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


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

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

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

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

Special Supplement - Pain Management 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

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

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

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

Cover Story

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

The future delivered 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. Introduction 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, wh

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. Introduction 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 un

Preventing malnutrition and enforcing nutritional guidelines 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

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

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

Informatics and Technology

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


The paper highlights the present clinical rationale for extravascular lung water measurement as a key to personalisation of haemodynamic therapy. Introduction 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 a

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 Introduction 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

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

Management Matters

Vital minutes before unconsciousness 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 i

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

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


Advanced haemodynamic monitoring methods 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 Inte

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] 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-lif

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