Intensive care medicine
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Intensive care medicine · Jun 2016
Multicenter StudyCAESAR: a new tool to assess relatives' experience of dying and death in the ICU.
To develop an instrument designed specifically to assess the experience of relatives of patients who die in the intensive care unit (ICU). ⋯ The CAESAR score 21 days after death in the ICU is strongly associated with post-ICU burden in the bereaved relatives. The CAESAR score should prove a useful primary endpoint in trials of interventions to improve relatives' well-being.
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Intensive care medicine · Jun 2016
Practice GuidelineGuidelines for the withdrawal of life-sustaining measures.
Withdrawal of life-sustaining measures is a common event in the intensive care unit yet it involves a complex balance of medical, legal and ethical considerations. Very few healthcare providers have been specifically trained to withdraw life-sustaining measures, and no comprehensive guidelines exist to help ensure clinicians deliver the highest quality of care to patients and families. Hence, we sought to develop guidelines for the process of withdrawing life-sustaining measures in the clinical setting. ⋯ We present these guidelines to help physicians provide high-quality end of life (EOL) care in the ICU. Future studies should address their effectiveness from both critical care team and family perspectives.
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Intensive care medicine · Jun 2016
Effect of ICU strain on timing of limitations in life-sustaining therapy and on death.
The effect of capacity strain in an ICU on the timing of end-of-life decision-making is unknown. We sought to determine how changes in strain impact timing of new do-not-resuscitate (DNR) orders and of death. ⋯ Strains in ICU capacity are associated with end-of-life decision-making, with shorter times to placement of DNR orders and death for patients admitted during high-strain days.