keyword
https://read.qxmd.com/read/38528556/predictors-and-outcomes-of-withholding-and-withdrawal-of-life-sustaining-treatments-in-intensive-care-units-in-singapore-a-multicentre-observational-study
#1
JOURNAL ARTICLE
Clare Fong, Wern Lunn Kueh, Sennen Jin Wen Lew, Benjamin Choon Heng Ho, Yu-Lin Wong, Yie Hui Lau, Yew Woon Chia, Hui Ling Tan, Ying Hao Christopher Seet, Wen Ting Siow, Graeme MacLaren, Rohit Agrawal, Tian Jin Lim, Shir Lynn Lim, Toon Wei Lim, Vui Kian Ho, Chai Rick Soh, Duu Wen Sewa, Chian Min Loo, Faheem Ahmed Khan, Chee Keat Tan, Roshni Sadashiv Gokhale, Chuin Siau, Noelle Louise Siew Hua Lim, Chik-Foo Yim, Jonathen Venkatachalam, Kumaresh Venkatesan, Naville Chi Hock Chia, Mei Fong Liew, Guihong Li, Li Li, Su Mon Myat, Zena Zena, Shuling Zhuo, Ling Ling Yueh, Caroline Shu Fang Tan, Jing Ma, Siew Lian Yeo, Yiong Huak Chan, Jason Phua
BACKGROUND: Clinical practice guidelines on limitation of life-sustaining treatments (LST) in the intensive care unit (ICU), in the form of withholding or withdrawal of LST, state that there is no ethical difference between the two. Such statements are not uniformly accepted worldwide, and there are few studies on LST limitation in Asia. This study aimed to evaluate the predictors and outcomes of withholding and withdrawal of LST in Singapore, focusing on the similarities and differences between the two approaches...
March 26, 2024: Journal of Intensive Care
https://read.qxmd.com/read/38475798/long-term-outcome-in-new-onset-refractory-status-epilepticus-a-retrospective-study
#2
JOURNAL ARTICLE
Federica Stretti, Stefan Yu Bögli, Francesca Casagrande, Amanda Eisele, Marian Galovic, Emanuela Keller, Giovanna Brandi
BACKGROUND: New onset refractory status epilepticus (NORSE) is a neurologic emergency without an immediately identifiable cause. The complicated and long ICU stay of the patients can lead to perceiving a prolongation of therapies as futile. However, a recovery is possible even in severe cases. This retrospective study investigates ICU treatments, short- and long-term outcome and ethical decisions of a case series of patients with NORSE. METHODS: Overall, 283 adults were admitted with status epilepticus (SE) to the Neurocritical Care Unit of the University Hospital Zurich, Switzerland, between 01...
March 12, 2024: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/38463033/experiences-in-the-use-of-multiple-doses-of-convalescent-plasma-in-critically-ill-patients-with-covid-19-an-early-phase-1-descriptive-study
#3
JOURNAL ARTICLE
Ricardo Aguilar, Sandra López-Vergès, Anarellys Quintana, Johanna Morris, Lineth Lopez, Ana Cooke, Dimas Quiel, Natalie Buitron, Yaseikiry Pérez, Lesbia Lobo, Maura Ballesteros, Yaneth Pitti, Yamilka Diaz, Lisseth Saenz, Danilo Franco, Daniel Castillo, Elimelec Valdespino, Isabel Blanco, Emilio Romero, Alcibiades Villarreal, Idalina Cubilla-Batista
BACKGROUND: At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, transfusion of coronavirus disease 2019 (COVID-19) convalescent plasma (CCP) emerged as a potential therapeutic strategy to help patients severely afflicted by COVID-19. The efficacy of CCP has been controversial as it depends on many variables pertaining to the plasma donor and the patient with COVID-19, for example, time of convalescence or symptoms onset. This feasibility and descriptive study aimed to assess the safety of multiple doses of CCP in mechanically ventilated, intubated patients with respiratory failure due to COVID-19...
March 2024: Health Science Reports
https://read.qxmd.com/read/38446208/acute-kidney-injury-requiring-dialysis-in-children-a-multicentric-emerging-country-perspective
#4
JOURNAL ARTICLE
Thais Lira Cleto-Yamane, Conrado Lysandro R Gomes, Paulo Cesar Koch-Nogueira, José Hermógenes Rocco Suassuna
BACKGROUND: Acute kidney injury (AKI) is a life-threatening condition, especially in extreme age groups and when kidney replacement therapy (KRT) is necessary. Studies worldwide report mortality rates of 10-63% in pediatric patients undergoing KRT. METHODS: Over 13 years, this multicenter study analyzed data from 693 patients with AKI, all receiving KRT, across 74 hospitals and medical facilities in Rio de Janeiro, Brazil. RESULTS: The majority were male (59...
March 6, 2024: Pediatric Nephrology
https://read.qxmd.com/read/38445440/portal-vein-thrombosis-and-liver-transplantation-management-matching-and-outcomes-a-retrospective-multicenter-cohort-study
#5
JOURNAL ARTICLE
Fabrizio Di Benedetto, Paolo Magistri, Stefano Di Sandro, Riccardo Boetto, Francesco Tandoi, Stefania Camagni, Andrea Lauterio, Duilio Pagano, Daniele Nicolini, Paola Violi, Daniele Dondossola, Nicola Guglielmo, Vittorio Cherchi, Quirino Lai, Luca Toti, Marco Bongini, Samuele Frassoni, Vincenzo Bagnardi, Vincenzo Mazzaferro, Giuseppe Tisone, Massimo Rossi, Umberto Baccarani, Giuseppe Maria Ettorre, Lucio Caccamo, Amedeo Carraro, Marco Vivarelli, Salvatore Gruttadauria, Luciano De Carlis, Michele Colledan, Renato Romagnoli, Umberto Cillo
BACKGROUND AND AIMS: Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients...
March 4, 2024: International Journal of Surgery
https://read.qxmd.com/read/38342305/factors-associated-with-limitation-of-life-support-post-icu-mortality-case-study-of-a-tertiary-hospital
#6
JOURNAL ARTICLE
U A López González, D Bautista Rentero, M Crespo Gómez, P Cárcamo Ibarra, A M Míguez Santiyán
BACKGROUND: Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it. OBJECTIVE: To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU. DESIGN: Retrospective longitudinal study...
February 9, 2024: Revista española de anestesiología y reanimación
https://read.qxmd.com/read/38301032/predicting-time-to-asystole-following-withdrawal-of-life-sustaining-treatment-a-systematic-review
#7
REVIEW
C Nicolson, A Burke, D Gardiner, D Harvey, L Munshi, M Shaw, A Tsanas, N Lone, K Puxty
The planned withdrawal of life-sustaining treatment is a common practice in the intensive care unit for patients where ongoing organ support is recognised to be futile. Predicting the time to asystole following withdrawal of life-sustaining treatment is crucial for setting expectations, resource utilisation and identifying patients suitable for organ donation after circulatory death. This systematic review evaluates the literature for variables associated with, and predictive models for, time to asystole in patients managed on intensive care units...
February 1, 2024: Anaesthesia
https://read.qxmd.com/read/38288778/ethical-issues-in-pain-and-palliation
#8
JOURNAL ARTICLE
Marco Cascella, Alessandro Laudani, Giuliana Scarpati, Ornella Piazza
PURPOSE OF REVIEW: Increased public awareness of ethical issues in pain and palliative care, along with patient advocacy groups, put pressure on healthcare systems and professionals to address these concerns.Our aim is to review the ethics dilemmas concerning palliative care in ICU, artificial intelligence applications in pain therapy and palliative care, and the opioids epidemics. RECENT FINDINGS: In this focus review, we highlighted state of the art papers that were published in the last 18 months, on ethical issues in palliative care within the ICU, artificial intelligence trajectories, and how opioids epidemics has impacted pain management practices (see Visual Abstract)...
January 30, 2024: Current Opinion in Anaesthesiology
https://read.qxmd.com/read/38172296/phase-3-trial-of-recombinant-human-alkaline-phosphatase-for-patients-with-sepsis-associated-acute-kidney-injury-revival
#9
JOURNAL ARTICLE
Peter Pickkers, Derek C Angus, Kristie Bass, Rinaldo Bellomo, Erik van den Berg, Juliane Bernholz, Morten H Bestle, Kent Doi, Chistopher J Doig, Ricard Ferrer, Bruno Francois, Henrik Gammelager, Ulf Goettrup Pedersen, Eric Hoste, Susanne Iversen, Michael Joannidis, John A Kellum, Kathleen Liu, Melanie Meersch, Ravindra Mehta, Scott Millington, Patrick T Murray, Alistair Nichol, Marlies Ostermann, Ville Pettilä, Christoffer Solling, Matthias Winkel, Paul J Young, Alexander Zarbock
PURPOSE: Ilofotase alfa is a human recombinant alkaline phosphatase with reno-protective effects that showed improved survival and reduced Major Adverse Kidney Events by 90 days (MAKE90) in sepsis-associated acute kidney injury (SA-AKI) patients. REVIVAL, was a phase-3 trial conducted to confirm its efficacy and safety. METHODS: In this international double-blinded randomized-controlled trial, SA-AKI patients were enrolled < 72 h on vasopressor and < 24 h of AKI...
January 3, 2024: Intensive Care Medicine
https://read.qxmd.com/read/38116787/moral-distress-among-critical-care-nurses-before-and-during-the-covid-19-pandemic-a-systematic-review
#10
REVIEW
Fatemeh Beheshtaeen, Camellia Torabizadeh, Sahar Khaki, Narjes Abshorshori, Fatemeh Vizeshfar
Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic review compares the factors influencing moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress...
December 20, 2023: Nursing Ethics
https://read.qxmd.com/read/38074503/liver-transplant-selection-criteria-and-outcomes-in%C3%A2-critically-ill-patients-with-aclf
#11
JOURNAL ARTICLE
Sophie-Caroline- Sacleux, Philippe Ichaï, Audrey Coilly, Marc Boudon, Elise Lemaitre, Rodolphe Sobesky, Eleonora De Martin, Valérie Cailliez, Ilias Kounis, Edoardo Poli, Marie-Amélie Ordan, Alina Pascale, Jean-Charles Duclos-Vallée, Cyrille Feray, Daniel Azoulay, Eric Vibert, Daniel Cherqui, René Adam, Didier Samuel, Faouzi Saliba
BACKGROUND & AIMS: Retrospective studies have reported good results with liver transplantation (LTx) for acute-on-chronic liver failure (ACLF) in selected patients. The aim of this study was to evaluate the selection process for LTx in patients with ACLF admitted to the intensive care unit (ICU) and to assess outcomes. METHODS: This prospective, non-interventional, single high-volume center study collected data on patients with ACLF admitted to the ICU between 2017-2020...
January 2024: JHEP reports: innovation in hepatology
https://read.qxmd.com/read/38058590/palliative-extubation-in-pediatric-patients-in-the-intensive-care-unit-and-at-home-a-scoping-review
#12
REVIEW
Joana Neto, Hugo Jorge Casimiro, Paulo Reis-Pina
AIM: This scoping review is aimed at systematically mapping the evidence on palliative extubation in the pediatric intensive care unit. METHODS: MEDLINE, EBSCO, and Cochrane databases were searched for articles published between January 2018 and December 2022, in English. Critical appraisal of sources of evidence was done using the Joanna Briggs Institute tools. PRISMA guidelines for scoping reviews were followed. RESULTS: Six studies were included, with 366 patients, from the USA ( n = 4), Brazil ( n = 1), and Germany ( n = 1)...
2023: International Journal of Pediatrics
https://read.qxmd.com/read/38050047/futile-life-sustaining-treatment-in-the-intensive-care-unit-nurse-and-physician-experiences-meta-synthesis
#13
REVIEW
Hye Ri Choi, Mu-Hsing Ho, Chia-Chin Lin
BACKGROUND: Continuing futile life-sustaining treatment prolongs patients' suffering and family members' and medical staff's psychological distress. Additionally, continuing futile treatment is inefficient in healthcare resource distribution. Although the withdrawal of futile life-sustaining treatment is ideal, the prevalence is variable. OBJECTIVE: To synthesise nurses' and physicians' experiences with continuing futile life-sustaining treatment in the intensive care unit...
November 29, 2023: BMJ Supportive & Palliative Care
https://read.qxmd.com/read/38024788/becoming-futile-the-emotional-pain-of-treating-covid-19-patients
#14
JOURNAL ARTICLE
Jason Rodriquez
INTRODUCTION: The COVID-19 pandemic has had a profoundly detrimental impact on the emotional wellbeing of health care workers. Numerous studies have shown that their rates of the various forms of work-related distress, which were already high before the pandemic, have worsened as the demands on health care workers intensified. Yet much less is known about the specific social processes that have generated these outcomes. This study adds to our collective knowledge by focusing on how one specific social process, the act of treating critically ill COVID-19 patients, contributed to emotional pain among health care workers...
2023: Frontiers in sociology
https://read.qxmd.com/read/37977159/efficacy-and-safety-of-baricitinib-or-ravulizumab-in-adult-patients-with-severe-covid-19-tactic-r-a-randomised-parallel-arm-open-label-phase-4-trial
#15
RANDOMIZED CONTROLLED TRIAL
Frances C Hall, Joseph Cheriyan, Andrew P Cope, James Galloway, Ian Wilkinson, Simon Bond, Sam Norton, Edward Banham-Hall, Hannah Bayes, Michalis Kostapanos, Marianna Nodale, William G Petchey, Thomas Sheeran, Jonathan Underwood, David R Jayne
BACKGROUND: From early in the COVID-19 pandemic, evidence suggested a role for cytokine dysregulation and complement activation in severe disease. In the TACTIC-R trial, we evaluated the efficacy and safety of baricitinib, an inhibitor of Janus kinase 1 (JAK1) and JAK2, and ravulizumab, a monoclonal inhibitor of complement C5 activation, as an adjunct to standard of care for the treatment of adult patients hospitalised with COVID-19. METHODS: TACTIC-R was a phase 4, randomised, parallel-arm, open-label platform trial that was undertaken in the UK with urgent public health designation to assess the potential of repurposing immunosuppressants for the treatment of severe COVID-19, stratified by a risk score...
December 2023: Lancet Respiratory Medicine
https://read.qxmd.com/read/37968108/navigating-parental-requests-considering-the-relational-potential-standard-in-paediatric-end-of-life-care-in-the-paediatric-intensive-care-unit
#16
JOURNAL ARTICLE
Jenny Kingsley, Jonna Clark, Mithya Lewis-Newby, Denise Marie Dudzinski, Douglas Diekema
Families and clinicians approaching a child's death in the paediatric intensive care unit (PICU) frequently encounter questions surrounding medical decision-making at the end of life (EOL), including defining what is in the child's best interest, finding an optimal balance of benefit over harm, and sometimes addressing potential futility and moral distress. The best interest standard (BIS) is often marshalled by clinicians to help navigate these dilemmas and focuses on a clinician's primary ethical duty to the paediatric patient...
November 15, 2023: Journal of Medical Ethics
https://read.qxmd.com/read/37904241/efficacy-of-haloperidol-to-decrease-the-burden-of-delirium-in-adult-critically-ill-patients-the-euridice-randomized-clinical-trial
#17
RANDOMIZED CONTROLLED TRIAL
Lisa Smit, Arjen J C Slooter, John W Devlin, Zoran Trogrlic, Nicole G M Hunfeld, Robert Jan Osse, Huibert H Ponssen, Arjen J B W Brouwers, Jeannette F Schoonderbeek, Koen S Simons, Mark van den Boogaard, Judith A Lens, Dirk P Boer, Diederik A M P J Gommers, Wim J R Rietdijk, Mathieu van der Jagt
BACKGROUND: The role of haloperidol as treatment for ICU delirium and related symptoms remains controversial despite two recent large controlled trials evaluating its efficacy and safety. We sought to determine whether haloperidol when compared to placebo in critically ill adults with delirium reduces days with delirium and coma and improves delirium-related sequelae. METHODS: This multi-center double-blind, placebo-controlled randomized trial at eight mixed medical-surgical Dutch ICUs included critically ill adults with delirium (Intensive Care Delirium Screening Checklist ≥ 4 or a positive Confusion Assessment Method for the ICU) admitted between February 2018 and January 2020...
October 30, 2023: Critical Care: the Official Journal of the Critical Care Forum
https://read.qxmd.com/read/37877585/intravenous-vitamin-c-for-patients-hospitalized-with-covid-19-two-harmonized-randomized-clinical-trials
#18
JOURNAL ARTICLE
Neill K J Adhikari, Madiha Hashmi, Bharath Kumar Tirupakuzhi Vijayaraghavan, Rashan Haniffa, Abi Beane, Steve A Webb, Derek C Angus, Anthony C Gordon, Deborah J Cook, Gordon H Guyatt, Lindsay R Berry, Elizabeth Lorenzi, Paul R Mouncey, Carly Au, Ruxandra Pinto, Julie Ménard, Sheila Sprague, Marie-Hélène Masse, David T Huang, Daren K Heyland, Alistair D Nichol, Colin J McArthur, Angelique de Man, Farah Al-Beidh, Djillali Annane, Matthew Anstey, Yaseen M Arabi, Marie-Claude Battista, Scott Berry, Zahra Bhimani, Marc J M Bonten, Charlotte A Bradbury, Emily B Brant, Frank M Brunkhorst, Aidan Burrell, Meredith Buxton, Maurizio Cecconi, Allen C Cheng, Dian Cohen, Matthew E Cove, Andrew G Day, Lennie P G Derde, Michelle A Detry, Lise J Estcourt, Elizabeth O Fagbodun, Mark Fitzgerald, Herman Goossens, Cameron Green, Alisa M Higgins, Thomas E Hills, Nao Ichihara, Devachandran Jayakumar, Salmaan Kanji, Muhammad Nasir Khoso, Patrick R Lawler, Roger J Lewis, Edward Litton, John C Marshall, Daniel F McAuley, Anna McGlothlin, Shay P McGuinness, Zoe K McQuilten, Bryan J McVerry, Srinivas Murthy, Rachael L Parke, Jane C Parker, Luis Felipe Reyes, Kathryn M Rowan, Hiroki Saito, Nawal Salahuddin, Marlene S Santos, Christina T Saunders, Christopher W Seymour, Manu Shankar-Hari, Timo Tolppa, Tony Trapani, Alexis F Turgeon, Anne M Turner, Andrew A Udy, Frank L van de Veerdonk, Ryan Zarychanski, François Lamontagne
IMPORTANCE: The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain. OBJECTIVE: To determine whether vitamin C improves outcomes for patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Two prospectively harmonized randomized clinical trials enrolled critically ill patients receiving organ support in intensive care units (90 sites) and patients who were not critically ill (40 sites) between July 23, 2020, and July 15, 2022, on 4 continents...
October 25, 2023: JAMA
https://read.qxmd.com/read/37712806/effects-of-mechanical-in-exsufflation-in-preventing-postextubation-acute-respiratory-failure-in-intensive-care-acquired-weakness-patients-a-randomized-controlled-trial
#19
RANDOMIZED CONTROLLED TRIAL
Philippe Wibart, Thomas Réginault, Margarita Garcia-Fontan, Bérangère Barbrel, Clement Bader, Antoine Benard, Verônica Franco Parreira, Daniel Gonzalez-Antón, Nam H Bui, Didier Gruson, Gilles Hilbert, Roberto Martinez-Alejos, Frédéric Vargas
OBJECTIVE: We hypothesized that the use of mechanical insufflation-exsufflation can reduce the incidence of acute respiratory failure within the 48-hour post-extubation period in intensive care unit-acquired weakness patients. METHODS: This was a prospective randomized controlled open-label trial. Patients diagnosed with intensive care unit-acquired weakness were consecutively enrolled based on a Medical Research Council score ≤ 48/60. The patients randomly received two daily sessions; in the control group, conventional chest physiotherapy was performed, while in the intervention group, chest physiotherapy was associated with mechanical insufflation-exsufflation...
2023: Crit Care Sci
https://read.qxmd.com/read/37706168/assessing-the-impact-of-palliative-care-admission-of-end-of-life-cancer-adults
#20
JOURNAL ARTICLE
Jose F Díez-Concha, Diego Mauricio Gómez-García, Julián Alberto Agudelo, Edwin Alexander Lizarazo Herrera
BACKGROUND: There is evidence that early admission to the palliative care (PC) program in adult cancer patients improves symptoms management, reduces unplanned hospital admissions, minimizes aggressive cancer treatments, and enables patients to make decisions about their end-of-life (EOL) care. OBJECTIVES: This retrospective cohort study aimed to determine whether late admission to a PC program is associated with aggressive treatment at the EOL in adult patients with oncological diseases from their admission until death...
2023: Palliative care and social practice
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