Latest Articles in icu
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Vasoactive medication and RCTs - an impossible marriage
A review and introduction of the concept “enough.” We provide a brief overview of important physiology and the pharmacology of vasoactive drugs that are currently used in the ICU as well as newer agents, along with a concise review of recent publications comparing these agents. We attempt to answer the question what drug dose should be administered...
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Advances in source control in patients with sepsis and septic shock
In the past decades there have been significant advances in the diagnosis and management of patients with sepsis and septic shock, and overall awareness has increased significantly (Angus and van der Poll 2013). Emphasis is currently on the early detection of sepsis and rapid initiation of fluid administration and antibiotic therapy, all of which...
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Organ cross-talk in shock and critical illness
Organ cross-talk is a popular mechanism invoked to explain the progression of multi-organ dysfunction syndrome; however this term is often ill-defined and may encompass many differing mechanisms of organ interaction. In this article the concept of cross-talk is reviewed and its real meaning to the clinical is critically appraised. Multi-organ...
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Cancer patients in the intensive care unit
Recent advances and new challenges. It has been thought for years that cancer patients have not benefitted from intensive care unit (ICU) admission when they suffer from severe and potentially reversible acute illnesses. Fortunately, numerous studies have shown that this is not the case. Today, the number of cancer patients in ICUs around the...
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What should we stop doing in the ICU?
In this article, I highlight that the most important thing intensive care physicians should stop doing is ignoring that they are prone to several cognitive biases. I will first support my statement by looking for conceptual caveats and cognitive bias in routine intensive care unit (ICU) care, and then move to specific patient and structural problems....
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Caring for very old patients in the ICU
Describes the epidemiology and outcomes for very old patients as known in 2018, along with a short introduction to the most relevant “geriatric syndromes” important also for intensivists, and discusses where we should increase our body of knowledge to make a more precise triage in this patient group. The very old ICU patient is a term often...
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The sepsis box, bag and trolley
Evaluation of aids to the delivery of sepsis treatment. In NHS Wales the Sepsis 6 bundle, delivered within one hour of sepsis recognition, has been standard treatment in acute hospital settings since 2013. We describe various methods for increasing the speed and effectiveness of Sepsis 6 bundle delivery that have been trialled with positive...
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Key decisions in a goal-directed coagulation management approach
An individualised goal-directed approach to managing coagulopathy is recommended to treat bleeding trauma patients. Severe trauma is a great burden to society, with millions of victims worldwide. If trauma patients are hazardly bleeding, surgical bleeding requires the surgeon to fix the problem, while coagulopathy requires management...
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Evidence for using first-line coagulation factor concentrates for trauma- induced coagulopathy
Fibrinogen limits coagulopathy and massive bleeding, has less transfusion requirements and thereby decreases the risk of multi-organ failure in trauma patients. What stops the bleeding? Haemostatic therapy aims to stop the bleeding, but is it a concentration of coagulation factors, mainly assessed by international normalised ratio (INR)...
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Implementation of a revised trauma management protocol
Goal-directed therapy of coagulopathy is recommended for trauma patients. Can guidelines direct our strategy? When presented with bleeding trauma patients, our management strategy may be directed by guidelines, e.g. the European trauma guideline (Rossaint et al. 2016). This recommends treatment with fibrinogen concentrate or cryoprecipitate...
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