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Professor Department of Intensive Care Erasme Hospital Université libre de Bruxelles
Decision-making in the ICU is a multifaceted process that involves clinical assessment, collaboration among multidisciplinary teams, ethical considerations, evidence-based practice, communication, and continuous adaptation to evolving clinical scenarios. Balancing the complex factors requires expertise, teamwork, and a patient-centred approach. Improving the decision-making process in ICUs is...
READ MOREPharmacists play a crucial role in the ICU, where patients often require complex medication regimens, including multiple medications and intravenous therapies. The role of a critical care pharmacist is multifaceted and vital to ensuring optimal patient care in the critical care setting. Critical care pharmacists ensure patients receive safe, effective, and appropriate medication therapy....
READ MORECollaboration between critical care doctors, patients and families is essential to managing critically ill patients. Promoting open communication, shared decision-making, and emotional support is essential to ensure a patient-centred approach in critical care settings. Communication plays a crucial role in a critical care setting. Critical care teams are trained to manage comple
READ MOREArtificial Intelligence (AI) is making significant strides in healthcare, and its application in critical care is no exception. AI technologies can potentially enhance patient care, improve clinical outcomes, and streamline healthcare operations in the ICU. There are numerous ways in which AI can be effectively utilised in the ICU. AI algorithms can analyse patient data in real-t
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A woman came to see me a few days ago: her 44-year-old husband recently died from sepsis in another hospital, and she wanted to have a discussion about this tragic story. Her husband had had just...
READ MOREIntensive care units are essential in providing life-saving care to critically ill patients. However, ICUs can have an environmental impact. Approximately 5% of worldwide anthropogenic greenhouse gases result from healthcare activities. ICUs use significant energy to power equipment, ventilators, monitoring systems, and other life-support devices. They also consume substantial amou
READ MOREOrgan support is a life-saving measure and crucial in many critically ill patients. However, organ support can be associated with complications. Join our panellists as they discuss progress in the management of multiorgan failure and different forms of organ support and treatment strategies for acute kidney injury, respiratory failure, cardiac failure and liver failure. Register here ! ...
READ MOREWhen patients are critically ill, one or more organs may not function optimally or even fail, so organ support is an important component of ICU management. However, organ support can be associated with complications such as infections, bleeding, and damage to surrounding tissue or organs. These complications can alter the patient's condition, leading to additional interventions or treatments....
READ MOREBiomarkers are quantifiable indicators of physiological or pathological processes in the body. They can be more effectively utilised in intensive care by improving standardised protocols for biomarker testing and interpretation. Join our panellists as they discuss the use of Biomarkers in critical care and where and how biomarkers can provide valuable diagnostic, prognostic and therapeutic value. ...
READ MOREBiomarkers are quantifiable indicators of physiological or pathological processes in the body. They can be useful in establishing a diagnosis, assessing disease progression and a patient's condition and guide therapeutic interventions. However, a great deal could still be done to further improve the utilisation of biomarkers in critical care. Biomarkers can help identify early signs of disease,...
READ MOREImaging is integral to managing critically ill patients in the ICU as it is a key source of diagnostic information to guide clinical decision-making. In recent years, there has been significant evolution in the field of critical care imaging with an increased focus on improving imaging modalities and methodologies and increasing access to imaging findings. Whether it is critical care ultrasound (including
READ MOREInfections occur frequently in critically ill patients in the ICU. They may be the reason for admission and could also be due to immunosuppression associated with critical illness. Antibiotics are essential tools for treating both common and complex infections. It is recommended that antibiotics should be administered as soon as possible once an infection is identified. However, managing these infections...
READ MOREAntibiotic resistance is one of the most significant public health challenges today. Join our panellists as they discuss the problem of antibiotic resistance, its impact on patient outcomes, the importance of effective antimicrobial stewardship programmes, the role of rapid diagnostic testing, and important strategies to reduce the spread of antimicrobial resistance. Moderator Jean-Louis
READ MOREEffective pain relief is one of the most important priorities in the ICU. Join our panellists as they discuss different aspects of pain management in critically ill patients and the use and effects of analgesia and sedation in the ICU. Moderator Jean-Louis Vincent (MODERATOR) Editor-in-Chief ICU Management & Practice Professor Department of Intensive Care Erasme Hospital Université...
READ MOREPain is frequently encountered in intensive care unit (ICU) patients. Several studies have shown that improved pain management is associated with improved patient outcomes. However, pain management continues to be a significant challenge in the ICU setting. Effective pain relief is one of the most important priorities in the ICU. The goal is to ensure optimised clinical outcomes and patient...
READ MORESepsis is a leading cause of morbidity and mortality in the intensive care unit. Nearly 14 million adults and 2.5 million children survive sepsis each year worldwide. In addition, sepsis survivors are known to experience poor long-term outcomes and often develop functional limitations thereafter. It is thus evident that the long-term impact of sepsis is an issue that must be addressed.
READ MORESepsis is a leading cause of admission to the ICU and is associated with a high mortality rate. Join our panellists as they discuss the impact of sepsis in critical care, characteristics of patients with sepsis, causative factors, and effective preventive and therapeutic interventions. Moderator Jean-Louis Vincent Editor-in-Chief ICU Management & Practice Professor Department of Inte
READ MOREPatients in the intensive care unit generally have complex healthcare issues with underlying comorbidities and organ dysfunction. They are thus more vulnerable to medical errors. Often, the treatment of these patients requires the use of interventions that could potentially result in adverse events, errors and harm. While critical care guidelines provide the necessary recommendations to ensure these...
READ MOREJoin our panellists on March 1 at 16:00 CET as they discuss the prevalence and types of medical errors in the ICU, the psychological impact of these errors, and strategies to prevent them and improve the safety of critically ill patients. Moderator Jean-Louis Vincent Editor-in-Chief ICU Management & Practice Professor Department of Intensive Care Erasme Hospital Université l
READ MOREJoin our panellists on November 30 at 16:00 CET as they discuss coagulation, anaemia, haematological malignancy, and other important presentations of haematological disease in critical care. Register here ! Moderator Jean-Louis Vincent Editor-in-Chief ICU Management & Practice Professor Department of Intensive Care Erasme Hospital Université libre de Bruxelles Brussels,
READ MOREP atients in the intensive care unit frequently report haematological issues. These issues are often a result of critical illness. The most common haematological complications seen in the ICU include thrombocytopenia, anaemia, leukocytosis, thrombocytosis, and coagulopathies. In addition, emergencies in malignant haematology are commonly seen in the ICU and can cause significant mortality and morbidity...
READ MOREJoin our panellists on October 12 at 16:00 CET as they discuss the role of microbiome in critical illness, possible complications and potential microbiome treatment strategies and approaches. Register here ! Moderator JEAN-LOUIS VINCENT Editor-in-Chief ICU Management & Practice Professor Department of Intensive Care Erasme Hospital Université libre de Bruxelles Brussels, B
READ MOREM ultiple factors can bring the microbiome out of balance in critically ill patients in the intensive care unit. These include antibiotic use, mechanical ventilation, changes in diet and inflammatory responses. The dysbiosis of the microbiome can alter immunological responses and could potentially have an impact on patient outcomes. There are approximately 100 billion microorganisms...
READ MOREG ender inequity in critical care medicine remains a pressing issue as the representation of women and minorities continues to be lowest in this specialty. Women continue to be underrepresented in leadership roles and senior positions. Whether it is overall compensation, lucrative opportunities, recipients of research funding, lead authors and editors, or presence at medical conferences, men continue...
READ MORES upplemental oxygen is an essential component of intensive care and is a commonly used therapy worldwide. The primary goal of oxygen therapy is to prevent hypoxaemia. Since oxygen is usually widely available (except in special circumstances such as during the COVID-19 pandemic) and is relatively inexpensive, it is frequently used in patients with declining oxygen saturation. However, while
READ MOREAn overview of strategies and measures that can be implemented to improve wellbeing of staff and patients in the ICU. 1. Make the patient the centre of our preoccupations This is the first principle of wellbeing in the ICU and should be written in large letters when one enters an ICU. Wellbeing must concern first and foremost the patient. The patient should be positioned, figuratively,...
READ MOREH ealthcare workers across the world have been facing significant challenges due to the COVID-19 pandemic. In particular, critical care workers have had to deal with several issues, including a surge of seriously ill patients, shortages of staff and resources, long shifts, exhaustion, risk of infection, fear of transmission to family, constant exposure to illness and the tragedy of patient deaths....
READ MOREThe COVID-19 pandemic has had a significant impact on ICUs and critical care healthcare providers all across the globe. As of this week, 110 million people have been infected with the virus worldwide, and 2.4 million have died. Many of the infected patients need hospitalisation and admission to the ICU. A high percentage of severely ill patients with COVID-19 require mechanical ventilation. Hence,...
READ MORE2020 has been an unusual year. As we begin 2021, it is important for intensivists to look back over what has happened and see whether lessons can be learned from our combined experiences . T he year 2020 has been unusual in so many ways and as we start a new year, it is interesting and important as intensivists to look back and reflect on what has happened. Populations worldwide have experienced...
READ MOREN umerous patients are admitted to the Intensive Care Unit (ICU) every year. Many of these critically ill patients receive multiple interventions to treat and manage acute conditions and prevent further deterioration. However, these treatments can often affect a patient's mind and body. That is why many ICU survivors, as they transition out of the ICU, do not have the same abilities as they did...
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Jean-Louis Vincent is a Consultant in the Department of Intensive Care at Erasme University Hospital in Brussels and a Professor of Intensive Care at the Université libre de Bruxelles.He is the editor
READ MORET he process of ageing cannot be defined by a number. The World Health Organization classifies anyone over the age of 65 as elderly. However, it is important to understand that ageing is a complex process, and we must consider physiological and cognitive vulnerabilities when talking about ageing as they can make some elderly people more prone to disease and acute medical events. Also, comorbidities...
READ MOREJean-Louis Vincent is a Consultant in the Department of Intensive Care at Erasme University Hospital in Brussels and a Professor of Intensive Care at the Université libre de Bruxelles.He is the editor-in-chief of ICU Management & Practice, Critical Care, and Current Opinion in Critical Care and member of the editorial board of many other healthcare publications. Prof. Vincent has received several...
READ MOREIs the worst over? Have patients most at risk already been affected and died? Or has the SAR-CoV-2 virus mutated to a less severe form? Where exactly do we stand with COVID-19? U ndoubtedly, the COVID-19 pandemic has been a terrible experience - worse than expected for many worldwide. As we follow the COVID-19 situation, there is a tendency to focus on the many deaths as a way to quantify...
READ MORET hey say that in the world of the intensive care unit (ICU), there is no night. It can be qualified as a lesser day, but not really as a night. The hustle and bustle may be slower, patient flow and activity may be less, conversations may be negligible, and the staff on duty may be limited, but patient care continues, alarms are in place, and the usual "rhythm" of intensive care remains. You can...
READ MOREClinicians are faced with a serious disease with no effective therapy. Several options are being considered to treat COVID-19, but how promising are these drugs? A number of colleagues and friends from outside the hospital have asked me whether they should take hydroxychloroquine for their COVID-19. A friend asked me whether he should take lopinavir-ritonavir even though he is not...
READ MOREC oronavirus disease (COVID-19) continues to spread. While nations that were hit early are now seeing a flattening of the curve from mitigation strategies, countries that have been hit more recently continue to suffer. It is true that the majority of the population experiences mild symptoms of the disease, but age, comorbidity, and male sex are important risk factors that are still resulting in...
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A number of colleagues and friends from outside the hospital have asked me whether they should take hydroxychloroquine for their COVID-19. A friend asked me whether he should take lopinavir-riton
READ MORECritical Care Medicine has existed for many years, but was only recognised as a specialty in the last 40 years or so. However, during this time, there has been a tremendous amount of change. Over the years, our understanding of different critical illnesses has improved, and our treatment strategies have become more effective. Technology has also played a key role in improving patient care, and adopting...
READ MOREThe critically ill patient is often unable to feed by mouth. This condition, in some patients, can range from days to months. It is imperative that these patients receive macronutrients either through enteral or parenteral nutrition. If they don't, there is a risk of an energy deficit that could lead to loss of lean body mass and subsequently, other adverse outcomes. Muscle wasting and weakness due...
READ MOREReducing sedation and managing and treating pain are important objectives for clinicians. The primary goal should always be to promote the comfort of the patient and to minimise pain through the proper use of multimodal analgesia. The use of opioid drugs should be avoided unless absolutely necessary; and focus should be placed on achieving pain control through combined pain management strategies....
READ MOREManaging sedation analgesia for patient-centred care in the ICU Pain management and sedation are closely linked in the intensive care unit. In the past, clinicians were using sedative agents too liberally, often with benzodiazepines. And several issues were observed in the ICU, including the problems of delirium, weakness and prolonged ICU course. In recent years, attempts have be
READ MOREIt is never easy when children are in the hospital. And it is even more stressful when they're in the Paediatric Intensive Care Unit (PICU). When a child is admitted to the PICU, it means that they require the highest level of medical care. Children in the PICU present with different symptoms and conditions - from serious infections to heart conditions; from asthma to diabetes; from a traumatic injury...
READ MOREThe burden of critical illness is a major concern in healthcare. This burden is expected to continue to increase as our population ages. Our cover story Innovation highlights the growing problem of critical illness and the need to develop improved practices and implement new and advanced solutions to meet the expected challenges. Our contributors envision the ICU of the future and discuss the changing...
READ MOREOur cover story this issue is Imaging. The radiology armamentarium is vast, with many imaging modalities available to aid diagnosis and monitoring of therapy in critically ill patients—both at the bedside (x-ray, ultrasound) and in the radiology department (MRI, CT and PET). Research is underway to image even deeper, such as the PROTEUS collaboration in the UK, which is investigating molecular...
READ MOREShock is an emergency, and if it is not treated, it will mostly be fatal. Early intervention and admission to the ICU is essential. Our cover story considers several aspects of shock, including pathophysiology and multi-organ dysfunction syndrome, as well as source control, fluids, differentiation using point-of-care ultrasound and vasoactive medication. Francesco Forfori, Greta Giuliano and...
READ MOREWhat happens before patients arrive in the ICU? We know that status pre-ICU is associated with outcomes after patients leave the ICU. We also know that we want patients to come to the ICU only if it is needed. This ties in to having an adequate emergency medicine system and innovative techniques in trauma as well as monitoring hospital patients at risk of clinical deterioration. Our cover story...
READ MOREInterventions intended to support one organ can have unexpected implications on the patient, presenting physicians with critical decisions. These can be aided with innovative technologies and new techniques, but only if well understood. We often come across multiple organ dysfunction syndrome (MODS), with incremental degrees of physiologic derangements in individual organs, which should be seen as...
READ MORE“The function of education is to teach one to think intensively and to think critically” Martin Luther King Worldwide there is still much variation in type and duration of intensive care medicine training programmes (Amin et al. 2016). What is clear is that training programmes need to cover the ‘basics’ as well as adapt to accommodate new skills, such as pointof- care ultrasound. Education...
READ MORERecovery after critical illness has received increasing attention in recent years, and rightly so. We highlighted neglect of recovery as one of the ten big mistakes in intensive care medicine (Vincent et al. 2014). While survival has improved tremendously, for a long time insufficient attention was given to how patients (and their families and caregivers) were coping after leaving the ICU. Planning...
READ MOREThe “chain of survival” metaphor for improving outcomes from sudden cardiac arrest (CA) was first coined in the 1980s. Since adopted by the American Heart Association and the International Liaison Committee on Resuscitation amongst others, it is a useful tool to concentrate efforts on how to optimise every link in the chain to improve survival and neurologically intact outcomes for CA patients. Mortality...
READ MOREThe specialty of intensive care medicine grew out of the realisation that critically ill patients needed more attention and specialised treatment than could be provided on a general ward, and that many of these patients had similar clinical problems and processes, so management would be facilitated if they were grouped together in one place. Since those early days, intensive care medicine has grown...
READ MOREThe progress towards, and potential of, personalised/ precision medicine in intensive care is the theme for our cover story. We are making progress in moving away from therapies based on poorly characterised patient populations to more personalised treatment of critically ill patients, although true precision medicine, based on individual genes, environment and so on lies some way in the future. Andrew...
READ MOREEditor-in-Chief, ICU Management & Practice Professor of Intensive Care Medicine, University of Brussels Our health is our most precious good and helping people whose health is damaged or at stake is the highest privilege on earth Management Tip: Make everybody happy… and make sure they can take their responsibilities without exce
READ MOREProviding seamless emergency care is the ideal for those of us who work in emergency medicine and intensive care. In the past, intensive care units were a closed part of the hospital, and admission was strictly controlled. This idea is obsolete now. It is heartening that we are providing more integrated care between emergency and intensive care. Intensivists need to go out of the ICU and take action...
READ MOREAn emphasis on quality of care has always underpinned healthcare, but in recent years quality measurement has come to the fore, as countries around the world seek to provide the best outcomes for patients while facing ever-increasing healthcare costs. In intensive care, despite the heterogeneity of the patient population, great strides have been made in defining and measuring quality in order to improve...
READ MOREManaging the abdomen and its complications in the intensive care unit is the subject of our Cover Story. First, Jan de Waele considers the data on new antibiotics for complicated intra-abdominal infections. While these, singly and in combination, show promise, he cautions that recent studies have certain shortcomings from a critical care perspective, and recommends that local antibiotic stewardship
READ MOREThe publication of the landmark Institute of Medicine report To Err is Human shocked with its estimate that as many as 98,000 people die in U.S hospitals each year due to medical errors (Kohn et al. 2000). Has patient safety improved since the report’s publication? Perhaps not as much as anticipated. A recent paper estimates that medical error is the 3rd leading cause of death in the United States
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We are delighted to feature ICU Management's Editor-in-Chief, Professor Jean-Louis Vincent, in Zoom On. Dr. Vincent is Professor of Intensive Care at the University of Brussels, and intensive care ph
READ MOREThe use of extracorporeal membrane oxygenation (ECMO) in critical care is growing. From its initial use back in the 1950s in cardiac surgery, it is now an important tool for life-saving organ support, with clear indications for use in neonates and growing use in paediatric ICUs. ECMO for adult patients is also expanding in use (over 400% between 2006 and 2011 in the USA, for example (Sauer et al....
READ MORETreatment of neurological illnesses and complications in the intensive care unit remains a challenge. And as intensivists we are aware of the risks of cognitive impairment for many ICU patients. For our cover story this issue we address practical brain matters. Nino Stochetti explains how to choose fluids for brain injured patients to achieve the goals of preserving cerebral perfusion, controlling...
READ MOREThere are not many good books on this topic, and the present one includes contributions from North American and Australian experts in the field. The book has three main sections: organisation, improvement and integration, and a shorter fourth section on global and future perspectives. The list of topics is quite comprehensive, from ICU practitioners to computers, from quality to teamwork, from rationing...
READ MOREMany studies, some already published a long time ago, have reported that hyperglycaemia (Dungan et al. 2009), or “dysglycaemia” (Smith et al. 2010) as some prefer, is an independent prognostic marker in acutely ill patients. For example, after cardiac surgery, glycaemia above 180 mg/dl, implying poor glucose control, was consistently and independently associated with an increased rate of postoperative...
READ MOREIn medicine the benefits of treatment are always weighed against possible harms. In these times of budgetary constraints financial considerations also come even more into focus. Costeffectiveness in medicine works at many levels. In clinical trials the cost of quality-adjusted life years (QALYs) may be one of the outcomes measured. At a department or hospital level, directors need to consider the cost-effe
READ MOREInterview With Professor Jean-Louis Vincent, WFSICCM President What have been the highlights of your term of office? With modern communication means, it is easier to interact all over the world, to know each other better, and learn from each other. We have started the organisation of large trials, inviting the entire word to contribute – the ICON study has been a great success! We have put several...
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We are delighted to feature ICU Management's Editor-in-Chief, Professor Jean-Louis Vincent, in Zoom On. Dr. Vincent is Professor of Intensive Care at the University of Brussels, and intensive care...
READ MOREWithin any given hospital, the critically ill are among those patients requiring the highest level of specialised care and resources; but as it is increasingly noted, there are growing sub-populations of patients who require even more specialised care, equipment and protocols. In past issues of ICU Management, we have focused on many of these distinctive groups - from the management of obese patients...
READ MORECommunication skills are perhaps even more important in intensive care medicine than in other specialties. Critical illness can be frightening for both patients and families, and it is a given that errors in communication can impede care and even harm the patient. But when time and resources are stretched, what is the best way to communicate? In the first article in our cover story, Taylor Thompson...
READ MOREEditor-in-Chief, Professor Jean-Louis Vincent, has welcomed three distinguished intensivists to the ICU Management Editorial Board. Prof. Jan de Waele, MD, Phd (Belgium) Prof. De Waele is an intensivist at the Surgical ICU of the Ghent University Hospital in Ghent, Belgium. As the current President of WSACS – the Abdominal Compartment Society, he will host the 2015 World Congress on the...
READ MOREA warm welcome to Brussels for the 35th International Symposium on Intensive Care and Emergency Medicine. In 1980 we welcomed just a few hundred delegates to Brussels - pre-mobile phones and pre-Internet! While networking has become even easier with mobile and online technology, nothing beats meeting our colleagues in person. This year more than 6,300 participants will convene for ISICEM. Allow...
READ MOREGoal-directed therapy (GDT) continues to be a subject of controversy in intensive care medicine, especially after the results of recent trials exploring its effectiveness. Our cover story this issue looks at two aspects of GDT. Azriel Perel addresses some of the remaining questions about the practice of perioperative goal-directed therapy. Despite evidence supporting its routine use, it has not been...
READ MOREEarly Recognition of Sepsis Patients with sepsis, now defined as a severe infection with some degree of associated organ dysfunction, make up a large proportion of the critically ill population and, although outcomes have improved over the last decade, mortality rates remain above 20-30%, and even close to 40% when shock is present. There are no effective specific anti-sepsis treatments, and management...
READ MOREIs there such a thing as a perfect ICU? Organisation and design of the ICU has evolved exponentially since the first units delivering intensive care were set up in the 1950s. Organisation and design of the perfect ICU involves many factors – architecture, equipment and technology, staffing, patients and families. In our cover story this issue we include two articles, which suggest there is much still...
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