Advancements in Critical Care

Dr. Ilkka Kalli, MD, PhD, MBA Editor-in-chief, Clinical Window Web Journal See the editor-in-chief working and his Curriculum Vitae

Dear clinician,

The November 2003 issue of the Clinical Window Web Journal (CWWJ) has just appeared, and our new topic is Advancements in critical care.

In the last few years, various factors have influenced healthcare and medical technology, and that transformation seems to continue. Despite the environmental change, patients and care providers will continue their daily work, and the need for clinical education will persist. CWWJ’s mission is to spread that information globally. Indeed, this is our 15th clinical issue, publishing has kept our editorial team busy for over three years. All of our articles can be found on the web, and we will also prepare a collection CD for our readers in the near future.

Hemodynamic instability
Firstly, Dr. James Bailey, MD, PhD (Emory University School of Medicine, Atlanta, Georgia, USA) reviews for our readers the important topic of Hemodynamic instability.
Numerous hemodynamic parameters can be monitored but the two variables that most directly reflect organ perfusion are blood pressure and indices of global perfusion, such as cardiac output or mixed-venous hemoglobin oxygen saturation. Control of coronary and cerebral perfusion has traditionally been regarded important, but the author also emphasizes the importance of renal and mesenteric perfusion in the control of risk patient’s hemodynamic instability.

This paper appears in our series of GASNet-provided articles, and I am excited in seeing deepening of collaboration between GASNet and CWWJ.

Indirect calorimetry
Our next paper is by Chris L. Harris, RRCP, RRT (London Health Sciences Center, Ontario, Canada) who writes from the clinical and respiratory therapy viewpoint about Indirect calorimetry - Practical applications.

This paper follows his Clinical Window presentation on metabolic monitoring at the 16th ESICM Annual Congress in Amsterdam, Netherlands 5-8 October 2003. When you come to our web pages, you should also visit CWWJ’s Podium area, where you will find the author’s presentation slides.

Ventilator performance
Another paper based on an ESICM Clinical Window presentation is Ventilator performance, criteria for comparison by Karl Cornelius-Lorenz, M.Sc. (Dipl. Ing) (Technologie-Institut Medizin GmbH, Göttingen, Germany).

Modern ventilation strategies need adequate high-tech equipment, the author points out, but technical data given in the operation manuals are not necessarily sufficient to determine how adaptable the ventilator really is to patient needs in practice. To measure ventilator performance in a laboratory setting, he has developed technology based on a spontaneously breathing lung model. This approach makes it possible to measure important ventilator-related parameters ‘off-line’. Lung model values that correspond to alveolar pressure appear to give significant new information on how the ventilator reacts to the patient’s demand.

Another focus of this paper is device ergonomics and ease of use, where test methods using patient simulators can acquire new relevant data. For example, the applicability of the user interface can be estimated by observing scenarios using a full-scale patient simulator.

Hypernatremia in a one-month-old baby (a case report)
Last but not least I have selected a case report form a pediatric critical care department: Hypernatremia in a one-month-old baby, a case report, by Dr. Seppo Ranta, MD, PhD (Helsinki University Central Hospital, Hospital for Children and Adolescents, Helsinki, Finland).

A 24-day old baby girl was admitted to the pediatric intensive care in extreme hypernatremic contraction, and her serum sodium was then over 200 mmol/L. The author first gives us insight into patient history and then explains how the baby’s condition was gradually corrected. He then discusses underlying causes and factors. In fact, extreme hypernatremia and hyperosmolality are associated with high morbidity and mortality. However, good for this baby, in the follow-up there were no signs of abnormality.

There are also original examples of clinical trend graphs. Clinical information systems may provide assistance in the critical care process by making complex calculations easier and by providing more easily comprehensible data for decision making.
Read the whole article to learn how the baby recovered, and how she was finally discharged home after a 17-day hospital stay.

A few more points
I wish to express my sincere thanks to our authors and to our thousands of readers. We in the CWWJ editorial team feel privileged to be in your service. GASNet and Virtual Anaesthesia Textbook web sites also deserve special mention for their regular co-operation with us.

Keep in mind our previous issues, many of them have a critical care topic, and they are worth revisiting. Furthermore, if you visited the CWWJ for a certain Amsterdam presentation in mind but did not find it here, I would be happy to see you return next time. Some of the ESICM abstracts will come out in the next CWWJ issue, which I will try to get to your computer displays still before the end of the year. It will include monitoring, brain, entropy, anesthesia and drug administration. We will also have a clinical columnist writing about his observations on obstetric pain services.

Keep sending me your comments and feedback as before. I greatly appreciate hearing your opinions.

Ilkka S. Kalli, MD, PhD, MBA
Anesthesiologist, Editor-in-Chief
Clinical Window Web Journal

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Last updated: 1 November 2003Created
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