This month in JICS.

Abstract

On 25 April this year, Nepal experienced an earthquake with a surface magnitude of 8.1 (severe), which resulted in the worst natural disaster in the region for over 80 years. More than 8000 individuals lost their lives, with twice this number injured, and hundreds of thousands displaced from their homes. At the time of writing, the latter situation remains, as aftershocks have generated a justifiable fear of returning to vulnerable buildings; the transport infrastructure has been severely disrupted and aid is slow to be distributed. The number of those killed or injured will have likely increased further by the time this issue comes to print. Following events such as this, one can’t help but be introspective; they are a reminder of how fickle life can be. The images relayed to our own homes demonstrate the challenges faced in providing the most basic survival tools for those in need. They are a reminder of how fortunate we are in the UK; we have a health service that can provide for our own needs, and a society which has the wealth and good will to extend its arm of support to those needing it on the other side of the globe. We have the resources to allow us to provide intensive care to the critically ill or injured, a far cry from the care that can be delivered currently in Nepal. Indeed, intensive care is very much a First World luxury; from a healthy economy perspective, intensive care provides extremely poor value for money. Public Health, on the other hand, can save thousands of lives (e.g. through vaccinations or improved sanitation) at a fraction of the cost of an average intensive care unit. What we do in intensive care unit (ICU) is amazing; however, events such as that in Nepal should give us humility and perspective. Amidst all the expensive technology and drugs, the one aspect of intensive care that costs nothing (but means so much) is our empathy for patients and their relatives, and the altruism shown by our profession. In this issue of JICS (as with most others), you will find a paucity (indeed absence) of funding for the articles within. Of course there is benefit to individuals from being able to add publications to their curriculum vitae or appraisal form, but there are far easier ways of ticking boxes! So, as always, I must offer my sincere thanks to those who have contributed to this issue as authors, reviewers or editors. It would be arrogant of me to try to precis this issue’s excellent articles into just a few words, so I will highlight a few of particular note. You will notice that this issue includes two abstracts, one with Dr Hulse and the other with Dr Campbell as the first author. These are the winning abstracts from the Scottish Intensive Care Society’s 2014 annual conference, and it is with great pleasure that I am able to publish them in JICS; my congratulations to all the authors of these studies. Also, in this issue is a fantastic example of old and new medical research techniques coming together to provide valuable insight into the risks of one of our most common procedures: central line insertion. Dr Chandra and colleagues compared ultrasound images taken during routine right internal jugular vein cannulation with cadaveric dissection findings to ascertain the risk to arterial structures lying posterior to the vein. Their findings suggest that the technique of venous transfixion and lower approaches could pose higher risks of arterial puncture than hitherto appreciated. Meanwhile, in their analysis of patient safety incidents, Dr Thomas and colleagues provide a rare insight into the risks to which staff are exposed while working in the ICU. In true JICS style, there is a diversity of thought, commentary and science. We have editorials considering the issue of driving after critical illness, and that sepsis isn’t the only cause for pyrexia in the critically ill. Olivia Clancy and colleagues provide a pragmatic review of psychological and neurocognitive dysfunction after critical illness, while Dr MacDonald and colleagues highlight the challenges of the ‘great weight debate’ in ICU. All of which, I hope, will make for an enjoyable and educational read. If you have any thoughts, comments, or experiences to share, or if you simply can’t get your paper published in the Lancet, then please get in touch; there is a place in JICS for you all.