The role of microRNAs in critical illness—do miRs truly ‘miRror’ muscle wasting?

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Gernot MarxFigureDr Gernot Marx, MD, FRCA is full Professor of Anesthesiology and Critical Care Medicine and Chair at the University RWTH Aachen, Germany. He is Head of the Department of Intensive Care Medicine and Intermediate Care at the University Hospital RWTH Aachen. He is full board member of the German Society of Anaesthesia and Intensive Care and full board member of the interdisciplinary German Society of Intensive Care and Emergency Medicine. He graduated and took his residency at the Medizinische Hochschule Hannover in Germany. He was Senior Lecturer in Anaesthesia and Intensive Care Medicine at the University of Liverpool, UK and full Professor for Anaesthesiology, Intensive Care and Emergency Medicine at the Friedrich-Schiller-Universität Jena, Germany. He received the Fellowship by election of the Royal College of Anaesthetists. His research interest is focused on sepsis, fluid therapy and telemedicine. He is Editor of two books, Checklist Intensive Care Medicine and The Intensive Care Medicine. He is Editor of AINS (Anaesthesiologie Intensivmedizin Notfallmedizin Schmerztherapie) and Associate Editor of British Journal of Anaesthesia. Hartmut BürkleFigureHartmut Bürkle, MD, PhD is full Professor of Anesthesiology and Critical Care Medicine, and Chair of the Department of Anesthesiology and Intensive Care Medicine at the University Medical Center Freiburg, Germany. After his residency in Anesthesiology in Hamburg and a postdoctoral fellowship at the UCSD, San Diego (Prof T. L. Yaksh) he joined Prof Hugo Van Aken[Combining Acute Accent]s anesthesia and intensive care medicine group in Muenster, Germany. His research interests are centered on regional anesthesia techniques, perioperative pain therapy and perioperative rehabilitation, highlighting patient's outcome. During the last decade, he has also focused on the development of safe anesthesia strategies, the economical and ethical issues of modern health systems related to anesthesia and intensive care medicine, as well as on implementing peer reviewed quality care in anesthesiology and intensive care medicine. He has published more than 120 studies and acted as reviewer for most of the national and international journals of anesthesiology and intensive care medicine. Kai ZacharowskiFigureProfessor Kai Zacharowski holds the position of the Ordinarius and is the Director of the Department of Anesthesia, Intensive Care Medicine and Pain Therapy at the University Hospital Frankfurt. His research, teaching, and consulting interests are in both clinical and basic aspects of patient safety, transfusion and clotting, innate immunity, cardiovascular and critical care medicine. Professor Zacharowski received his MD from the German University of Mainz and his PhD from Queen Mary, University of London (where he was working with the Nobel laureate Prof Sir John Vane → discovered how aspirin works). His scientific contributions are published in peer-reviewed journals such as Nature Medicine, Lancet, NEJM and Proceedings of the National Academy of Science and were awarded with numerous awards for Innovative Clinical Research. He is serving as Editor-in-Chief for the Journal of Anesthesia & Intensive Care Medicine as well as an Editorial Board member of numerous journals in Critical Care Medicine, Emergency Medicine and Anesthesia. He obtained 2 clinical specializations (Anesthesia/Intensive Care Medicine and Clinical Pharmacology) and is practicing Anesthesia and Critical Care Medicine in Frankfurt.

Climate change with global warming, natural disasters, species extinction and soil erosion is doubly relevant for medicine: On the one hand, heat waves, floods and other natural disasters lead to new disease patterns to which healthcare systems must adapt. On the other hand, the global healthcare system itself contributes to these effects, as it is estimated that the CO2 footprint of all healthcare facilities accounts for around 5% of global greenhouse gas emissions. National and international initiatives to promote sustainability concepts in intensive care and emergency medicine. Research on homepages of national and international (specialist) societies dealing with intensive and emergency care medicine and corresponding PubMed search (sustainability and climate change and emergency or intensive care medicine). Six of the 12national specialist societies surveyed have taken initiatives on sustainability, notable among them the initiative of Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) for anew registration of the S1guideline "Sustainability in intensive care and emergency medicine". On the international scene, the activities of the Australian and New Zealand Intensive Care Society (ANZICS) with numerous publications on the topic of sustainability in intensive care medicine and the practical guide "Abeginners guide to sustainability in intensive care medicine" as well as the European Society of Anaesthesiology and Intensive Care (ESAIC) with aconsensus paper on sustainability should be highlighted. At the national level, initiatives on sustainability (guidelines, working groups, forums) are emerging and are attracting increasing attention and activity. The umbrella organization of German Intensive Care Medicine, the Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), has so far shown no (discernible) activity; there is an urgent need for action here, and health policy and the German Medical Association should also become (even) more involved in reducing the CO2 footprint in the healthcare sector. Internationally, there are anumber of societies and institutions that are promoting the topic of "sustainability", although astronger focus on the area of intensive care and emergency medicine would also be desirable here.

Systematic Intensive Respiratory Care

Current Opinion in Anesthesiology was launched in 1988. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of anesthesiology is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Section Editors for this issue. SECTION EDITORS Gernot MarxGernot MarxDr Gernot Marx, MD, FRCA, is full Professor of Anesthesiology and Critical Care Medicine and Chair at the University RWTH Aachen, Germany. He is Head of the Department of Intensive Care Medicine and Intermediate Care at the University Hospital RWTH Aachen. He is Chairman of the Board of the German Society of Telemedicine. He is full Board Member of the German Society of Anaesthesia and Intensive Care and full Board Member of the German Interdisciplinary Society of Intensive Care and Emergency Medicine. He graduated and took his residency at the Medizinische Hochschule Hannover, Germany. He was Senior Lecturer in Anaesthesia and Intensive Care Medicine at the University of Liverpool, UK, and full Professor for Anaesthesiology, Intensive Care and Emergency Medicine at the Friedrich-Schiller-Universität Jena, Germany. He received the Fellowship by election of the Royal College of Anaesthetists. His research interest is focused on sepsis, fluid therapy and telemedicine. He is Editor of two books, Checklist Intensive Care Medicine and The Intensive Care Medicine. He is Editor in Chief of intensivup2date, Editor of AINS (Anaesthesiologie Intensivmedizin Notfallmedizin Schmerztherapie) and Associate Editor of British Journal of Anaesthesia. Stanley H. RosenbaumStanley H. RosenbaumStanley H. Rosenbaum, MA, MD, is Professor of Anesthesiology, Internal Medicine and Surgery at Yale University School of Medicine, USA. He is the Vice Chairman for Academic Affairs and the Director of the Division of Perioperative and Adult Anesthesia in the Department of Anesthesiology. Dr Rosenbaum has had a long career doing research and publishing numerous papers, monographs and textbooks on various aspects of anesthesiology, critical care medicine and medical ethics. In 2011 he was awarded the Lifetime Achievement Award of the Society of Critical Care Anesthesiologists. Kai ZacharowskiKai ZacharowskiProfessor Kai Zacharowski, MD, PhD, ML, FRCA, holds the position of the Ordinarius and is the Director of the Department of Anesthesia, Intensive Care Medicine and Pain Therapy at the University Hospital Frankfurt, Germany, since 2009. From 2006 until 2008 he was the Chair of Anesthesia and Intensive Care Medicine at the University Hospital Bristol, UK. His research, teaching, and consulting interests are in both clinical and basic aspects of patient safety, transfusion and clotting, innate immunity, cardiovascular and critical care medicine. Professor Zacharowski received his MD from the German University of Mainz, Germany, and his PhD from Queen Mary, University of London, UK, where he was working with the Nobel laureate Prof Sir John Vane who discovered how aspirin works. His scientific contributions have been published in peer-reviewed journals such as Nature Medicine, Lancet, NEJM and Proceedings of the National Academy of Science and were awarded with numerous awards for Innovative Clinical Research. He is serving as Editor-in-Chief for the Journal of Anesthesia & Intensive Care Medicine as well as an Editorial Board member of numerous journals in Critical Care Medicine, Emergency Medicine and Anesthesia and is the CEO of the Lohfert Foundation. He is practicing Anesthesia and Critical Care Medicine in Frankfurt.

Maintenance of a CPP above 70 mm Hg is a therapeutic option that may be associated with a substantial reduction in mortality and improvement in quality of survival and is likely to enhance perfusion to ischemic regions of the brain following severe TBI. No study has demonstrated that the incidence of intracranial hypertension, morbidity, or mortality is increased by the active maintenance of CPP above 70 mm Hg, even if this means normalizing the intravascular volume or inducing systemic hypertension.

Editorial introductions

Current Opinion in Critical Care was launched in 1995. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of critical care is divided into 13 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the journal's Editor and Section Editor for this issue. EDITOR-IN-CHIEF Jean-Louis VincentJean-Louis VincentDr Vincent is Professor of intensive care at the University of Brussels, Belgium, and Head of the Department of Intensive Care at the Erasme University Hospital in Brussels, Belgium. He earned his medical degree from the Universite Libre de Bruxelles, Belgium, with magna cum laude, with a specialty in Internal Medicine and Intensive Care Medicine. His training included two years of fellowship in critical care medicine at the University of Southern California, USA with Prof. Max Harry Weil. Dr Vincent has signed more than 700 original articles, more than 280 book chapters and review articles, and around 800 original abstracts. He has edited 86 books including 63 in his own series Update in Intensive Care and Emergency Medicine and Yearbook in Intensive Care and Emergency Medicine published by Springer-Verlag (Heidelberg, Berlin, New York). He is co-editor of the Textbook of Critical Care (Elsevier Saunders, 5th Edition). He has also written a French Manual of Intensive Care and Emergency Medicine (Springer, France), and is the co-editor of the series Le point sur… (Springer, France). Dr Vincent is the editor-in-chief of Critical Care, Current Opinion in Critical Care, and ICU Management. He is member of the Editorial Boards of about 30 journals including Critical Care Medicine (senior editor), PLoS Medicine, Lancet Infectious Diseases, Intensive Care Medicine, Chest, Shock, and Journal of Critical Care. Dr Vincent is presently Secretary General of the World Federation of Societies of Intensive and Critical Care Medicine. He is a Past-President of the European Society of Intensive Care Medicine and the European Shock Society, and the Past-Chairman of the International Sepsis Forum. For 31 years he has organized an International Symposium on Intensive Care and Emergency Medicine which is held every March in Brussels. This symposium, which gathers 5,000 participants, has become one of the largest meetings in the field. He received the Foundation André Loicq award in 1986, the Foundation De Kerckheer award in 2000, the Distinguished Investigator award of the Society of Critical Care Medicine in 2001 and the College Medalist Award of the American College of Chest Physicians in 2003. He was the Recipient of the "Society Medal” (lifetime award) of the European Society of Intensive Care Medicine in 2009 and he received “ Prix Scientifique Joseph Maison-Sciences biomédicales cliniques” (scientific award of the FRS-FNRS) in 2010. SECTION EDITOR Arthur P. WheelerArthur P. WheelerArthur Wheeler is a Professor in the Division of Allergy, Pulmonary and Critical Care Medicine at Vanderbilt University, USA, and serves as the Director of the Vanderbilt ICU. He is a graduate of the University Of Maryland School Of Medicine, USA, then completed training programs in Internal Medicine, Pulmonary Disease and Critical Care at Vanderbilt University. Dr Wheeler's research interest in severe sepsis, acute lung injury and thromboembolic disease has resulted in more than 100 publications. He is also the co-author of a successful textbook of Critical Care Medicine now in its fourth edition. He has delivered hundreds of national and international lectures and is the recipient of numerous teaching awards. Most recently Dr Wheeler has been developing and testing the effectiveness of alternative care delivery models in critical care including the use of nurse practitioners.

Improving Palliative Care For Patients In The Intensive Care Unit

Response

Support for the Anaesthetists' Academic Foundation

To develop a scale to assess basic competence in intensive and critical care nursing. In this study, basic competence denotes preliminary competence to practice in an intensive care unit. There is a need for competence assessment scales in intensive care nursing practice and education. The nursing care performed in the intensive care unit is special by its nature and needs to be assessed as such. At this moment, however, there is no tested, reliable and valid scale in this field. A multi-phase, multi-method development and psychometric testing of the scale was conducted. The scale was developed in three phases. First, following a literature review and Delphi study, the items were created. Second, the scale was pilot tested twice by nursing students (n1 = 18, n2 = 56) and intensive care nurses (n1 = 12, n2 = 54), and revisions were made. Third, reliability and construct validity were tested by graduating nursing students (n = 139) and intensive care nurses (n = 431). The Intensive and Critical Care Nursing Competence Scale (ICCN-CS-1) is a self-assessment test consisting of 144 items. Basic competence is divided into patient-related clinical competence and general professional competence. In addition, basic competence is comprised of knowledge base, skill base, attitude and value base and experience base. ICCN-CS-1 is a reliable and tolerably valid scale. The ICCN-CS-1 is a promising scale for use among nursing students and nurses. Future research is needed to evaluate its construct validity further and to assess its suitability for completion during intensive care unit's orientation programmes and nursing students' clinical practice in an intensive care unit. The ICCN-CS-1 can be used for basic competence assessment in professional development discussions in intensive care units, in mentor evaluation situations during nursing students' clinical practice and in intensive care nursing education.

The systemic response to stress caused by a critical surgical illness is characterized by a series of events that precede metabolic and neuroendocrine dysregulation. However, the relevance of theclassically described 'stress response' is now highly questionable in an era where profound physiological deconditioning is common in critically ill, surgical and non-surgical patients. Common assessment techniques do not accurately reflect the integrity of the hypothalamic-pituitary-thyroid axis in the course of a critical chronic disease state. The clinical presentation ismostly masked by symptoms of the underlying critical illness when plasma thyroid hormone concentrations are altered. The frequent development of multimorbidity in critically ill patients is the reason for the need for a more detailed analysis of the neuroendocrine model of activation. Basic scientific studies suggest that low levels of circulating thyroid hormones in the acute phase are an adaptive process, but the chronic condition could directly cause organ damage. Here, we review factors that have emerged to challenge the conventional model of euthyroid sick syndrome (ESS) in the surgically critically ill as an adaptive process, and suggest that the stage of the critical illness is an important consideration in the critically ill. Examining the stressresponse in the critically ill presents opportunities to improve outcomes through improved understanding of the neuroendocrine aspects.

Critical Care Medicine: Organizing and Staffing Intensive Care Units

There is very little European research on intensive care nursing.

Objective. To improve the quality and safety of medical services by developing an intensive nursing care protocol and implementing it in the practice of anesthesiology, resuscitation, and intensive care units.Methods. The process of developing and implementing the protocol consisted of the following stages: the protocol was designed taking into account the procedures performed and the specifics of intensive care. The developed protocol was discussed, necessary changes and additions were made, and it was integrated into daily practice. The quality of the department's work during the period of protocol application was analyzed. The criteria for the quality of intensive care included: the incidence of pressure ulcers, the frequency of catheter-related infectious complications, the rate of hospital-acquired infections, the rate of ventilator-associated pneumonia, and the number of complaints from physicians regarding the quality of nurses' work. To assess patient satisfaction, a survey of 50 patients was conducted.Results. Based on the evaluation of the periods during which the protocol was applied, despite an increase in the number of critically ill patients, there was a reduction in hospital-acquired infections, catheter-associated infections, and pressure ulcers. Ventilator-associated pneumonia decreased from 0.54% to 0.26%. Complaints about the quality of nurses' work decreased. 90% of the surveyed patients were fully satisfied with the quality of medical services provided in the anesthesiology, resuscitation, and intensive care unit.Conclusion. The development and implementation of a nursing care protocol is one of the most important steps in improving treatment outcomes and enhancing the quality of medical care. The presented intensive nursing care protocol is an effective tool aimed at improving patient outcomes in the anesthesiology, resuscitation, and intensive care unit.Keywords: intensive nursing care protocol, quality of medical care, intensive care.