Communication skills are perhaps even more important in intensive care medicine than in other specialties. Critical illness can be frightening for both patients and families, and it is a given that errors in communication can impede care and even harm the patient. But when time and resources are stretched, what is the best way to communicate? In the first article in our cover story, Taylor Thompson and Lillian Ananian write about family presence on ICU work rounds. Recognising that poor communication probably underlies many of the conflicts that develop between ICU clinicians and families, they trialled inviting families on ICU work rounds. They outline the benefits their medical ICU has experienced and consider the potential downsides. They conclude that it is an opportunity to exchange information, build trust and make the ICU workplace more enjoyable. Next, Paul Barach and Gautham Suresh look at how to improve handoffs – the crucial process that ultimately ensures that the patient’s care continues without errors. Handoff is often affected by communication barriers, and Barach and Suresh look at the scale and causes of the problem, how handoffs can be studied and improved, potential solutions and training.
Continuing our series on Fluids, Manu Malbrain, Johan Huygh and Joost Wauters discuss the different parameters related to bio-electrical impedance analysis and their use to monitor fluid status and guide fluid management.
Our Matrix starts with Jaume Mestre and Néstor Bacelor’s article on care of the multiple organ donor. They outline best practice in caring for the donor, with the aim of reversing the derangements resulting from previous disease and brain death, stabilising the donor and helping to obtain more and better functioning organs. Next, Yuda Sutherasan, Raquel Rodríguez-González and Paolo Pelosi consider prevention of perioperative complications, inspired by the saying “It takes a village to raise a child.” Collaboration is needed to improve outcomes, they argue. Michael Reade follows with a review of bleeding, coagulopathy and blood products in major trauma. With evidence for existing practice being challenged, there are implications for blood supply, and new therapies are being investigated. He writes that regulators must balance caution with innovation in what has, until recently, been an evidence-free field. Lastly, Zaccaria Ricci, Gianluca Villa, Stefano Romagnoli and Claudio Ronco discuss the multidimensional aspects of adequate dialysis in the ICU. They detail basic concepts related to the dialytic dose, current evidence available on the topic, and explain the concept of adequacy.
The role of intensivists in emergency mass critical care (EMCC) is explored by Mary King and Niranjan Kissoon in the Management section. They advocate better education about EMCC so that ICU providers may be better prepared and organised during future disasters. They argue that intensivists also have a professional obligation to play an integral role along the continuum of EMCC planning and delivery.
Daniel De Backer is President-Elect of the European Society of Intensive Care Medicine (ESICM). He is our interview subject this issue, and talks about his aspirations for ESICM as well as his thoughts on priorities for intensive care research.
Our Country Focus visits Chile. Intensive care medicine is a relatively young discipline in that country. Sebastián Ugarte explains in his glance at intensive care medicine that while economic development has led to more investment in healthcare, the challenge is to quality enough intensivists to keep up with demand. Ugarte joins Juan Espinoza to write about the use of ECMO. Following disappointing results in the H1N1 pandemic of 2009, results since then have been promising with the development of ECMO referral centres and availability of well-trained personnel.
The European Society of Intensive Care Medicine meets in Barcelona in September. Please drop by the ICU Management booth #– We are always delighted to meet our readers and contributors. Hope to see you there!
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