ICU Management & Practice, Volume 19 - Issue 2, 2019
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Editorial
Paediatrics
It is never easy when children are in the hospital. And it is even more stressful when they're in the Paediatric Intensive Care Unit (PICU). When a child is admitted to the PICU, it means that they require the highest level of medical care. Children in the PICU present with different symptoms and conditions - from serious infections to heart conditions; from asthma to diabetes; from a traumatic injury to a...
Point-of-View
Can Goal-Directed Therapy solve the economic burden of postsurgical complications?
The clinical and economic burden of post-surgical complications and the economic impact of Goal-Directed Fluid Therapy (GDFT) implementation. Improving the quality of care by reducing post-surgical complications, decreasing mortality, and decreasing hospital length-of-stay for surgical patients while also reducing cost, is a widespread goal of health services and healt...
News
Use of sedation and controlled paralysis in ICU patients with ARDS
According to a National Institutes of Health sponsored clinical trial that was conducted at several North American hospitals and was led by clinician-scientists at the University of Pittsburgh and University of Colorado schools of medicine, reversibly paralysing and sedating hospitalised patients with severe breathing problems does not prove improve patient outcomes in a large majority of cases. Findings w...
New recommendations for stroke systems of care - American Stroke Association policy statement
Approximately 7.2 million Americans 20 years or older have had a stroke. Nearly 800,000 people in the U.S. have a new or recurrent stroke each year. A stroke occurs every 40 seconds in the U.S., and someone dies of a stroke every four minutes. According to a policy statement published by the American Stroke Association, and published in the journal Stroke, improvements in stroke systems of care are imper...
Cocoon bed aims to lower ICU delirium
The intensive care unit environment can be extremely stressful, even if they provide some of the best care in the world. It is believed that a patient in the ICU has their sleep interrupted approximately every three minutes either through noise, lights, or medical intervention. Up to 80% of patients in the ICU suffer from some form of delirium, and nearly 30% develop post-traumatic stress disorder. In or...
Big Data and hidden subtypes of sepsis
Results of a study conducted by the University of Pittsburgh School of Medicine suggests that sepsis is not one condition, but many conditions that could benefit from different treatments. The findings are published in JAMA and were presented at the American Thoracic Society's Annual Meeting. Sepsis is the number one killer of hospitalised patients and is a life-threatening condition that arises when the...
Sedation with dexmedetomidine in critically ill patients
Dexmedetomidine is used to sedate patients while maintaining a certain degree of sustainability. The use of dexmedetomidine is known to reduce the duration of mechanical ventilation and delirium among patients in the intensive care unit (ICU). However, its use as the sole sedative agent in patients undergoing mechanical ventilation has not been studied extensively. An open-label, randomised trial was con...
Use of opioids in the ICU not linked to continued prescriptions
According to a new study, opioids prescribed in the intensive care unit (ICU) do not drive risks for continued use or prescriptions. The findings were presented at the American Thoracic Society (ATS) 2019 International Meeting in Dallas, TX. Opiate abuse is a major healthcare issue. In the U.S., opioid-related deaths have increased more than three-fold from 2000 to 2016. The use of opioids in the ICU hav...
Cover Story
Quality improvement in the PICU – a primer for intensivists
Quality improvement provides tools that help the transformation of an intensive care unit into a highly reliable and safe environment, that nurtures continuous learning and delivery of high-quality care that improves patient experience and outcomes. Despite advances in healthcare and dramatic improvements in survival across the spectrum of disease states, there exists a chasm between ideal care and actu...
PICU Up! A multicomponent early mobility intervention for critically ill children
An overview of the 'PICU Up!' mobility programme at Johns Hopkins Children's Center, which integrates sleep promotion, delirium prevention, and sedation optimisation to increase mobilisation in critically ill children. Paediatric intensive units traditionally have had a culture where critically ill children are intubated and mechanically ventilated, immobilised, and highly sedated. This practice is pr...
PICU-acquired complications: the new marker of the quality of care
This article describes the rise in PICU-acquired morbidities and its impact on patient outcomes. It discusses early rehabilitation strategies to improve patient outcomes in PICU. Critical care has traditionally been focused on early recognition of life-threatening conditions, resuscitation, and stabilisation of organ dysfunction, and ultimately improving mortality. Our ability to deliver critical care...
Caring for children in the PICU
Challenges and opportunities to improve care and practice in the PICU. “Martin, 2 years old. Sepsis and pneumoniae. High monitoring systems and modern therapies. A nurse is talking to his parents. A smile and a kind gesture help them in this overwhelming experience. Fear and hope.” This is only an instant picture from a Paediatric Intensive Care Unit (PICU) to illustrate the challenge of critical...
Virtual reality experience in the PICU
An overview of the virtual reality programme at the Ann & Robert H. Lurie Children’s Hospital of Chicago and its potential benefits on patient outcomes. Ann & Robert H. Lurie Children's Hospital of Chicago has introduced virtual reality into their paediatric intensive care unit. A pilot study was conducted with 32 participants between the ages of 3 and 17 years to evaluate whether the stimulatio...
Informatics and Technology
Seven steps to design, procure, implement and maintain a Clinical Information System for your ICU
How to design, procure, test, parameterise, implement and maintain a Clinical Information System for an intensive care unit. e-Health applications, in our case Clinical Information Systems (CIS) or Patient Data Management Systems (PDMS), are taking medicine by storm, and intensive care is not an exception. Ensuring delivery of safe, cost-effective, high-quality care in the most expensive hospital beds,...
Matrix
Respiratory physiotherapy in critically ill patients
Respiratory pathologies are among the most common causes of admission to critical care. Respiratory physiotherapy represents a fundamental part of the standard practice in ICU. The following review provides a practical and feasible description of the main physiotherapeutic tools and strategies that can be applied to critically ill patients. Respiratory physiotherapy [RP] is an integral part of the multi...
A structural approach for diagnosing weaning failure
Using a case of a former patient we describe the structured approach of analysis of the cause of weaning failure with corresponding specific therapies used in our Centre for Expertise. Previously, we suggested a structural approach for diagnosing the cause of weaning failure (Heunks and van der Hoeven 2010; Schellekens et al. 2016). Here we discuss how we apply ‘the ABC of weaning failure’ at the R...
Vitamin D deficiency in ICU patients
A review on the role of vitamin D in a well-defined setting of critically ill patients: patients undergoing cardiac surgery and organ transplantation, and the potential benefit of vitamin D supplementation. Vitamin D research has experienced a true hype in all fields of medicine in the last decades. In critical illness, this increased interest has only started 10 years ago. The high prevalence of vitamin...
Management Matters
Noise in the intensive care unit: where does it come from and what can you do about it?
Practical measures and interventions to reduce noise levels in the ICU and to improve the patient experience. The intensive care unit (ICU) is known to be noisy and is getting louder (Busch-Vishniac et al. 2007). Despite several trials, no interventions have been able to reduce noise levels by a meaningful amount (Li et al. 2011; Boyko et al. 2017; Johansson et al. 2017). There tends to be a view that hig...
Keeping the Person in Personalised Medicine
As Personalised Medicine endeavours to discover more specific aetiologies and treatments of disease based on genetics and basic science research, it is crucial to maintain a focus on the patient-doctor relationship in order to more fully optimise patient care. In a world where the cutting edge is a crowded place, and people’s lives are at stake, healthcare is an industry where growth is happening inward...
Interview
European guidelines on the management of traumatic induced bleeding
Rolf Rossaint is a Professor and Chairman of the Department of Anaesthesiology of the University Hospital at the RWTH University Aachen, Germany. Prof. Rossaint has published several high-quality studies dealing with the treatment of severe acute respiratory distress syndrome (ARDS). He has also been actively involved in research on the pathophysiology of trauma associated coagulopathy and possible treatme...
I-I-I Blog
Highlights from the I-I-I Blog
A selection from the ICU Management & Practice I-I-I blog. Have you got something to say? Visit https://healthmanagement.org/c/icu/list/blog or contact [email protected] Peter Pronovost Chief Clinical Transformation Officer - University Hospitals Cleveland, USA @PeterPronovost What should the intensivist of the future look like? “The intensivist of the future will need three sets o...