Post Intensive Care

The management of acutely sick surgical and medical patients by the appropriately skilled staff, in the best setting is an aim of best clinical practice. Key components of improved outcomes for the sickest patients, who do not quite need Intensive care or have been stepped down from the Intensive Care unit, are: a senior experienced clinician, often with a Critical Care training background, skilled nursing and support staff, and a close working relationship with the Intensive Care/High Dependency unit.

The common complications of acutely sick patients include sepsis (i.e the manifestations of infection), which is still an underrecognised and often inadequately managed condition, that is as common as acute myocardial infarction, and yet accounts for between 30-60% of deaths in critically ill patients. See www.survivingsepsis.org The challenge is to identify the features of sepsis, its likely cause, removal of the source of the infection, timely fluid and haemodynamic management, and early, appropriate antibiotic treatment.