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ICU Futility

Andrew McGuire, Paul C McConnell
PURPOSE OF REVIEW: Increasing scarcity of resources on the background of ever improving medical care and prolonged life expectancy has placed a burden on all aspects of health care. In this article we examine the current problems with resource allocation in intensive care and question whether we can find guidance on appropriate resource allocation through ethical models. RECENT FINDINGS: The problem of fair and ethical resource allocation has perpetually plagued health care...
April 2019: Current Opinion in Anaesthesiology
Pei-Fan Mu, Yun-Min Tseng, Chia-Chi Wang, Yi-Ju Chen, Shu-He Huang, Teh-Fu Hsu, Kristine L Florczak
The experiences of end-of-life care by nurses in the pediatric intensive care unit are the subject of this systematic review. Six qualitative articles from three different countries were chosen for the review using methods from Joanna Briggs Institute. The themes discovered included the following: insufficient communication, emotional burden, moral distress from medical futility, strengthening resilience, and taking steps toward hospice. These themes are discussed in detail followed by recommendations for practice to assist nurses in their quest for a good death for their pediatric patients...
January 2019: Nursing Science Quarterly
Joseph J Fins, Diego Real de Asúa
Undocumented and undomiciled, Gustavo Jiménez had been in the United States for several years. He knew his leg wasn't right when it began to swell and redden. After the cellulitis spread to his bloodstream, he was found unconscious on the street and admitted to the intensive care unit. He improved quickly and was soon able to tell a social worker his name and that he had family in Quito. Then his health took a turn for the worse, and he developed multisystem organ failure. His doctors believed his prognosis grave and further care futile...
January 2019: Hastings Center Report
Kunal Bailoor, Thomas S Valley, Stephanie Kukora, Darin B Zahuranec
RATIONALE: National guidelines have laid out a process to conflict resolution in cases of potentially inappropriate medical interventions. OBJECTIVE: To determine the effect of information about a process-based approach on lay public perceptions of the appropriateness of withholding medically inappropriate interventions. METHODS: Respondents from a nationwide sample completed a survey with two adult ICU-based vignettes: one about advanced cancer where doctors told the family that additional chemotherapy would not be offered, and a second case of multi-organ failure after brain hemorrhage where dialysis would not be offered...
February 21, 2019: Annals of the American Thoracic Society
Leili Yekefallah, Tahereh Ashktorab, Houman Manoochehri, Hamid Alavi Majd
Background: In Iran, futile care has become a challenge for intensive care nurses. The aim of the study was to develop a tool for assessing the reasons of futile care at intensive care units (ICUs). Materials and Methods: A sequential mixed method in three stages was applied. In the first stage, a phenomenological study was performed with van Manen's method by interviewing 25 nurses at ICUs of 11 hospitals in Qazvin. To extract the items of the tool in the second stage, the concept of futile care in ICUs and its reasons were defined...
January 2019: Iranian Journal of Nursing and Midwifery Research
Sergio Maimone, Francesca Saffioti, Roberto Filomia, Angela Alibrandi, Grazia Isgrò, Vincenza Calvaruso, Elias Xirouchakis, Gian Piero Guerrini, Andrew K Burroughs, Emmanuel Tsochatzis, David Patch
BACKGROUND: Transjugular intrahepatic portosystemic shunt (TIPS) has proven clinical efficacy as rescue therapy for cirrhotic patients with acute portal hypertensive bleeding who fail endoscopic treatment. AIMS: To investigate predictive factors of 6-week and 1-year mortality in patients undergoing salvage TIPS for refractory portal hypertensive bleeding. METHODS: A total of 144 consecutive patients were retrospectively evaluated. Three logistic regression multivariate models were estimated to individualize prognostic factors for 6-week and 12-month mortality...
December 17, 2018: Digestive Diseases and Sciences
Andrew McGuire, Paul C McConnell
PURPOSE OF REVIEW: Increasing scarcity of resources on the background of ever improving medical care and prolonged life expectancy has placed a burden on all aspects of health care. In this article we examine the current problems with resource allocation in intensive care and question whether we can find guidance on appropriate resource allocation through ethical models. RECENT FINDINGS: The problem of fair and ethical resource allocation has perpetually plagued health care...
December 6, 2018: Current Opinion in Anaesthesiology
Matthew H Anstey, Edward Litton, Nihar Jha, Michelle L Trevenen, Steve Webb, Imogen A Mitchell
BACKGROUND: Achieving shared decision-making in the intensive care unit (ICU) is challenging because of limited patient capacity, leading to a reliance on surrogate decision-makers. Prior research shows that ICU staff members often perceive that patients receive inappropriate or futile treatments while some surrogate decision-makers of patients admitted to the ICU report inadequate communication with physicians. Therefore, understanding the perceptions of both ICU staff and surrogate decision-makers around wishes for ICU treatments is an essential component to improve these situations...
November 13, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
A Sandiumenge, S Ramírez-Estrada, C Mazo, M Rubiera, S Boned, B Domínguez-Gil, T Pont
OBJECTIVE: We evaluate the impact of a web-based collaborative system on the referral of possible organ donors from outside of the intensive care unit (ICU). STUDY DESIGN: Cohort prospective study. SETTINGS: University hospital. PATIENTS AND INTERVENTION: In 2015 a virtual collaborative system using a cross-platform instant messaging application replaced the previous 2014 protocol for the referral of patients outside of the ICU with a severe brain injury in whom all treatment options were deemed futile by the attending team to the donor coordination (DC)...
November 2, 2018: Medicina Intensiva
Cornelius Engelmann, Karen Louise Thomsen, Nekisa Zakeri, Mohammed Sheikh, Banwari Agarwal, Rajiv Jalan, Rajeshwar P Mookerjee
BACKGROUND: Acute-on-chronic liver failure (ACLF) is a severe complication of cirrhosis and is defined by organ failure and high rates of short-term mortality. Patients with ACLF are managed with multiorgan support in the intensive care unit (ICU). Currently, it is unclear when this supportive care becomes futile, particularly in patients who are not candidates for liver transplant. The aim of this study was to determine whether the currently available prognostic scores can identify patients with ACLF in whom prolonged ICU care is likely to be futile despite maximal treatment efforts...
October 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
Saber D Barbar, Raphaël Clere-Jehl, Abderrahmane Bourredjem, Romain Hernu, Florent Montini, Rémi Bruyère, Christine Lebert, Julien Bohé, Julio Badie, Jean-Pierre Eraldi, Jean-Philippe Rigaud, Bruno Levy, Shidasp Siami, Guillaume Louis, Lila Bouadma, Jean-Michel Constantin, Emmanuelle Mercier, Kada Klouche, Damien du Cheyron, Gaël Piton, Djillali Annane, Samir Jaber, Thierry van der Linden, Gilles Blasco, Jean-Paul Mira, Carole Schwebel, Loïc Chimot, Philippe Guiot, Mai-Anh Nay, Ferhat Meziani, Julie Helms, Claire Roger, Benjamin Louart, Remi Trusson, Auguste Dargent, Christine Binquet, Jean-Pierre Quenot
BACKGROUND: Acute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standard of care for severe acute kidney injury, the ideal time for initiation remains controversial. METHODS: In a multicenter, randomized, controlled trial, we assigned patients with early-stage septic shock who had severe acute kidney injury at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) classification system but without life-threatening complications related to acute kidney injury to receive renal-replacement therapy either within 12 hours after documentation of failure-stage acute kidney injury (early strategy) or after a delay of 48 hours if renal recovery had not occurred (delayed strategy)...
October 11, 2018: New England Journal of Medicine
Jacek Siewiera, Dariusz Tomaszewski, Jacek Piechocki, Andrzej Kübler
BACKGROUND: In intensive care units (ICUs), a patient's vital functions may be maintained, regardless of the patient's chances of survival. A key issue is how to precisely determine the moment in which life-support treatment should be withheld. In many countries, the decision-making process is regulated by the guidelines of scientific societies. However, heuristic errors may influence this process. OBJECTIVES: The objective of this study was to assess factors involved in decisions to implement or withhold treatment in general ICUs in Poland...
October 2, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
Hamid Asayesh, Mojtaba Mosavi, Mohammad Abdi, Mohammad Parvaresh Masoud, Kurosh Jodaki
Moral distress is among the various types of distress that involves nurses and can lead to multiple complications. It is therefore rather important to identify the factors related to moral distress. The purpose of this study was to examine the relationship between futile care perception and moral distress among intensive care unit (ICU) nurses. This cross-sectional study used a descriptive-correlation method and was conducted on 117 ICU nurses of Qom hospitals in 2016. Data were collected using a 17-item futile care perception questionnaire, and Jameton's moral distress questionnaire containing 30 questions...
2018: Journal of Medical Ethics and History of Medicine
Jakub Fronczek, Kamil Jurand Polok, Ilona Nowak-Kózka, Anna Włudarczyk, Jacek Górka, Mirosław Czuczwar, Paweł Krawczyk, Mirosław Ziętkiewicz, Łukasz R Nowak, Maciej Żukowski, Katarzyna Kotfis, Katarzyna Cwyl, Ryszard Gajdosz, Romuald Bohatyrewicz, Jowita Biernawska, Paweł Grudzień, Paweł Nasiłowski, Natalia Popek, Waldemar Cyrankiewicz, Katarzyna Wawrzyniak, Marek Wnuk, Dariusz Maciejewski, Dorota Studzińska, Szymon Bernas, Mariusz Piechota, Waldemar Machała, Marta Serwa, Maria Wujtewicz, Jan Stefaniak, Małgorzata Szymkowiak, Ryszard Gawda, Barbara Adamik, Natalia Kozera, Waldemar Goździk, Hans Flaatten, Wojciech Szczeklik
BACKGROUND: The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. METHODS: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected...
2018: Anaesthesiology Intensive Therapy
Elisabet Periche Pedra, Melinda Rita Koborzan, Fabrizio Sbraga, Arnau Blasco Lucas, David Toral Sepúlveda
Introduction: Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that has been used to support cardiopulmonary disease refractory to conventional therapy. The experience with the use of ECMO in acute hypoxemic respiratory failure is still limited. The aim of this study was to report clinical outcomes in adult patients with acute hypoxemic respiratory failure refractory to mechanical ventilation treated with ECMO. Methods: Between July 2011 and October 2017, 18 adult patients with hypoxemic respiratory failure refractory to mechanical ventilation were admitted to the Intensive Care Unit of an acute care tertiary hospital in Barcelona, Spain...
2018: Respiratory Medicine Case Reports
Niels D Martin, Sagar P Patel, Kristen Chreiman, Jose L Pascual, Benjamin Braslow, Patrick M Reilly, Lewis J Kaplan
Background: Critically ill patients are often evaluated for an intra-abdominal catastrophe. In the absence of a preoperative diagnosis, abdominal exploration may be offered despite desperate circumstances. We hypothesize that (1) abdominal exploration for such patients is associated with a high mortality and (2) commonly obtained physiologic measures at laparotomy anticipate mortality. Methods: All acute care surgery (ACS) patients undergoing emergency laparotomy at a quaternary referral center during a 3-year period were reviewed...
2018: Critical Care Research and Practice
Sebastiano Mercadante, Cesare Gregoretti, Andrea Cortegiani
Palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering when "curative" therapies are futile. In the Intensive Care Unit (ICU), critically ill patients receive life-sustaining therapies with the goal of restoring or maintaining organ function. Palliative Care in the ICU is a widely discussed topic and it is increasingly applied in clinics. It encompasses symptoms control and end-of-life management, communication with relatives and setting goals of care ensuring dignity in death and decision-making power...
August 16, 2018: BMC Anesthesiology
Paul M Reynolds, Robert MacLaren
STUDY OBJECTIVE: Because recent studies have challenged the efficacy of stress ulcer prophylaxis (SUP) in the critically ill patient, our objective was to evaluate the efficacy of SUP with proton pump inhibitors (PPIs) or histamine2 -receptor antagonists (H2 RAs) against placebo, control, no therapy, or enteral nutrition alone in critically ill adults. DESIGN: Meta-analysis with trial sequential analysis (TSA) of 34 randomized controlled trials. PATIENTS: A total of 3220 critically ill adults who received PPIs or H2 RAs versus placebo, control, no therapy, or enteral nutrition...
August 13, 2018: Pharmacotherapy
Fernando G Zampieri
No abstract text is available yet for this article.
June 2018: Journal of Thoracic Disease
Danielle Houlden, Dmitriy Khodorskiy, Sandra Miller-Portman, Maria Li
Introduction  Unlike low-pressure hydrocephalus, very low pressure hydrocephalus (VLPH) is a rarely reported clinical entity previously described to be associated with poor outcomes and to be possibly refractory to treatment with continued cerebrospinal fluid (CSF) drainage at subatmospheric pressures. 1, 2 We present four cases of VLPH following resection of suprasellar lesions and hypothesize that untreatable patients can be identified early, thereby avoiding futile prolonged external ventricular drainage in ICU...
August 2018: Journal of Neurological Surgery. Part B, Skull Base
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