Publications

SCOPUS: le.j

Severe sepsis is characterized by increased oxygen demand, alteration of oxygen extraction, and a diminution of myocardial contractility. The importance of each of these three factors is directly related to the severity of the sepsis. The combination of these factors may lead to tissue hypoxia, which is the shortest route to development of multiple organ failure (MOF). The presence of tissue hypoxia should be suspected in the presence of lactic acidosis. The phenomenon of dependence on oxygen consumption (VO2) in relation to oxygen transport (DO2) is detectable where there is a rise in DO2 induced by perfusion of liquids or administration of vasoactive agents. Study of the relationship between cardiac flow and oxygen extraction is a simple means of studying the relations between VO2 and DO2 at the patient's bedside.

Editorial

Dept of Intensive Care, Erasme University Hospital, Free University of Brussels, 808 route de Lennik, 1070 Brussels, Belgium.

Critical illness is a continuum, but patient care is often fragmented. Value-based critical care focuses on the overall health of the patient, not on an episode of care. The "ICU without borders" model incorporates a concept where members of the critical care team are involved in the management of patients from the onset of critical illness until recovery and beyond. In this paper, we summarise the potential benefits and challenges to patients, families, staff and the wider healthcare system and list some essential requirements, including a tight governance framework, advanced technologies, investment and trust. We also argue that "ICU without borders" should be viewed as a bi-directional model, allowing extended visiting hours, giving patients and families direct access to experienced critical care staff and offering mutual aid when needed.

The incidence of fungal infections in the intensive care unit (ICU) is increasing, and systemic infection is associated with considerable morbidity and mortality. The diagnosis of fungal infection remains difficult in the absence of specific techniques able to distinguish colonization from invasive and disseminated disease. The treatment of fungal infections can be considered as prophylactic, early presumptive, empiric, or definitive. Several anti-fungal agents are effective, including amphotericin B and fluconazole, and others will be available in the near future. Immunomodulatory therapies are under investigation. We review the epidemiology, diagnosis and management of infections caused by the most common fungal pathogens, Candida and Aspergillus, in ICU patients.