Volume 20 - Issue 3, 2020

The process of ageing cannot be defined by a number. The World Health Organization classifies anyone over the age of 65 as elderly. However, it is important to understand that ageing is a complex process, and we must consider physiological and cognitive vulnerabilities when talking about ageing as they can make some elderly people more prone to disease and acute medical events. Also, comorbidities tend to...

Jean-Louis Vincent is a Consultant in the Department of Intensive Care at Erasme University Hospital in Brussels and a Professor of Intensive Care at the Université libre de Bruxelles.He is the editor-in-chief of ICU Management & Practice, Critical Care, and Current Opinion in Critical Care and member of the editorial board of many other healthcare publications. Prof. Vincent has received several award...

COVID-19 has resulted in an enormous demand for critical care personnell and increased consumption of resources. How can healthcare systems prepare for the allocation of scarce resources? Health care crises, like the COVID-19 pandemic, can lead to a pronounced regional, national and even supranational discrepancy between the need for medical care and the ability of the health care systems to provide it....

Elderly patients have damaging and serious complications when they acquire SARS-CoV2 infection. It is thus important to consider this particular age group for better management of COVID-19. The gradual reversal of the population pyramid that has developed in recent decades has resulted in older adults being mostly affected in a pandemic situation. Senior people are the defenceless group, and the ones wh...

Medicine is an activity of special dignity at all times. Healthcare professionals are responsible actors and have to consider the business of operating ethics. Weighing up values under considerable time pressure, existential fates and critically discussed evidence is a considerable challenge for them, not only in pandemic times but always. Ethics as Superpower in Medicine Medicine has been an activity...

Professor Michael Mansour is a physician-scientist with a research concentration in immune responses against invading pathogens. He attends on the Clinical Transplant Infectious Diseases and Immunocompromised Host Service at the Massachusetts General Hospital - Division of Infectious Diseases, where he cares for solid and stem cell transplant recipients and individuals with weakened immunity. He also direc...

Sepsis and septic shock are the leading causes of death in the ICU. With an estimated mortality rate of 40-60%, septic shock is in the focus of adult critical care medicine. It is broadly accepted that intervention in the very early phase of sepsis before the complex inflammatory host response is initiated should be one major area that clinical research should focus on. Currently, sepsis and septic shock...

An overview of the VIP project that studies a subgroup of patients ≥ 80 years, the oldest old, since both ICU mortality and morbidity are increased with advanced age. During the last 10 years, we have observed an increased interest in research into our oldest intensive care patients. This is brought forward with the expectation of a two-fold increase in citizens ≥ 80 years towards 2050 (Figure 1)....

Older adults who survive critical illness are at risk of adverse long-term outcomes, including long-term mortality and impairment in physical function, cognitive function, and mental health. In this article, we discuss the evidence behind prediction of these outcomes in older ICU survivors, and review risk factors that should be considered in future prediction modelling studies. Older adults who survive...

A review of available evidence and an overview of recommendations for the nutritional management of the critically ill older adult. Worldwide, there is a shift in the distribution of the population towards older ages. This shift is similarly being experienced in the Intensive Care Unit (ICU), with the median age of the entire ICU in some countries above 65 years (Flaatten et al. 2017). Older adults are...

The COVID-19 pandemic has resulted in many changes to society and the practice of critical care medicine. Perhaps now is the time to address deficiencies in communication and decision-making that impact quality of care provided to older patients with serious illness. The COVID-19 pandemic has created a juxtaposition of triumph and tragedy. In triumph, the pandemic has metaphorically brought humans toget...

In this article we discuss mind, mobility, medications, multi-complexity, and what matters most. These are key domains from geriatric medicine that are relevant to the practice of intensive care medicine. The notion that advanced age is a sufficient reason to decline admission to the Intensive Care Unit (ICU) is no longer widely accepted by clinicians, patients, or their families. In many settings, olde...

This article explores a system for assessing quality of care in critically ill elderly patients. Decision-making processes around the admission of critically ill elderly patients have been put into sharp focus in 2020. The urgent need to meet the demands associated with large numbers of acutely ill patients during the COVID-19 pandemic has quickened discussions about prioritisation of resources with a f...

Problems associated with ageing, complications of critical illness in the elderly patient, and an overview of the gaps in the treatment of critically ill older adults....

Did the VITDALIZE study and the VIOLET study manage to answer some of the questions regarding vitamin D deficiency and its impact on critically ill patients? Experts compare the findings and present an overview. Vitamin D deficiency is very common in the ICU (usually >60%) because many critically ill patients were already chronically ill before their acute illness. Current guidelines recommend low dos...

Post cardiopulmonary bypass vasoplegia is common, and associated with poor outcomes. Traditional management strategies involving escalating doses of catecholamines, vasopressin and adjuncts such as methylene blue and hydroxycobalamin or ascorbic acid have not shown promising results. Since ACE enzyme dysfunction, high serum renin and low endogenous angiotensin II may be a common problem in these patients,...

The purpose of this article is to give an up-to-date, comprehensive review on the utilisation of extracorporeal blood purification techniques and immunostimulation in septic patients after cardiac surgery. Sepsis is a potentially life-threatening state caused by an infection and an inadequate, dysregulated host immune response. In general, sepsis ranks in the top ten causes of death and is potentially h...

An overview of real-time digital assessment of microcirculation and quantification of tissue perfusion and the physiological and technical considerations that may, in the near future, change the way we look at circulatory shock in critically ill patients. Despite recent advances in the timely restoration of impairments in the oxygen supply chain to the tissue (Yealy et al. 2014; Peake et al. 2014; Mounc...

This article will focus on the non-clinical, human aspects of critical care, namely the patient and the ICU team. The modern concepts of humanising ICU care, the healing environment and future-proofing the ICU team will be discussed. Despite being a relatively young specialty, critical care has made remarkable progress since its inception during the polio epidemic in Copenhagen in the 1950s. Though the...

OCTOBER 2-5 ANESTHESIOLOGY 2020 Virtual conference https://iii.hm/14ri 4-7 Critical Care Canada Forum Virtual conference https://iii.hm/14rj 16-19 EAPS 2020 - European Academy of Paediatric Societies Virtual conference https://iii.hm/14rk NOVEMBER 2-6 38th Vicenza Course on AKI & CRRT Virtual conference https://iii.hm/14rl 5-7 9th Annual Johns Hopkins Critical Care Rehabilitation Conference Virtu...