Journal of critical care
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Journal of critical care · Dec 2018
The Italian law on informed consent and advance directives: New rules of conduct for the autonomy of doctors and patients in end-of-life care.
Italy has long lacked a law regulating patients' informed consent and advance directives (ADs). All previous attempts to introduce a law on this matter failed to reach positive outcomes, and aroused heated ideological debate over the exact meaning of life and death. We report on the new law on informed consent and ADs approved by the Italian Parliament on 14th December 2017. ⋯ The effects of the new law must be tested in the field. Its objectives will be achieved if, in clinical practice, ADs are able to satisfactorily represent informed personal preferences through patients' relationships with their physicians, as part of personalized advance care planning. Future studies are necessary to assess the impact of the new law in Italy.
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Journal of critical care · Dec 2018
Utility of routine methemoglobin laboratory assays in critically ill pediatric subjects receiving inhaled nitric oxide.
Inhaled nitric oxide (iNO) has been associated with safety risks including reports of methemoglobinemia. While standard of care recommends routine monitoring of methemoglobin in subjects on iNO therapy, the utility of this practice remains unknown. ⋯ Pediatric patients receiving iNO at doses below 40 ppm have minimal risk of developing clinically significant methemoglobinemia. Routine, ongoing monitoring of metHb levels in all pediatric subjects receiving iNO therapy at doses <40 ppm without the presence of risk factors predisposing the subject to increased risk of methemoglobinemia is unnecessary and should be avoided.
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Journal of critical care · Dec 2018
Organ donation education in the ICU setting: a qualitative and quantitative analysis of family preferences.
Determine family-centered methods of providing organ donation education to families in ICU waiting rooms. ⋯ ICU families desire accurate information about organ donation, and are receptive to its provision in the acute ICU setting. Family-centered approaches to information delivery may enhance understanding of organ donation processes and aid decision-making about organ donation.
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Journal of critical care · Dec 2018
Editorial CommentFluid overload FADEs away! Time for fluid stewardship.