The continuous use of technology is the norm in critical care nursing. In fact, over the past 2 decades, the necessity of the bedside nurse in the intensive care unit (ICU) to have multiple technological competencies has increased dramatically. It is today not just the bedside physiological monitor and a mechanical ventilator, the technology used on almost every patient is "smart" intravenous pumps and intermittent compression devices. In addition, critical care nurses obtain specialized technological competencies, which include continuous cardiac output measurement devices, continuous renal replacement therapy (dialysis), continuous hemoglobin monitoring, intra-aortic balloon pumps, intracranial pressure monitors, wound VAC devices, as well as extracorporeal membrane oxygenation. Along with these special competencies to use the various technologies comes the need to be able to troubleshoot them and understand how to interpret their data.

With so much technology in use each and every day in the critical care environment, it can be difficult to find the patient (or the person) in the midst of all the wires, cables, and tubes. In fact, primary assessment of our patients often mostly comes from technology and less from physical assessment skills received during basic nursing education and training. Even when critical care nurses respond to rapid responses or medical emergencies outside of the ICU, the vital signs and other assessments are obtained via vital sign machines and not with a sphygmomanometer and stethoscope and 2 fingers placed on the patient's wrist. It could even be said that we no longer have our "finger on the pulse of our patients."

Good critical thinking is also fundamental to critical care nursing. However, in our growing technologically advanced critical care environment, ICU nurses not only are being asked to be good clinicians and technologically savvy but also are learning to use technology as decision (or critical thinking) support. Our electronic medical records (EMRs) use multiple data sources (vital signs, laboratory results, etc) to launch practice alerts or best practice advisories, as well as helping identify drug-drug interactions or possible life-threatening conditions such as sepsis or acute respiratory distress syndrome. This type of technology support can be more broadly identified as artificial intelligence (AI). On a more basic level, a simple form of AI would be the dysrhythmia computers in our bedside monitors, or the EMR and drug database interfaces in the medication dispensing machines (eg, Pyxis). There are many more AI modalities, some being extremely advanced.

With all this technology permeating throughout critical care, a question arises-if we did not have all this technology, or if the technology failed, would our current critical care nurses have the skill set to continue providing the excellent care they provide each day? Or, have we allowed ourselves to become "technologically codependent" in order to provide that care. The articles in this issue explore those questions, as well as how technology can be effectively used in critical care. They include discussions on the use of continuous lactate monitoring, nursing use of protective lung strategies, management of shivering during targeted temperature management, the nurses' "human touch," AI robots, and an analysis of delirium using a dynamic systems model.

The goal of this issue is to provide critical care clinicians with not only tools they might want to consider utilizing in their practice but also "food for thought" regarding the emerging concept of technological codependency. Especially in the current environment and national emergency surrounding the COVID-19 virus, it is imperative that our ICU nurses obtain and maintain strong assessment, diagnostic, critical thinking, and technological use skills. It is with the dynamic interplay between our fundamental nursing skills and advanced technologies and AI that critical care nursing will be launched into it next best destiny of clinical excellence. Our ICU nurses are at the forefront of our public health national emergency, and I am confident that they can and will lead the way through this crisis and guide our nursing profession into a state of technological independence-where technology remains a tool in, and not the means of, critical care nursing practice.

To all those ICU nurses around the world, this issue is dedicated to you, as our frontline defense and offense against the COVID-19 virus and all the clinical issues you confront each and every day. Thank You!

-Scot Nolan, DNP, RN, CNS, CCRN, CNRN, FCNS

Issue Editor