43 Update in Intensive Care and Emergency Medicine

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Edited by J.-L. Vincent

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Intensive Care Medicine in 10 Years

M.P. Fink P. M. Suter W.J. Sibbald (Eds.)

With 70 Figures and 43 Tables

123

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ISSN 0933-6788

ISBN-10 3-540-26092-7 Springer-Verlag Berlin Heidelberg NewYork ISBN-13 987-3-540-26092-9 Springer-Verlag Berlin Heidelberg NewYork

Library of Congress Control Number: 2005932381

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Series Editor

Prof. Jean-Louis Vincent

Head, Department of Intensive Care Erasme University Hospital Route de Lennik 808, 1070 Brussels Belgium

jlvincen@ulb.ac.be

Volume Editors

Professor Michell P. Fink

Chair, Department of Critical Care Medicine

University of Pittsburgh School of Medicine Suite 616A, Scaife Hall 3550 Terrace St.

Pittsburgh, PA 15261, USA

Professor Peter M. Suter

Head, Department of Anesthesiology, Pharmacology,

and Surgical Intensive Care University Hospital Rue Michel-du-Crest 24 1211 Geneva 14 Switzerland

Professor William J. Sibbald Physician-in-Chief

Department of Medicine Sunnybrook & Women’s College Health Sciences Centre

University of Toronto

2075 Bayview Avenue, Suite D4, 74 Toronto, M4N 3M5

Canada

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Contents

Setting the Stage

Setting the Scene . . . 3 J. L. Vincent

Managing and Leading in Critical Care . . . 23 W. J. Sibbald

Critical Care from 50,000 Feet . . . 41 D. C. Angus

Expectations around Intensive Care – 10 Years on . . . 55 K. Hillman

The Safety and Quality Agenda in Critical Care Medicine . . . 61 T. Dorman

The Challenge of Emerging Infections

and Progressive Antibiotic Resistance . . . 69 S. M. Opal

Technology Assessment . . . 87 J. Bakker and P. Verboom

Trends in Pediatric and Neonatal Critical Care

in the next 10 Years . . . 99 R.C. Tasker

Diagnostic, Therapeutic and Information Technologies 10 Years from Now

The Patient Process as the Basis for the Design of an ICU . . . 115 B. Regli and J. Takala

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VI Contents

Information Technology . . . 133 G.D. Martich, D.C. Van Pelt, and D. Lovasik

Diagnostic Technologies to Assess Tissue Perfusion

and Cardiorespiratory Performance . . . 153 M.R. Pinsky

Microcirculatory Distress in Critically Ill Patients:

Meaning and Future . . . 165 C. Ince

Managing Infection: From Agar Plate to Genome Scan . . . 177 J. Cohen

Immunological Monitoring, Functional Genomics

and Proteomics . . . 189 E. Abraham

Improving Organ Function . . . 201 M. Singer

The Proﬁ le and Management

of Acute Respiratory Distress Syndrome . . . 213 L. Gattinoni, P. Caironi, and E. Carlesso

The Ventilator of Tomorrow . . . 227 L. Brochard, M. Dojat, and F. Lellouche

My NeuroICU 10 Years from Now . . . 239 D.K. Menon

Disaster Medicine . . . 257 P.E. Pepe, K.J. Rinnert, and J.G. Wigginton

How Might Critical Care Medicine be Organized and Regulated?

Hospital and Medical School Organization

of Critical Care Services . . . 273 M.P. Fink

Physician Stafﬁ ng in the ICU 10 Years from Now . . . 279 J.A. Russell and A. Sutherland

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Contents VII

ICU Research – One Decade from Now . . . 291 J.J. Marini and D.J. Dries

Organizing Clinical Critical Care Research

and Implementing the Results . . . 311 D. Cook and S. Finfer

Funding and Accounting Systems . . . 325 P.M. Suter

Measuring Performance . . . 335 G.D. Rubenfeld

Ethics and End-of-Life Care . . . 345 J.R. Curtis

Rationing in the ICU: Fear, Fiction and Fact . . . 363 M.M. Levy

Training

Training Pathways – Physician and Non-Physician . . . 377 J. Bion, H. Barrett, and T. Clutton-Brock

Simulation Training in Critical Care Medicine . . . 389 P.B. Angood

The Critical Care ‘Agenda’

The Agenda for the Intensivist . . . 401 V.M. Ranieri and G.L. Rosboch

Transforming Adult Critical Care Service Delivery in Ontario . . . 413 H. MacLeod

Subject Index . . . 431

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Abraham E

Division of Pulmonary Sciences and Critical Care Medicine University of Colorado Health Sciences Center

4200 E. Ninth Avenue Denver, CO 80200 USA

Angood PB

Ofﬁ ce of Patient Safety

Joint Commission for Accreditation of Healthcare Organizations One Renaissance Blvd Chicago, IL 60181 USA

Angus DC

Dept of Critical Care Medicine University of Pittsburgh 604 Scaife Hall

3550 Terrace Street Pittsburgh, PA 15261 USA

Bakker J

Dept of Intensive Care Medicine Erasmus Hospital

PO Box 2040 Room V-212 3000 CA Rotterdam Netherlands

Barrett H

Dept of Intensive Care Medicine The University of Birmingham Edgbaston N5

Birmingham, EH4 2XU United Kingdom

Bion J

Brochard L

Dept of Intensive Care Medicine Henri Mondor Hospital

51, avenue du Maréchal de Lattre de Tassigny

94010 Créteil France

Caironi P

Institute of Anesthesiology and Intensive Care Medicine Ospedale Maggiore Policlinico- IRCCS

Via Francesco Sforza 35 20122 Milan

Italy

Carlesso E

Italy

Clutton-Brock T

Contributors

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Cohen J

Dept of Medicine

Brighton & Sussex Medical School Falmer, BN1 9PX

United Kingdom

Cook D

Dept of Medicine and Epidemiology and Biostatistics

McMaster University Health Sciences Center

Room 2C11

1200 Main Street West Hamilton, ON L8N 3Z5 Canada

Curtis JR

Dept of Pulmonary and Critical Care Medicine

Harborview Medical Center Box 359762

325 9^th Avenue Seattle, WA 98104-2499 USA

Dojat M

UM 594 INSERM-UJF University Hospital Center Pavillion B

BP 217 38043 Grenoble France

Dorman T

Dept of Anesthesiology and Critical Care Medicine

Johns Hopkins Hospital Meyer 291

600 N. Wolfe Street Baltimore, MD 21287-7294 USA

Dries DJ

Regions Hospital 640 Jackson Street St. Paul, MN 55101 USA

Finfer S

Dept of Intensive Care Medicine Royal North Shore Hospital 2065 Sydney

Australia

Fink MP

Dept of Critical Care Medicine University Hospital

606 Scaife Hall 3550 Terrace Street Pittsburgh, PA 15261 USA

Gattinoni L

Italy

Hillman K

Dept of Intensive Care Medicine University of New South Wales The Liverpool Health Service Locked Bag 7103

Liverpool BC, NSW 1871 Australia

Ince C

Dept of Physiology Academic Medical Center Meibergdreef 9

1105 AZ Amsterdam Netherlands

Lellouche F

Dept of Intensive Care Medicine Henri Mondor Hospital

51, avenue du Maréchal de Lattre de Tassigny

94010 Créteil France

Levy MM

Brown University Rhode Island Hospital

593 Eddy Street Providence, RI 02906 USA

X Contributors

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Lovasik D

Critical Care Information Systems Dept

University Hospital 3550 Terrace Street Pittsburgh, PA 15261 USA

MacLeod H Ministry of Health and Long-Term Care 8th ﬂ oor, Hepburn Block 80 Grosvenor Street Toronto, ON M7A 1R3 Canada

Marini JJ

Dept of Pulmonary and Critical Care Medicine Regions Hospital

640 Jackson Street St. Paul, MN 55101 USA

Martich GD

3550 Terrace Street Room 602B

Pittsburgh, PA 15261 USA

Menon DK Dept of Anesthesia Addenbrooke’s Hospital Box 93

Cambridge, CB2 2QQ United Kingdom

Opal SM

Infectious Disease Division Memorial Hospital of RI 111 Brewster Street Pawtucket, RI 02860 USA

Pepe PE

Dept of Emergency Medicine University of Texas Southwestern Medical Center

5323 Harry Hines Boulevard, Mail Code 8579

Dallas, TX 75390-8579 USA

Pinsky MR

606 Scaife Hall 3550 Terrace Street Pittsburgh, PA 15261 USA

Ranieri VM

Dept of Anesthesiology and Intensive Care Medicine San Giovanni Battista Hospital Corso Dogliotti 14

1026 Torino Italy

Regli B

Dept of Intensive Care Medicine University Hospital

3010 Bern Switzerland

Rinnert KJ Dept of Surgery

University of Texas Southwestern Medical Center

Rosboch GL

Dept of Anesthesiology and Intensive Care Medicine San Giovanni Battista Hospital Corso Dogliotti 14

1026 Torino Italy

Rubenfeld GD

Harborview Medical Center Box 359762

325 9^th Avenue Seattle, WA 98104-2499 USA

Contributors XI

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Russell JA Dept of Medicine St. Paul’s Hospital 1081 Burrard Street Vancouver, BC Canada

Sibbald WJ Dept of Medicine

Sunnybrook and Women’s College Health Science Center

2075 Bayview Avenue, Suite D474 Toronto, Ontario M4N 3M5 Canada

Singer M

Bloomsbury Institute of Intensive Care Medicine

University College Gower Street London, WC1E 6BT United Kingdom

Suter PM

Department APSIC University Hospitals 24, rue Micheli-du-Crest 1211 Geneva

Switzerland

Sutherland A

Dept of Experimental Medicine St. Paul’s Hospital

1081 Burrard Street Vancouver, BC Canada

Takala J

Dept of Intensive Care Medicine University Hospital

3010 Bern Switzerland

Tasker RC Dept of Pediatrics Addenbrooke’s Hospital Hills Road

Cambridge, CB2 2QQ United Kingdom

Van Pelt DC

3550 Terrace Street Room 602B

Pittsburgh, PA 15261 USA

Verboom P

Institute for Medical Technology Assessment

Erasmus Hospital PO Box 2040 3000 CA Rotterdam Netherlands

Vincent JL

Dept of Intensive Care Medicine Erasme University Hospital Route de Lennik 808 1070 Brussels Belgium

Wigginton JG Dept of Surgery

University of Texas Southwestern Medical Center

XII Contributors

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Common Abbreviations

ALI Acute lung injury

ARDS Acute respiratory distress syndrome

CIS Clinical information system

CT Computed tomography

DNR Do-not-resuscitate

EBM Evidence-based medicine

EKG Electrocardiogram

EMR Electronic medical record

ICU Intensive care unit

LAN Local area network

MET Medical emergency team

MRI Magnetic resonance imaging

MRSA Methicillin-resistant Staphylococcus aureus PEEP Positive end-expiratory pressure

RCT Randomized controlled trial

SARS Severe acute respiratory syndrome

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Setting the Stage