Browsing by Author "Wischmeyer, Paul"

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    A few of our favorite unconfirmed ideas.
    (Crit Care, 2015) Marini, John J; Gattinoni, Luciano; Ince, Can; Kozek-Langenecker, Sibylle; Mehta, Ravindra L; Pichard, Claude; Westphal, Martin; Wischmeyer, Paul; Vincent, Jean-Louis
    Medical practice is rooted in our dependence on the best available evidence from incremental scientific experimentation and rigorous clinical trials. Progress toward determining the true worth of ongoing practice or suggested innovations can be glacially slow when we insist on following the stepwise scientific pathway, and a prevailing but imperfect paradigm often proves difficult to challenge. Yet most experienced clinicians and clinical scientists harbor strong thoughts about how care could or should be improved, even if the existing evidence base is thin or lacking. One of our Future of Critical Care Medicine conference sessions encouraged sharing of novel ideas, each presented with what the speaker considers a defensible rationale. Our intent was to stimulate insightful thinking and free interchange, and perhaps to point in new directions toward lines of innovative theory and improved care of the critically ill. In what follows, a brief background outlines the rationale for each novel and deliberately provocative unconfirmed idea endorsed by the presenter.
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    Metabolic and nutritional support of critically ill patients: consensus and controversies.
    (Crit Care, 2015-01-29) Preiser, Jean-Charles; van Zanten, Arthur RH; Berger, Mette M; Biolo, Gianni; Casaer, Michael P; Doig, Gordon S; Griffiths, Richard D; Heyland, Daren K; Hiesmayr, Michael; Iapichino, Gaetano; Laviano, Alessandro; Pichard, Claude; Singer, Pierre; Van den Berghe, Greet; Wernerman, Jan; Wischmeyer, Paul; Vincent, Jean-Louis
    The results of recent large-scale clinical trials have led us to review our understanding of the metabolic response to stress and the most appropriate means of managing nutrition in critically ill patients. This review presents an update in this field, identifying and discussing a number of areas for which consensus has been reached and others where controversy remains and presenting areas for future research. We discuss optimal calorie and protein intake, the incidence and management of re-feeding syndrome, the role of gastric residual volume monitoring, the place of supplemental parenteral nutrition when enteral feeding is deemed insufficient, the role of indirect calorimetry, and potential indications for several pharmaconutrients.
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    Seven unconfirmed ideas to improve future ICU practice.
    (Crit Care, 2017-12-28) Marini, John J; De Backer, Daniel; Ince, Can; Singer, Mervyn; Van Haren, Frank; Westphal, Martin; Wischmeyer, Paul
    With imprecise definitions, inexact measurement tools, and flawed study execution, our clinical science often lags behind bedside experience and simply documents what appear to be the apparent faults or validity of ongoing practices. These impressions are later confirmed, modified, or overturned by the results of the next trial. On the other hand, insights that stem from the intuitions of experienced clinicians, scientists and educators-while often neglected-help place current thinking into proper perspective and occasionally point the way toward formulating novel hypotheses that direct future research. Both streams of information and opinion contribute to progress. In this paper we present a wide-ranging set of unproven 'out of the mainstream' ideas of our FCCM faculty, each with a defensible rationale and holding clear implications for altering bedside management. Each proposition was designed deliberately to be provocative so as to raise awareness, stimulate new thinking and initiate lively dialog.