ICU Management & Practice, ICU Volume 9 - Issue 1 - Spring 2009


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For the last few decades there has been an increasingly louder and more urgent discussion underway in the healthcare sector –that of our aging population and moreover, the difficulties and costs involved with treating this expanding group of patients.

As critical care managers we are faced with a growing challenge to maintain a high level of quality of care within our units, while dealing with increasing numbers of vulnerable elderly patients who are susceptible to a host of infections. In addition, we must balance the patients' treatment wishes with those of their family and the medical consensus of our own team.

In this ICU Management, Dr. Csomos tackles the issue of the cost-effectiveness of providing quality care to elderly patients, while Dr. Michaelson offers some thoughts on end-of-life care for these patients. Dr. Barraco brings us the final installment of his series on elderly care with an eyeopening focus on treatment of the frail elderly.

As many of us have seen the photo of the cardiac patient covered with frozen products from a supermarket freezer, we acknowledge that cooling of patients outside of the hospital has been done. In his contribution to this issue, Mike Clumpner discusses the studies – outlining the benefits, challenges and costs attached to using therapeutic hypothermia in the pre-hospital setting.

In our Management section, Dr. Vandijck and colleagues outline ways of measuring quality of life in the ICU; while Dr. Ondategui-Parra explains what every manager should know when it comes to cost-effectiveness analysis.

Dr. Pronovost takes time out of his busy schedule to discuss the simple (and not so simple) aspects of critical care with Managing Editor Sherry Scharff and reminds us of the powers we all have to initiate change within our teams.

We travel to France this issue for our Country Focus for a discussion of current trends and reforms underway in hospitals throughout the country and the healthcare system as a whole. Dr. de la Fournière and colleagues highlight how France is dealing with the problems associated with an increasing number of elderly patients within their borders in his article on governance and geriatrics. To round out this focus, Philippe El Sair describes the mandates of the organisation he heads, the national union of hospital managerial staff (SNCH): an independent group which represents all hospital managerial staff, including administrative and technical staff, as well as doctors and nurses.

The challenge of caring for a rapidly aging population is just one of the struggles foreseen in the coming decades in our field. A common thread in this issue is the need within our community of critical care providers to join together, share data, experiences and challenges. It is only through this collaborative exchange, whether it be at congresses and symposia, through associations, networks or joint research projects that we will be able to obtain our communal goal of improving efficiency, safety and quality of care despite the changing environment of our ICUs.

For the last few decades there has been an increasingly louder and more urgent discussion underway in the healthcare sector –that of our aging populatio

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