%0 Journal Article
%T Clinical review: Thinking outside the box - an iconoclastic view of current practice
%A Mervyn Singer
%A Michael A Matthay
%J Critical Care
%D 2011
%I BioMed Central
%R 10.1186/cc10245
%X "In all affairs, it's a healthy thing now and then tohang a question mark on the things youhave long taken for granted."Bertrand RussellThe roundtable meeting held in Brussels in March 2010 was designed specifically to challenge established dogma and evaluate new ideas for advancing critical care practice. Participants submitted provocative and iconoclastic ideas, offering a broad sweep of ideas involving changes in specific practices, new concepts in the process of care delivery, and paradigm shifts with regard to understanding of critical illness and current management approaches. The rules were simple; a scientific basis had to be offered to underpin assertions with subsequent debate impelling defence or modification of the stance.Some of these hypotheses may turn out to be misguided and others will require more refinement and evaluation. We are nevertheless grateful to the participants listed at the end of this article for raising their heads above the parapet and making us 'think outside the box'. This article summarizes the potpourri of novel thinking offered at the meeting. For more depth, we refer you to the individual articles provided in a supplement of Critical Care Medicine.A disease is a process of deranged physiological or bio-chemical function, often with an identifiable cause and a pathological signature. However, critical illness with its syndromic manifestations (for example, acute respiratory distress syndrome (ARDS), sepsis) are often deliberate consequences of the aggressive interventions inflicted upon patients to save their lives, rather than simply the natural progression of the precipitating condition. For instance, fluid resuscitation restores organ perfusion in severe haemorrhage but, due to increased capillary permeability, may be at the cost of pulmonary oedema with compromised lung function. Subsequent sedation, intubation and mechanical ventilation may, in turn, produce haemodynamic, immune and other perturbations with increased risks
%U http://ccforum.com/content/15/4/225