Providing care for patients who are critically ill provides many challenges. There are varied approaches to managing the variety of illnesses that can occur in an individual patient. Many times these varied approaches can result in inconsistencies in care. Although formal guidelines have been developed for many components of care for the critically ill patient, many have yet to be researched and developed. This journal updates the most recent information regarding the management of 4 different types of patient situations.

Many types of renal replacement therapies are used for patients with kidney disease. The article by Chrysochoou et al discusses the currently available types of renal replacement therapy that are used with suggestions for the use of these therapies under various conditions. Gastrointestinal prophylaxis continues to be a major component of the care of all patients in the intensive care unit (ICU). Singh and coauthors describe a "best practices" approach for providing such prophylaxis.

Infection control in the ICU continues to be a major concern associated with increased morbidity and mortality of critically ill patients. The article by Kanouff et al describes the current state of the art regarding preventive measures relating to ventilator-associated pneumonia and central line--associated bacteremia. Finally, Patel and coauthors describe an often-unrecognized problem occurring in the ICU: sleep deprivation. A description of the pathophysiology of sleep in the patient who is critically ill and medical implications with suggestions for therapy to minimize sleep deprivation in the ICU is made.

Other articles in the issue cover general topics of interest to critical care nurses. The article by Angerio discusses the role of cytokines, such as interleukins, in the inflammatory processes associated with chronic obstructive pulmonary diseases. He concludes that an understanding of cytokines involved in the pathophysiology of chronic obstructive pulmonary disease is essential for developing effective pharmacologic agents to treat these prevalent diseases. Thomure and Estes review the role of aspirin for the primary prevention of cardiovascular events in the general population. The decision to adopt, alter, or reject aspirin regimens requires understanding of recent research findings reported in the scientific literature. Finally, Pati et al compare and contrast medical gas booms and traditional headwalls in the ICU environment. Their findings and personal insights are helpful to nurses and others who are constructing, remodeling, or designing new critical care units.

These articles update the reader on the most recent information regarding rationale for medical decisions in the ICU. The authors provide suggestions for therapy, which should help improve the care of the patient with acute illness. Finally, research-based insights into improving the physical environment of the critical care unit are offered. Details about unit design and equipment selection are offered, with emphasis on medical gas booms and headwall utilities.

Brian W. Carlin, MD

Issue Editor, Division of Pulmonary and Critical Care Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania