Head Department of Intensive Care, Erasme Hospital / Free
University of Brussels, Brussels, Belgium
Prevention and treatment of severe pulmonary infections is the subject of this issue’s cover story. Lung infections are common in the ICU and have a number of challenges in prevention, diagnosis and treatment.
First, Dr. Matthieu Boisson and Prof. Olivier Mimoz outline measures for the prevention of ventilator- assisted pneumonia (VAP), which they think must be a priority in the management of critically ill patients. The incidence of VAP has been hard to measure in the absence of objective diagnostic criteria. Dr. David Pearson and colleagues discuss the need for objectivity for surveillance of patients treated by mechanical ventilation, in the context of the U.S. Centers for Disease Control and Prevention’s Ventilator Associated Event diagnostic key. It is important that this new tool is validated, to provide objective validated criteria for the diagnosis of ventilator-associated events. Next, Prof. Michael Niederman describes recent findings in the use of aerosolised antibiotics in mechanically ventilated ICU patients, and argues that it may be time to reevaluate their use for therapy of lower respiratory tract infection.
In the final article in our Sepsis series, Prof. Martin Matejovic and colleagues look at the ongoing debate on the role of haemodynamic alterations in sepsis-related renal failure.
In the Matrix section, Prof. Samuel Tisherman reviews the role of therapeutic hypothermia in severe trauma, which may be of benefit for haemorrhagic shock, traumatic cardiac arrest, traumatic brain injury and spinal cord injury. Next, Prof. Terence Valenzuela looks at the potential of ischaemic conditioning, including preconditioning, preconditioning and postconditioning, for neuroprotection in stroke.
In the Management Section, Univ.- Prof. Gernot Marx and Mr. Rainer Beckers discuss the promise of teleintensive care medicine in improving healthcare outcomes, workflow, efficiency and quality.
As we approach the 100th anniversary of World War I, it is salutary to be reminded of the advances in military medicine. Mobile critical care in combat, and the benefits flowing on for remote critical care and evacuation of civilians in natural disasters, is the subject of the article by Lieutenant Colonel Michael Reade. Next, Dr. Chris Subbe highlights the impact of rapid response teams on the ICU. Such teams improve referral to the ICU and affect rates of admissions. Further improvements may be gained through advances in technology.
Prof. Jan Bakker is well-known for his research on blood lactate. He is interviewed for this issue on this and other interests, which include ethics and end-of-life care.
Our Country Focus is Saudi Arabia. Dr. Mariam Alansari and Prof. A.H. Alzeer discuss the Kingdom of Saudi Arabia’s healthcare framework for Haj, the annual mass gathering of pilgrims to Mecca, which brings unique challenges.