THE ARTICLE OF THE MONTH
The chairman of the Editorial and Publication Committee together with the journal Editor-in-Chief, Massimo Antonelli, select one article per month among the manuscripts published in Intensive Care Medicine Online First and afterwards in the paper issues.
The aim of this exercise is to provide you with a recently published manuscript on a timely topic that is commented and highlighted. It can serve as a basis for fruitful discussions and exchange of information within the Society and also with the co-authors.
Post traumatic stress disorder (PTSD) is describing the development of psychological and / or physical disorders after a major traumatic event. In recent years it became evident that a stay in the intensive care unit can act as such a traumatic episode triggering PTSD in ICU survivors. This notion is of major importance to the intensive care community as it highlights possible impact of our ICU settings and treatment strategies on the development. We begin to understand that the level of analgesia and sedation, episodes of hypoxemia or the severity of the disease as such might be important for the development of PTSD.
Based on this the article of the month by Boer and colleagues was chosen since it highlights the incidence of PTSD in patients who have survived an abdominal sepsis and were followed up one year after the ICU stay using a standardized questionnaire to assess PTSD. The results show that as much as 38 % of those patients might suffer from PTSD and that factors such as younger age, traumatic memories associated with the ICU stay and length of stay in the ICU were associated with the development of PTSD. The authors propose a normogram as a possible guide to identify patients at risk fro this development which would be most helpful in stratifying patients for potential prevention measures. Evidently, such a normogram would need to be validated in a larger patient population before it could be recommended for clinical use. However, the data open the field to further research on this most interesting topic which intensive care practitioners should be aware of.
The ICU admission of patients with severe sepsis or even septic shock after recent chemotherapy for hematological malignancies remains a matter of debate among ICU physicians and oncologists since heterogeneous views about prognosis and intensity of therapy might occur. More aggressive chemo- and radiotherapy has resulted in remarkable achievements in the treatment of haematological malignancies over the last decade, however, as a result of the aggressiveness complications requiring ICU therapy are more common as well. The general notion among ICU physicians seems to be that severe sepsis or even septic shock in those patients is kind of a worse case scenario and therefore, the paper by Vandijck and colleagues on the impact of recent chemotherapy on the outcome of severe sepsis and septic shock is most interesting. In an retrospective analysis of 186 patients who were referred to the ICU with sever sepsis or septic shock while having a haematological malignancy the could not identify recent (< 3 weeks) chemotherapy as a risk factor for worse outcome. Instead, it became evident that recent chemotherapy was almost significantly associated with better clinical outcomes. We have chosen this paper as the article of the month May since this result is most interesting for ICU physicians when discussing these challenging questions with their patients and families as well as the referring doctors.
The article of the month June is a paper on the colonization and blood stream infections rates of central venous lines at different insertion sites. Gowardman and colleagues did a prospective study on more then 400 patients with more then 4000 central venous catheter days being observed. They found that colonization was lowest for the subclavian insertion site but that no differences were found in catheter related blood stream infections. Notably, independent from the insertion site catheters being inserted in the emergency department were more likely to be colonized then those coming from the operating room or the ICU. Most interestingly colonization rates were lower in female patients. |