Critical Care

Increasing numbers of patients are surviving the intensive care unit. Concordant with our shifting focus to minimizing intensive care unit-acquired morbidity, in the present issue of Critical Care Moyen, Camire, and Stelfox describe the importance of quality pharmacotherapy. They describe challenges and potential solutions to this source of iatrogenic injury in our vulnerable patients. Their article reminds us not to understate the importance of medication error, to avoid overstating the benefits of incompletely proven methods to prevent medication error, and to distinguish harmful medication errors from other types of medication error.

The pressure–volume (PV) curve is a physiological tool proposed for diagnostic or monitoring purposes during mechanical ventilation of acute respiratory distress syndrome. The reduction in compliance measured by the PV curve and the different inflection points on the curve are considered interesting markers of the severity of and the levels of opening and closing pressures. Tracing a curve, however, may in itself influence the degree of opening or distension of the lung, and interpretation of the curve has to take this effect into account. In some individuals tracing the curve may even have moderate hemodynamic effects. Fortunately, on average, most of these effects are transient or negligible and do not invalidate the PV curve measurement.

This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2022. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2022 . Further information about the Annual Update in Intensive Care and Emergency Medicine is available from https://link.springer.com/bookseries/8901 .

In the present issue of Critical Care, Frank and Matthay review the physiologic mechanisms that lead to ventilator-induced lung injury. Our greater understanding of basic physiologic principles has already had a major impact on the treatment of critically ill patients. Novel strategies to limit ventilator-induced lung injury have now been shown to improve survival. However, there has been debate in the literature regarding the safety and efficacy of the Acute Respiratory Distress Syndrome (ARDS) Network study protocol in reducing ventilator-induced lung injury. The issues surrounding the ARDS Network protocol and a recent meta-analysis criticizing its use are presented. As clinicians, we now have the responsibility to ensure that our patients benefit from these recent developments.

The use of goal-directed therapy as part of an enhanced recovery programme is well established in terms of management of the modern high-risk surgical patient in order to reduce both morbidity and mortality. The mechanisms behind this improvement are debated, but a reduction in the development of post-operative complications including acute kidney injury may be relevant. A recent study examining this relationship has been reported and is discussed here.