians. The primary goal should always be to promote the comfort of the patient and to minimise pain through the proper use of multimodal analgesia. The use of opioid drugs should be avoided unless absolutely necessary; and focus should be placed on achieving pain control through combined pain management strategies. The use o...

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Cover Story

  • Protecting ward patients

    Finding patients before they crash might be the next major opportunity to improve patient safety. This article describes recent advances and perspectives for ward monitoring with wearable sensors and smart algorithms. Hospital wards are dangerous. Indeed, they are where most unexpected deaths occur within institutions. In a UK national audit study, among 23,554 adult in-hospital cardiac arrests, more th...

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  • Innovations in ICU ventilation

    In this article, we aim to summarise the developments in mechanical ventilation that we believe are shaping the present and will shape the future ahead. Many centuries ago, Socrates stated that “the secret of change is to focus all of your energy, not on fighting the old, but on building the new.” Nowadays, we may relate his quote with the concept of innovation, which is considered the process of...

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  • Data-driven management for intensive care units

    This article focuses on the clinical and practical application of current available cloud-based data analysis to benchmarking in real-time and to optimise clinical care in the ICU. The ICU is a highly technological environment where each patient data generates thousands of data-points per day. However, most of this data is usually wasted thus missing the opportunity of using this data to understand pat...

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  • Technology innovations in delivering accurate nutrition

    An overview of the key obstacles for the enforcement of nutritional guidelines and innovative approaches that can be used to overcome these obstacles. Recent studies suggest that nutritional guidelines across the majority of intensive care units (ICUs) are not being implemented (Bendavid et al. 2017; Heyland et al. 2003). Lack of knowledge, no technology to support medical staff, and general noncomplia...

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  • The Intensive Care Unit - Past, Present and Future

    A quick look at why ICUs need to innovate and what lies ahead for the new ICU....

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  • The business of research

    What is the value of physicians and their contribution to the healthcare system and economic growth? This article talks about the need to understand the real value of physicians and to encourage them to be creative and innovative as this would improve their value beyond that of daily clinical labour. Disruptive innovations are critical for the exponential economic growth that our society enjoys (Press 20...

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Informatics and Technology

  • The role of disruptive and hybrid technologies in acute care

    Section Editor Theodorus Kyprianou introduces the “Informatics and Technology” section of ICU Management & Practice. It is with great pleasure that I introduce today “Informatics and Technology,” an open forum to discuss the role of new, disruptive, hybrid technologies in acute, emergency and intensive care medicine. This brand-new section reflects the vivid interest of the journal’s Editor...

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Matrix

  • Extravascular lung water as a target for intensive care

    The paper highlights the present clinical rationale for extravascular lung water measurement as a key to personalisation of haemodynamic therapy. Extravascular lung water (EVLW) remains a useful guide for monitoring pulmonary oedema (PO) and vascular permeability in sepsis, acute respiratory distress syndrome (ARDS), and heart failure (Jozwiak et al. 2015; Michard 2018). Increased EVLW is associated wi...

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  • Managing delirium in the ICU with sleep guardians

    Sleep guardians - a quality improvement initiative at the Lancashire and South Cumbria Critical Care Network (LSCCCN) to reduce and implement change while managing delirium in critical care patients Up to 85% of critical care patients may experience some form of delirium, but it can be very easily missed (Inouye et al. 2001; Page 2008) particularly in a very busy 24 bedded General Critical Care Unit th...

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  • The establishment and provision of an acute kidney injury service at a tertiary renal centre

    An overview of the acute kidney injury service launched at the Lancashire Teaching Hospitals NHS Foundation Trust The acute kidney injury service at Lancashire Teaching Hospitals NHS Foundation Trust was launched in October 2015. Key stakeholders were identified and included in the service development from the beginning and throughout which supported the smooth introduction of the service into the hospit...

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Management Matters

  • Communication myths of anaesthetists

    Anaesthesia is a diverse specialty with a wide range of necessary skills, one of which is effective communication. The myth that anaesthetists pick the specialty ‘because you don’t need to talk to your patients’ persists. Whether said in jest or disdain this concept gains ground because, yes for much of the time, our patients are mostly ‘asleep.’ But this ignores the vital communication that...

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  • The role of the Physician Assistant in critical care

    Physician Assistants play a leading role in the safe, efficient, value-based delivery of healthcare for the critically ill patient. Since inception in the mid-1960s, the Physician Asssitant (PA) profession has grown to become an integral part of healthcare delivery. As the name implies, PAs were historically seen as assistants to the physician, helping with task completion and the eventual offloading of...

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  • The need to humanise the ICU

    Susan East, a patient speaker at the ATS 2017 International Conference in Washington D.C. and a three times ARDS survivor shares her experience about her stay in the ICU. I am Susan East, a three times ARDS survivor. July 3, 2008, I had ARDS! I went to my primary physician on June 30, 2008 with symptoms of a sinus infection. He diagnosed me with walking pneumonia and I received a shot and a prescriptio...

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Interview

  • Noninvasive technologies for personalised haemodynamic monitoring

    Bernd Saugel, MD, EDIC is a Professor of Anesthesiology and works as a consultant in the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Prof. Saugel is a specialist in anaesthesiology, intensive care medicine, and internal medicine and holds a European Diploma in Intensive Care Medicine. His primary field o...

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I-I-I Blog

  • Highlights from the I-I-I Blog

    Visit https://healthmanagement.org/c/icu/list/blog or contact [email protected] Stacey Brown Critical Care Nurse, Canada @simplicity4jc From code cart to comfort cart in the ICU “When the time has come where having the code cart with the epinephrine and defibrillator is no longer appropriate we trade it out for our end-of-life comfort cart. With donations from families and money from fund...

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