Highlighting 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 new 18th issue of the Clinical Window Web Journal (CWWJ) has just appeared. With the title - Highlighting Critical Care – it starts the year 2005. Did you realize that our web publication is now reaching the mature age of five years? Hence, when the previous issue was published, I made the decision to concentrate on producing a Clinical Window Collection CD to emphasize that five-year milestone. The CD is now available, as it was released in January. Find out more about the CD project below.

Highlights of the new issue

For this current issue, I have selected two mechanical ventilation related articles, and added an interview to reflect the trends of ICU staff availability decline. I also wrote a report, including photos, about the proceedings at the recent Intensive Care Winter Congress.

Focusing on vent weaning in the intensive care, Dr. Melissa F Perkal, MD (New Haven, USA) writes about Discontinuation of mechanical ventilation. Delays in tracheal extubation result in increased complication rates. After first reviewing publications about the outcome of ventilated patients, the author continues to other published work on weaning parameters and spontaneous weaning trials. Weaning from the ventilator is often the critical event hallmarking the progression to recovery. This paper, which is a fine introduction to the current knowledge, was provided for us though our co-operation with GASNet.

In our present clinical environment, infections of various origins are an increasing burden, particularly in intensive care, where resistance to antibiotics is increasingly an everyday reality. In 2004, the Products Regulatory Agency in UK published an assessment: Evaluation of Breathing System Filters. This objective comparison is important, as it is a standardized and an objective approach on this matter. Breathing system filters have been suggested to reduce bacterial and viral contamination in ventilated patients, but up until now, there has been only limited evidence-based information on the performance of the filters. We have reviewed and compacted the extensive report into a four-page white paper.

I attended the 13th Winter Symposium of Intensive Care in January 2005, and made a report of its proceedings. The tradition of organizing high rated scientific seminars in the middle of spectacular nature and mountains continued, this time in Gstaad, Switzerland. Did you consider that fever in a septic patient may be reasons for neurological injury in the ICU? That takes me to one of the focuses of this congress. Critical illness polyneuropathy, delirium, and cognitive dysfunction may adversely affect the outcome of an ICU patient. Those conditions may be more common than expected. How to avoid the adverse effects of sedatives may then become an issue, and we need to know more about what the impact of brain monitoring is in patient outcome. GE Healthcare regards clinical education with high importance and therefore, was a major sponsor for the congress.

Trends and perspectives in critical care nursing is the article based on the interview of Wanda L. Johanson, the CEO of American Association of Critical-Care Nurses (AACN). The text revisits a current trend, which many ICUs are facing today - the nursing shortage. Stating: "who will care us when we are old", the CEO frames the problem in a way touching us all. Other aspects, like how the current trend influences hospitals, administrators, and hospital suppliers, will be discussed, as well as the important role of AACN in certification of critical care nurses are reviewed.

Clinical Window Collection CD 2000-2004 is ready

As is the case with many projects, completing the Clinical Window Collection CD took more time than expected. Because of this, I found it necessary to shift the release of this current issue up until now. However, I continuously followed visitors' feedback and statistics from the CWWJ web site. Seemingly, our previous issue "Evidence and Experience in Anesthesiology" was interesting to many, as over the autumn months, our number of visitors remained steady at over 10,000 per month. As the Editor, I take this as a satisfying signal, and I feel that we are sharing meaningful clinical information with our Clinical Window.

In January, I handed out a few hundred copies of the Clinical Window Collection CD at both the annual STA meeting in Florida, and at the Winter Congress of Intensive Care in Switzerland. Good news: more CDs will be available at the GE booth during major anesthesiology, intensive care, and cardiology congresses.

A few final points

As many of you already know, our tradition of clinical publishing will continue. GE Healthcare has promised to be our new sponsor. Our next issue will appear in May, before the ESA anesthesia congress in Vienna, Austria. We will focus on anesthesiology and pulse oximetry.

I would be delighted to receive input from our many readers, including letters, comments, and suggestions. You can even send me sample texts or short reviews. Our editorial advisory board will assess them and, if found fitting to our scope, we might consider a writing agreement with you!

Clinical Window will follow both ISICEM and ESA closely, and I will attend both congresses. It would be most enjoyable to meet our readers in person.

I greatly appreciate your opinions. Thank you in advance!

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

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Last updated: 21 March 2005Created
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