Capillary refill timeat the center of resuscitation,and the limits of driving pressure

Before 1970, measuring pressures in the right heart meant moving an unstable patient to a fluoroscopy suite. Swan, Ganz and Forrester described a balloon-tipped catheter that the bloodstream itself carried into the pulmonary artery.

The design decision that mattered was letting flow do the navigating instead of the operator. Half a century on we use it far more selectively — but the idea it introduced, continuous haemodynamic measurement at the bedside, never left.

In 2002 two trials — Bernard in Australia and HACA in Europe — reported better neurological outcomes when comatose survivors of cardiac arrest were cooled. Induced hypothermia entered guidelines quickly.

In 2013 the TTM trial randomised 33 °C against 36 °C and found no difference. The benefit had not come from the cold, but from preventing fever. TTM2 went further in 2021, comparing hypothermia against targeted normothermia.

The arc is worth keeping in mind: a number can survive in practice long after the reason for it has been revised.

Post-Intensive Care Syndrome names what follows discharge: physical, cognitive and psychiatric change that reduces quality of life — for the patient and often for the family too.

Around 60% of ICU survivors go on to have cognitive loss affecting memory, attention and reasoning. Time spent in delirium is independently associated with that later impairment.

It reframes what we are optimising for. Surviving the unit is the midpoint of the illness, not the end of it.

Schweickert and colleagues randomised mechanically ventilated patients to early physical and occupational therapy delivered during daily sedation interruption, rather than after recovery.

The intervention arm returned to independent function more often. Mobilisation stopped being convalescence and became part of acute care — and it now sits inside delirium-prevention bundles alongside sleep, sensory aids and restraint avoidance.

Humanisation in the ICU is often described as attitude. Read as practice, it is a list: manage noise and lighting, avoid physical restraint wherever safety allows, treat thirst, get analgesia and sedation right, mark the dates that matter to the patient, keep the family present — and the pet too.

The item that changes the most is the least technical: know the patient's biography. Ask what matters to them, and let the answer shape the care.

Each of those is auditable. That is the argument for treating humanisation as clinical practice rather than temperament — a thing with a protocol, and therefore a thing you can fail to do.