ICU Management & Practice, ICU Volume 12 - Issue 3 - Autumn 2012
Even in a world full of innovation, developments and advanced intensive care medicine, there are areas and issues within the realm of critical care that are overlooked, at least on a comprehensive scale. As more studies and research projects are completed, and new experiences and knowledge are shared across the speciality, the quality and standard of intensive care medicine and processes are improving in bounds on many levels. Still though, grey areas and hidden cracks are present in the framework, many of which are being explored by researchers and physicians in the hope of resolving some questions, raising awareness of existing disparities or gaps in care, and supporting positive change.
One area of intensive care medicine that warrants further recognition
and research is that of the relationship between the sex and gender of a
patient and the intensive care they receive. This is the topic of focus in this
issue of ICU Management, with the first article from Jennifer Innis and Dr. Arlene
Bierman, from the University of Toronto, Canada, suggesting application of a
sex and gender lens to quality improvement, in order for care access, quality,
and outcomes across genders to be optimised. Second in our Cover Story is a
stimulating article entitled “Unraveling the Effect of Gender on ICU Mortality”.
Dr. Irit Nachtigall and her team express the importance of a more detailed
understanding of differences in clinical presentation, course of diseases, and cure
processes in patients of different gender, with much of the research they
present centring on response to sepsis.
This focus on the sex and gender of
a patient is subsequently brought across to our Nutrition series. Here, Dr.
Sandra Stapel and her colleagues from VU University Medical Center in the
Netherlands describe several gender differences that relate to optimal
nutrition in intensive care, including their hypothetical implications for the
patient. Another specially focused nutrition piece, “Perioperative Nutrition in
Upper Gastrointestinal Cancer Patients”, follows, in which Prof. Christophe
Mariette provides current information and advice. Knowledge of the nutritional
status of individual patients in this sub-group is expressed as essential not
only in identifying malnourished and non-malnourished patients, but also in
allowing treatment adaptations along each step of the multimodal oncological
treatment path, with standard enteral nutrition (EN) and immunonutrition
serving as a complementary therapeutic limb.
As we move into our Matrix section,
we look at a topic explored in our Cover Story, sepsis, from a different angle.
Here, Drs. Marc Leone, Benoit Ragonnet and Claude Martin portray in
comprehensive detail the proper use of vasopressors in septic shock, putting
across key learning points. Following this, another infection, this time
ventilator associated pneumonia (VAP) is the focal point. Drs. Andrea Coppadoro,
Riccardo Pinciroli, and Lorenzo Berra look at innovative strategies for preventing
the infection by targeting the role of the endotracheal tube as the main
pathogenic factor involved in its development. Drs. Mariam Alansari and Khalid Maghrabi
from Riyadh, Saudi Arabia, write the final feature in this section, which
focuses on imaging efficacy. They put forward that unnecessary chest x-rays
need to be eliminated and replaced by an alternative technique. As well as suggesting
guidelines for efficient routine and on demand x-ray use, they also propose
ways in which future studies on the subject can be best designed.
Prof. Andrew Rhodes is the subject
of our interview, which focuses on his aspirations and recent achievements as
President of the European Society of Intensive Care Medicine (ESICM). Then, in
our management section, I question the role of intermediate care units in
reducing costs and improving outcomes, and suggest rather that efficiency could
be improved by combining intermediate care and intensive care in one unit.
To conclude, our Country Focus features two articles that examine the
Portuguese healthcare sector. The first, written by Paulo Alexandre Boto and
Fernando Leal da Costa, assistants to the Minister for Health, provides a
comprehensive overview of healthcare in the country, including a proposed
sustainability plan from the national Ministry of Health. Second is a feature
from Drs. Luís Coelho and João Gouveia that concentrates on the intensive care
sector. They discuss recent challenges in the Portuguese sector, some of which
other countries are also enduring, such as those stemming from the economic crisis
and an ageing population, and look at areas where new strategies are needed.