ICU Management & Practice, ICU Volume 9 - Issue 4 - Winter 2009/2010


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The World Health Organi sation predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese. Within the critical care field, this changing population is set to trigger a new set of requirements for clinicians – both with regards to equipment and staffing needs and demands as well as for specific management and treatment practices.

In our focus on OBESITY, we begin with an article that discusses the effects of this growing problem on the paediatric population and the specific obstacles that these younger patients encounter in the ICU. Drs. Mungekar and Conway from Beth Israel Medical Centre in New York highlight several common key concerns- from impaired glucose tolerance to asthma and obstructive sleep apnoea (OSA) and their influence on the management of critically ill obese children.

When management of obese patients is discussed, the optimal positioning of these patients is often debated. Drs. Klaus and Monika Lewandowski from Essen, Germany offer an overview of the most common positions and the best cases for the utilisation of each as well as a very useful diagram clearly illustrating the proper positioning. In his review, ICU Management Editorial Board Member Prof. Paolo Pelosi focusses on utilising a physiological based approach of perioperative management in obese patients.

In the Matrix, Dr. Salluh and his team from Brazil discuss the use of scoring systems in risk stratification of patients presenting with CAP in our emergency departments. In addition to the standard clinical practice tools widely utilised, he highlights how new scoring systems (SMART-COP and CAPPIRO) can predict intensive care support needs. The article further discusses how biomarkers may be incorporated into clinical practice in supporting the assessment of severity of illness and response to treatment. Our early mobility series also continues this issue with an article that discusses the feasibility and benefits of early mobility, describing how ICUs could utilise available personnel and equipment to facilitate early rehabilitation.

As the need to weather the financial storm that has hit the global healthcare sector continues, so does our quest to find new strategies to improve cost effectiveness while ensuring the continuation of quality care for our patients. To this end, prioritising has become the newest management concept geared towards bridging the gap between the depletion of resources and improved patient outcomes. The team from Gothenburg, Sweden led in this article by Dr. Khorram-Manesh, considers whether prioritising can be an effective way to counter the current economic crisis within the healthcare system, and outlines how it might be utilised.

In this edition of the journal, we look to Belgium for our country focus, where Drs. Vandijck and Annemans give us a brief overview of the health system and its financing, and Sonia Labeau lends a nurse's perspective to the topic of infection control. In our Viewpoints section, we feature a lively opinion piece from Dr. Baker of New Jersey Medical School, which serves as a timely follow-up to our discussion of the state of the US healthcare system in a prior issue of ICU Management.

The countdown is on: In just a few short months, we will celebrate the 30th Anniversary of the International Sym - posium on Intensive Care and Emergency Medicine (ISICEM), in Brussels. After three decades of gathering together more than 5000 critical care professionals for the most current scientific discussion, debates and social networking, we are proud to once again invite you to join us in the centre of Brussels from March 9 - 12... If you've missed the meeting in recent years, this is definitely the year to reconnect – This year's ISICEM promises to provide more opportunities than ever to network with colleagues from around the globe and will surely offer more than a couple of surprises!

The World Health Organi sation predicts there will be 2.3 billion overweight adults in the world by 2015 and more than 700 million of them will be obese.

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