Israel Medical Association Journal

Since the Surviving Sepsis Campaign Guideline (SSG) was published in 2004, critical care physicians can readily access the evidence and current recommendations regarding management of patients with severe sepsis and septic shock. However, several issues including a potential conflict of interest in developing the guidelines were disclosed. There have also been dramatic changes in the management of sepsis, supported by high levels of evidence. SSG[1] 2008 was developed to update the evidence using a new grading system. We reviewed select topics, routinely addressed by intensivists in the surgical intensive care unit, that have changed between SSG 2004 and SSG 2008: namely, glucose control, and administration of steroids, recombinant human activated protein C (rhAPC) and total parenteral nutrition.

Ultrasonography in the intensive care unit (ICU) has become a valuable tool for expeditiously, safely and effectively diagnosing and treating a myriad of conditions commonly encountered in this setting. Most surgeons are familiar with FAST (focused assessment with sonography in trauma) and can readily grasp the fundamentals of a limited or directed ultrasonographic exam. Thus, with appropriate training and practice, surgeons can utilize this tool in visualizing, characterizing and treating life-threatening conditions in their role as intensivists in the surgical ICU (SICU). In this review we will discuss the role of ultrasonography in evaluating the acute cardiac status of a patient in the SICU as well as its use in general critical care for assessing the thoracic, abdominal and vascular systems.