Pioneered in Australia, now widely adopted in the United Kingdom and being introduced elsewhere in the world, is the development of “outreach” services or medical emergency teams to the general wards to both identify and treat at an earlier stage patients who are deteriorating and at risk of becoming critically ill, and to follow up patients discharged from the ICU to ensure that adequate care is being provided in this “step-down” environment. However, a recent study suggests this approach may not affect the incidence of cardiac arrest, unplanned ICU admissions, or unexpected death. cialis professional 20 mg
One of the major advances in intensive care medicine has been the advent of the large, multicenter study not directly related to a new commercial product but organized by critical or intensive care societies or a government-funded body to address an important management question. Leading the way have been the Canadians (eg, sucralfate vs ranitidine, Transfusion Requirements in Critical Care); the Italians (eg, prone ventilation, supranormal oxygen delivery); the Australians (renal dose dopamine, albumin vs normal saline solution); the US ARDS-NET Group; European initiatives (eg, European Prevalance of Infection in Intensive Care, Sepsis Occurrence in Acutely Ill Patients, the CORTICUS project, Pulmonary Artery Catheters in Patient Management), and, most recently, the US National Institutes of Health Resuscitation Outcomes Consortium. Most of these trials have been completely altruistic, with intensivists collaborating together to answer clinically important questions. As a consequence, our knowledge base has expanded considerably, leading to identification of helpful as well as harmful practices and, eventually, to appropriate changes in our management of patients.