ICU Management Head Department of Intensive Care
Erasme Hospital / Free,University of Brussels
With thousands of patients dying from lack of donor organs every day, the topic of organ donation is a timely one. With ICUs often the location for the beginning of this process, our cover story focuses on this topic. Even without considering the loaded subject of the politics of ‘opt-in’ or ‘opt out’ systems of organ donation, there is much that can be done to improve the rate of organ donation.
Dr. Teresa Pont writes about implementing the concept of self-sufficiency, the critical pathway for organ donation after death, and including the option to donate as part of end-of-life care. She argues that the option of donation is an ethical commitment in end-of-life care.
Dr. Jonathan Ball writes about the optimal management of the potential donor patient following catastrophic brain injury, suggesting that more can be done to optimise organ function before assessment and retrieval, and he outlines best practice for this.
Prof. David Crippen and Prof. Leslie Whetstine argue the pros and cons of uncontrolled organ donation following cardiac arrest outside the hospital setting. Prof. Crippen proposes that preserving organs for organ donation early on while awaiting consent is ethically neutral and reasonable. Prof. Leslie Whetstine argures that uncontrolled donation after circulatory determination of death is ethically and medically specious.
Next, in our Matrix section, Dr. Yuda Sutherasan and colleagues look at the important topic of respiratory monitoring in the perioperative period, considering the tools available as well as monitoring in specific conditions. This is followed by Prof. David Linton and colleagues’ clinical experiences over the past decade of intelligent ventilation.
The European Society of Anaesthesia’s patient safety starter kit is the subject of Prof. Sven Staenders piece. The kit was launched at ESA in June, and the societies have a comprehensive plan to disseminate it with the goal of implementing the Helsinki Declaration on Patient Safety in Anaesthesiology.
Prof. Preiser and colleagues write about indirect calorimetry. Their article explores the different uses and clinical relevance of using indirect calorimetry to manage caloric prescription in critically ill patients. They consider the evidence and ask: is it an essential tool to optimise nutrition or more suited as a research tool?
In our Management section, Dr. Lascarrou and colleagues look at the topic of delayed admission to the ICU, and consider the causes. Given that most countries do not have enough ICU beds, it is important to look at reasons for delays.
Prof. Djillali Annane kindly found time to speak to us for our interview section. Prof. Annane’s research interests focus on sepsis, and he talks about the preliminary findings of the CRYSTAL study as well as his thoughts on fluid resuscitation, the role of clinical trials in the future, current hot topics and important breakthroughs.
Our country profile this issue is South Africa, and we are delighted to have talked to Dr. Dean Gopalan and Prof. Satish Bhagwanjee, co-chairs of the organising committee of the 11th Congress of the World Federation of Societies of Intensive and Critical Care Medicine, which will take place in Durban, South Africa, August 28th - September 1st 2013.