Critical care medicine
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End-of-life care of critically ill patients generally consists of two closely related practices: the withholding and withdrawal of life support, and the administration of palliative care. In the United States, the withholding or withdrawal of life support is legally justified by the principles of informed consent and informed refusal. The U. ⋯ Although some physicians use the concept of futility to unilaterally withhold or withdraw life support, the Supreme Court has not heard a futility case, and the only clear legal rule on futile treatment is the traditional malpractice test, which measures physician actions against standards of medical care. However, the Supreme Court has furnished guidelines on the administration of palliative care. By using the principle of double effect, these guidelines allow physicians to give sedative and analgesic agents to dying patients if they intend to relieve pain and suffering but not to hasten death.
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Critical care medicine · Feb 2001
Comparative StudyAccuracy and utility of a continuous intra-arterial blood gas monitoring system in pediatric patients.
To determine the accuracy of the Paratrend 7 continuous intra-arterial blood gas monitor (CI-ABGM) in radial and femoral artery catheters placed in children compared with simultaneous measurements of pH, Pa(CO2), and Pa(O2) performed by intermittent blood gas analysis. To determine sensor longevity in pediatric patients at different arterial sites. To determine the utility of CI-ABGM for tracking unanticipated events related to blood gas deterioration. ⋯ The Paratrend 7 CI-ABGM is accurate within the extremes of physiologic gas exchange typically encountered in the pediatric intensive care setting. The device is capable of tracking extreme fluctuations in gas exchange with a response rate suitable for making real-time therapeutic decisions. The sensor can be recommended for insertion into a femoral artery cannula. There is a high incidence of blood pressure waveform dampening encountered in radial artery use.
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End-of life care is in need of improvement, yet little is known about the effectiveness or cost of various end-of-life therapies. Economic analyses are used to help make decisions between two or more therapies when resources are constrained. In this chapter, we review the various types of economic analyses, the costs of dying, and how healthcare reform has impacted these costs. ⋯ As the national debate about healthcare costs, access, and quality continues, we will increasingly turn to economic analyses to help make resource allocation decisions. Cost-effectiveness analysis will continue to be the most popular form of economic analysis because it combines the results (effectiveness of treatment) with the costs of achieving the results. We must be aware of the limitations of cost-effectiveness analyses and the need for value judgments when using cost-effectiveness analyses to inform healthcare decisions.
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Critical care medicine · Feb 2001
Randomized Controlled Trial Comparative Study Clinical TrialEarly postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition.
To evaluate the potential clinical, metabolic, and economic advantages of enteral nutrition over total parenteral nutrition. ⋯ EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinically require postoperative artificial nutrition.
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To determine the risk factors for pressure ulceration in an intensive care setting, to evaluate the Braden scale as a predictor of pressure ulcer risk in critically ill patients, and to determine whether pressure ulcers are likely to occur early in the hospital stay. ⋯ Pressure ulcers may develop within the first week of hospitalization in the intensive care unit. Patients at risk have Braden scores of < or = 16 and are more likely to be underweight. These results suggest that aggressive preventive care should be focused on those patients with Braden scores of < or = 13 and/or a low body mass index at admission.