Critical care medicine
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Key principles of palliative care shed light on future opportunities and challenges for improving patient care and family support within critical care. Interdisciplinary team approaches to patient comfort and family support, coordination and continuity of care, communication as an ethical and therapeutic modality, assistance with emotional, social and spiritual experience, including issues of life completion, bereavement support to families and attention to staff well-being are all foci for future clinical and programmatic development and research. By collaborating to care well for the critically ill or injured patients and extend support for their families, the disciplines of critical care and palliative care can complete one another.
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Although evidence-based research is limited, results suggest that ethics consultations are associated with reductions in hospital days and intensive care unit days and in life-sustaining treatments in those patients who ultimately will not survive to discharge. Furthermore, the majority of healthcare providers and patients/surrogates agreed that ethics consultations in the intensive care unit were helpful in addressing treatment conflicts. Ethics consultations also reduce hospital costs without diminishing the quality of care. ⋯ Further research on whether ethics consultations are beneficial in other settings is needed to establish the optimal scope of this intervention. Also, the benefits described above were achieved by highly skilled and experienced consultants. It is not certain, therefore, how successful other hospitals will be when adopting this intervention.
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Critical care medicine · Nov 2006
Open lung ventilation preserves the response to delayed surfactant treatment in surfactant-deficient newborn piglets.
Delayed surfactant treatment (>2 hrs after birth) is less effective than early treatment in conventionally ventilated preterm infants with respiratory distress syndrome. The objective of this study was to evaluate if this time-dependent efficacy of surfactant treatment is also present during open lung ventilation. ⋯ In contrast to conventional ventilation, open lung ventilation preserves the response to delayed surfactant treatment in surfactant-deficient newborn piglets. This sustained response is accompanied by an attenuation of secondary lung injury.
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Critical care medicine · Nov 2006
Comparative StudyAbdominal lymph flow in an endotoxin sepsis model: influence of spontaneous breathing and mechanical ventilation.
Lymph flow from the abdomen was investigated in a sepsis model. We also compared the effect on thoracic duct lymph flow of mechanical ventilation with different levels of positive end-expiratory pressure (PEEP) and spontaneous breathing with continuous positive airway pressure (CPAP). ⋯ Endotoxin increases lymph flow from the abdomen. Mechanical ventilation with high PEEP impedes lymph drainage and could increase lymph production. Spontaneous breathing increases flow and improves drainage of abdominal edema.
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Critical care medicine · Nov 2006
Integrating palliative medicine and critical care in a community hospital.
Our objective was to describe the rationale and implementation of educational, environmental, clinical, and communication interventions designed to maximize indicators of improved palliative care in a community hospital intensive care unit. Surveys were used to develop educational content and methods for all levels of clinical staff and medical education. All clinical staff expressed confidence in clinical palliative processes but not in communication and psycho-spiritual issues shared with patient/families. ⋯ Communication with families was enhanced by the use of the ambassadors, comprehensive care planning and sharing with the family within 24-48 hrs of admission, and ongoing meetings triggered by care plan changes. Quality indicators for intensive care unit-based palliative care proposed by experts provided a benchmark for evaluating the completeness of our intervention. Although not easily measured or demonstrated, it is our implicit assertion that this set of process and education interventions changed the daily nature of discourse in the intensive care unit among staff and between the staff, patients, and families.