This article describes some of the factors to be weighed up when considering which patients are appropriate for admission to an intensive care unit in a country with limited resources. The authors describe their experience running an ICU in a rural part of Uganda, and use the audited outcomes of a cohort of 2,202 patients admitted over a six-year period.

Ray Towey and John Bosco Anyai

Download – Tracheostomy (Update 28, 2012)

This article describes the indications for this relatively common ICU procedure. It is of particular importance that ICU staff know how to manage airway emergencies in patients with tracheostomy. An example of a management algorithm is included.

Rakesh Bhandary and Niraj Niranjan

Many of the injuries that require immediate attention during resuscitation following trauma, involve the chest. This article describes a systematic approach to management of these injuries, using chest Xray and CT examples to demonstrate learning points.

Anil Hormis and Joanne Stone

Tetanus remains an important cause of death worldwide and is associated with a high mortality, particularly in the developing world. With modern intensive care management, death from acute respiratory failure should be prevented, but cardiovascular complications as a result of autonomic instability and other causes of death remain. In this article, the pathophysiology, clinical features and current management of tetanus are reviewed.

Ray Towey

A structured approach to assessment and management improves outcome. Management should incorporate best evidence and current care ‘bundles’. Checklists, such as FASTHUG, can aid the complete assessment of the ICU patient’s needs. Good documentation and communication between health professionals, the patient and family are vital parts of a daily review. Many of the disease processes and therapies described are discussed in more detail in later articles in this edition.

Sebastian Brown, Sophia Bratanow, Rebecca Appelboam

Many critically ill patients require sedation in order to tolerate more invasive therapies, such as intubation and ventilation. The level of sedation should be assessed regularly and ‘sedation holds’ may reduce the duration of ventilation. The available drugs are discussed with emphasis on their advantages and disadvantages.

Gavin Werrett

Rhabdomyolysis describes muscle breakdown due to a number of different pathological processes. This article describes the aetiology, clinical recognition and treatment of the condition.

Michelle Barnard

Acute kidney injury is common in the critically ill and RRT has a role in its management. It is also indicated in some cases of poisoning and in management of patients with severe sepsis. RRT is not universally available, however the next article describes how peritoneal dialysis may be a more cost-effective and safer technique in resource poor settings .

Andrew Baker and Richard Green

The author describes their first-hand experience with this technique in a resource poor setting. Although published trials of its efficacy and safety are few, the significantly lower cost of PD make it the ideal option in a low resource setting.

Brett Cullis

The aim of this article is to give an overview of the nutritional aspects in critically ill patients and summarise the latest guidelines and recommendations in establishing adequate nutritional support.

Sophia Bratanow and Sebastian Brown