What we really need to teach our trainees!


Richard Innes considers some of the more stressful decisions critical care consultants have to take and laments the lack of training in these areas.

When was the last time you sat with colleagues worried about how to treat someone with septic shock or ARDS?

A long time ago I suspect.

Much more likely they will be stressed about managing beds: who should have a bed, who should be discharged to let the next patient in,what to do about the patients waiting in recovery or ED who urgently, or not so urgently, needs a critical care  bed? The latter may require you to be pragmatic and  decide that a patient can be  managed outside of ICU as beds are short. If this is the case then you shoulder some, or all, of the responsibility should the patient deteriorate.  After all, you said they were OK to go!

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Serious Hazards of Transfusion Report

Jeremy Groves, ICS Council representative on the SHOT Steering Group, reflects on their latest report.


One of the great things about being on the ICS Council is the privilege of being able to represent the profession on various national committees.  Committees aren’t every ones cup of tea of course and when at a recent Council meeting, a vacancy came up for an ICS representative on the SHOT committee, everyone suddenly seemed more interested in their computers.

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GMC vs Bawa-Garba responses.


Dr Gary Masterson, president of the society, reflects on the Intensive Care Member response to the case of GMC Vs Bawa-Garba.

Following the recent judgement in the case of GMC vs Bawa-Garba in the High Court the Society has expressed its concerns to its members and passed on advice from the Academy of Medical Royal Colleges (AOMRC). We’ve received a number of replies from you, all of which offer food for thought.

There is, not surprisingly, serious concern expressed, both from working and retired members.

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Jeremy Groves considers the facts behind the recent Independent article on critical care winter activity and NHS England’s response.

You may have seen the article about critical care in the  Independent a couple of weeks ago.  In it our president, Gary Masterson, outlined the pressure units were under this winter.  NHS England’s press office went into overdrive.  Tweeting via NHS Media they said “It’s simply not true that intensive care beds are full”.  So where do they get their information from?

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Is ICM Training Fit for Purpose?

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Professor Hugh Montgomery considers the evolution of the patients and diseases we manage and worries that training may be too slow to adapt to change.

Some 252 million years ago, the Permian Mass Extinction saw the loss of the 96% of marine life and 70% of terrestrial vertebrate species due to a failure to adapt to their changing environment.

Arguably, the great polio epidemic of 1952 first led to the concept of ‘ICU’, the goal being to deliver life-saving mechanical ventilation. The requirement then was for staff who understood this domain, and that meant anaesthetists.

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Winter Pressures


Dr Gary Masterson, President of the Society, reflects on the current winter pressures facing those working and being treated in intensive care and high dependency units.

I’ve just completed a week covering my ITU and I suspect that many of you have or are currently experiencing the same sort of chaos I have just endured. There’s no doubt that this winter is intensely busy for us and the NHS in general. Many hospitals are log jammed with sick patients from the front door (ED), through the wards, including critical care, to our discharge lounges. This makes it difficult for all the nurses, AHPs, consultants and trainees working on our units.

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Intensive Care: Lessons from the future

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Will Angus, ST6 Anaesthesia and Intensive Care Medicine, runner up in the Pecha Kucha session at State of the Art 2017, gave the following presentation where he looked back from 100 years hence.

Reflecting on the past century working within the speciality of Intensive Care, from the vantage point of the year 2117, and with only fifty years left before I reach retirement age, I wanted to share some pearls from the future via the medium of t-t-e-mail (time travel electronic mail).

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State of the Art 2017 in Liverpool: “Surprise, Surprise”.

Peter Brindley Circle

Professor Peter Brindley looks back at this year’s meeting and concludes; “The Conference is Dead, Long Live the Conference”.

To the seemingly endless list of unique wonderful things to have come out of Liverpool,2 we can assuredly add 2017’s Intensive Care Society State of the Art conference (SOA). In the sage words of local-girl-done-good Cilla Black: “Surprise surprise…the unexpected hits you between the eyes”. Regardless, I knew I was somewhere special when I asked for a hotel wake-up call and was told: “Certainly Sir, climate change is real”.3 I am delighted to report that the conference was similarly provocative, unexpected, and refreshing.

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State of the Art Day 3 Roundup

Day 3 at the ‘State of the Art’ proved a fitting finale to a meeting packed with lively talks, discussion  and engagement.

The morning started with a call to action with respect to organ donation. Dr Paul Murphy discussed the Government’s consultation on whether to move from an opt in to an opt out system in England following the example set in Wales.  He felt that ‘the time is right’ for such a move. The talk coincided with the launch of an on-line survey aimed at gaining an insight into the views of the critical care community on presumed consent. You can find it here.  Don’t hold back & share you’re views.  The answers will help form the response to the consultation from the Society and Faculty.


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Organ Donation, opt-in, opt-out?


On October 3rd the Prime Minister announced plans to introduce an opt-out system of consent for organ donation into England (1), indicating that a consultation on the proposal would be launched before the end of the year.   Dr Paul Murphy, National Clinical Lead for Organ Donation, explains why the time for such a system is right.

Opt-out systems of consent are generally associated with higher donor numbers, although demonstrating a causal link remains elusive.  A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it (2), whilst a system of so-called deemed consent already operates in Wales.  The Welsh system was enacted in December 2015 following an intense period of public education and professional preparation.  Whilst there have been encouraging signs in consent rates, as yet none have reached statistical significance and neither has there been any demonstrable increase in donor numbers.


A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it

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