Advances in critical care

Simon Oczkowski, MD, MHSc, MSc, is an assistant professor in the Department of Medicine and Department of Health Research Methods, Evidence, and Impact at McMaster University and coauthor of Surviving Sepsis Campaign guidelines.

If you were to name the 3 most important recent advances in critical care that are relevant for everyday practice, what would they be?

In the past 5 years or so, I think there have been 3 major developments that have really shaped day-to-day practice in critical care for me.

I would say the first one that really changes what I do every day is the use of high-flow nasal cannula. This is a simple way of delivering oxygen to patients. It allows us to very quickly titrate oxygen levels to just the amount needed. I use this on patients every single day on the ward of the hospital, in the intensive care unit, and I think in the past 5 years [it] has probably changed at-the-bedside things the most for me.

The second development I think that’s been incredibly important is the development of point-of-care ultrasound. So, we use point-of-care ultrasound every day now. Even when I was training in critical care not too long ago, we weren’t using it very often. Now I use it every single day to assess volume status, to assess cardiac function. It’s really changed the way I treat patients.

And then I’d say the third development in critical care that’s really had a profound impact is the development of really varied large clinical trials and platform trials, things like RECOVERY and REMAP-CAP, which have allowed us to test new treatments and new therapies very rapidly. During coronavirus disease 2019 (COVID-19) we went from having no evidence about that disease to now having many, many therapies studied and I think that that kind of critical care trials infrastructure has been incredibly important in advancing the field.