ICU Management, Head Department of Intensive Care Erasme Hospital / Free
University of Brussels, Brussels, Belgium
In this issue our cover story focuses on one organ in particular, the kidney. As a commonly occurring complication in the ICU, acute kidney injury (AKI) has received much attention from intensive care clinicians in recent years. While there is more research to be done to combat this rapid-onset condition, our knowledge has increased over the last decade.
In the first article Profs. Lakhmir Chawla and John Kellum review biomarkers for AKI, including neutrophil gelatinase-associated lipocalin (NGAL) and urine output, noting that new discoveries along with reinvention of existing tools hold great promise. Despite inconclusive and sometimes controversial results from randomised controlled trials, interest in renal replacement therapy (RRT) is growing. Prof. Patrick Honoré and colleagues cover the state of RRT in 2013, with new insights on dosing, timing, modalities and membranes. The third article in our cover story, by Dr. Nakshatra Saxena, Prof. Ashita Tolwani and Dr. Keith Wille looks at anticoagulation in continuous renal replacement therapy, in particular the anticoagulants unfractionated heparin and regional citrate. Next, Dr. Manu Malbrain and colleagues provide an in-depth article on fluids and nutrition in AKI. In the final article in our cover story Drs. Max Bell and Johann Mårtensson discuss renal recovery after AKI, arguing that ICU management has a role in determining outcomes, and that for certain patients nephrology referral may minimise risk for -stage renal disease or death.
In the Matrix section, Drs. Yudi Sutherasan and Iole Brunetti with Prof. Paolo Pelosi discuss ventilation after cardiac arrest. Optimising ventilation and gas exchange by protective ventilation, keeping normoxia and avoiding hypocapnia may play a role in improving outcome. They also consider transcranial Doppler as a new non-invasive monitoring tool. Next, Profs. Martí Manyalich and Ricard Valero and Dr. Jesús Carazo discuss organ donation after circulatory determination of death, which has come to the fore as demand for organs has increased. The final Matrix article is about the recently published results of the European Centre for Disease Prevention and Control's point prevalence survey on healthcare-associated infections and antimicrobial use in European hospitals.
Dr. Christina Jones, in the Management section, follows with a review of the arguments for and against the controversial practice of physical restraint of patients in the ICU.
Prof. Gordon Rubenfeld is interviewed for this issue, providing a perspective from Canada on critical care, including his views on the limitations of, and priorities for ICU research, and current challenges in the field.
ICU Management will be at the European Society of Intensive Care Medicine (ESICM) congress in Paris this month, and therefore France is the topic of our Country Focus. Dr. Yên-Lan Nguyen and Prof. Bertrand Guidet provide an overview of the state of critical care in France, observing that French intensivists are very active in clinical research. This activity is the subject of the article by Prof. Catherine Paugam-Burtz and Dr. Samir Jaber, which reviews recently published and completed clinical trials. As always, if you would like to get in touch, please email [email protected].