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ICU Director Intensive Care Unit, University Hospital Brussels (UZB)
Professor Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB)
This article will focus on the non-clinical, human aspects of critical care, namely the patient and the ICU team. The modern concepts of humanising ICU care, the healing environment and future-proofing the ICU team will be discussed. Introduction Despite being a relatively young specialty, critical care has made remarkable progress since its inception during the polio epidemic in...
READ MOREAn overview of what has been published on fluid strategies in COVID-19, guidelines available and reflections on personal practice. Introduction The global COVID-19 pandemic has sharply focused the attention of the world onto critical care as a specialty. At the moment, there are no proven treatments for COVID-19, although several trials and case series extolling the merits of various...
READ MORECritical Care Ultrasound (CCUS) has progressed by leaps and bounds, and will continue to push boundaries, with techniques being modified to suit evolving clinical needs and new applications. Introduction With roots traceable to sonar technology developed for underwater listening and submarine detection, the era of medical ultrasound began during the Second World War; the first research...
READ MOREThe secrets of the abdomen Overview of abdominal point-of-care ultrasound use in the ICU, potential diagnoses and findings common to the critical care patient population. The use of point-of-care ultrasound (POCUS) in critical care as a diagnostic and monitoring tool is rapidly expanding. While its role in cardiovascular and respiratory assessment is well established (within critical care)
READ MORE(Part II): results from a meta-analysis and practical approach Co-authors Colin Cordemans, MD Intensive Care Unit ZNA Stuivenberg Antwerp, Belgium Niels van Regenmortel, MD Intensive Care Unit ZNA Stuivenberg Antwerp, Belgium Introduction In a previous issue of ICU Management (volume 12, issue 1), we suggested a three hit model of shock and emphasised that both early and late...
READ MOREA conceptual framework for developing institutional programmes and guidelines to enhance fluid stewardship (especially in the intensive care unit [ICU] environment), an activity that includes appropriate selection, dosing, duration, de-escalation, and monitoring of fluid therapy. The primary goal of fluid stewardship is to optimise clinical outcomes while minimising unintended consequences...
READ MOREKnowledge of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) is crucial for successful treatment of critically ill patients, whether medical or surgical, young or old (Kirkpatrick et al. 2013). Today we understand that IAH and ACS are frequent causes of increased morbidity and mortality (De Waele et al. 2016). More importantly, we now also know that IAH and ACS have correctable
READ MOREWhat Is New? Following a severe burn injury, an overwhelming systemic inflammatory response with capillary leak syndrome is initiated, resulting in a combined hypovolaemic and septic shock (Malbrain et al. 2014a). Numerous articles regarding burn resuscitation have been published over the last decades; however, there is no universal consensus on how to achieve adequate resuscitation whilst avoiding...
READ MOREThe impact of a positive fluid balance on morbidity and mortality has been well established. However, little is known about how to monitor fluid status and fluid overload. This article discusses the different parameters related to bio-electrical impedance analysis (BIA) and their use to monitor fluid status and to guide fluid management in critically ill patients. Introduction Bio-electrical...
READ MOREPart Two: From cardiac to thoracic - the other compartment syndrome In the last issue of ICU Management, we featured PART ONE of this article, which discussed Pelvic Compartment Syndrome, Abdominal Compartment Syndrome (ACS) and intra-abdominal pressure measurement. In the second part of this article, we will focus on the remaining compartment syndromes –Orbital (OCS), Intracranial (ICS),...
READ MOREPart One: Pathophysiology and Pressure Measurement of Pelvic and Abdominal Compartment Syndromes Introduction A Compartment Syndrome (CS) exists when the increased pressure in a closed anatomic space threatens the viability of surrounding tissue. Within the body there are 4 compartments, the head, the chest, the abdomen and the extremities. Within each compartment; an individual organ or a...
READ MOREThis article focuses on the impact of fluid and nutrition administration on kidney function. It discusses the deleterious effects of accumulating fluid overload leading to kidney oedema and worsening kidney function, and provides advice on how to adapt nutrition in the different stages of AKI, with or without RRT. Finally, information on the cardio-abdominal-renal syndrome (CARS) is provided, since...
READ MOREA Compartment Syndrome (CS) is Defined as Increased Pressure in a Closed anatomic space which threatens the viability of enclosed and surrounding tissue (Malbrain et al. 2006). Within the body there are four major compartments: the head, the chest, the abdomen and the extremities. Within each compartment, individual organs can be affected by a CS. As such, orbital CS, cardiac CS, hepatic...
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Dr. Manu Malbrain is the medical hospital director of the ZNA " Ziekenhuis Netwerk Antwerpen " Stuivenberg and ZNA St-Erasmus hospitals in Antwerp, Belgium since 2013. He is the manager and directo
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