Critical care medicine
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Critical care medicine · Jan 2009
Organ donation, patients' rights, and medical responsibilities at the end of life.
The 2006 revision of the Uniform Anatomical Gift Act (UAGA) attempts to enhance the availability of organs in part by granting new authority to organ procurement organizations over patients who are near death and may be candidates for donation after death while limiting patients' end of life (EOL) decisional authority through advance directives or surrogates. To examine the revised UAGA that may alter the ethics and law of EOL medical care in the United States. To analyze the revised UAGA in light of established legal and ethical standards. ⋯ The 2006 UAGA reflects the important public policy goal of making more organs available for transplantation. However, it transfers authority over EOL decisions from patients or surrogates to organ procurement organizations, which is inconsistent with EOL U.S. common law and the ethical and legal standards that govern medicine. The extent of informed consent transferred to organ procurement organizations at the time of signing a donor registry card is legally and ethically uncertain under the UAGA. As states consider enacting the 2006 UAGA, further revisions should be considered to balance the public policy goals of increasing the availability of donated organs with truly informed and voluntary EOL decisions for patients. Further revision of the 2006 UAGA is necessary to respect patients' civil liberties and the professional integrity of physicians who have legally and ethically recognized fiduciary duties to their dying patients.
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Critical care medicine · Jan 2009
ReviewBetter infrastructure for critical care trials: nomenclature, etymology, and informatics.
The goals of this review article are to review the importance and value of standardized definitions in clinical research, as well as to propose the necessary tools and infrastructure needed to advance nosology and medial taxonomy to improve the quality of clinical trials in the field of critical care. ⋯ The development, implementation, evaluation, revision, and reevaluation of standardized definitions are keys for advancing the quality of clinical trials in the critical care arena.
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There is an increasing evidence that survivors of critical illness suffer from impaired health-related quality of life. There are relatively few studies that have evaluated the effect of interventions in clinical trials to improve these long-term outcomes. Studies to improve long-term outcomes after critical illness face many of the same challenges encountered in studies designed to improve shorter term outcomes in the intensive care unit. ⋯ Research interest in developing interventions to improve long-term outcome after critical illness is in its infancy and it is too early to make strong clinical recommendations. Multiple potential treatment areas exist, both within the intensive care unit and after patients leave the hospital, for intensivists to target. Those interested in this area should collaborate to build on the lessons from effective multidisciplinary programs developed to treat other diseases.
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Critical care medicine · Jan 2009
Combined neuronal and inducible nitric oxide synthase inhibition in ovine acute lung injury.
Acute lung injury with subsequent pneumonia and sepsis represents a major cause of morbidity and mortality in thermally injured patients. Production of nitric oxide by the neuronal and inducible nitric oxide synthase may be critically involved in the pathophysiology of the disease process at different time points, and thus specific inhibition at different times may represent an effective treatment regimen. ⋯ The combination of early neuronal nitric oxide synthase and delayed inducible nitric oxide synthase inhibition shows potential benefit in ovine acute lung injury by reducing nitrosative stress in the lung and limiting the degree of airway obstruction.
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Critical care medicine · Jan 2009
Clinical significance of a positive serology for mimivirus in patients presenting a suspicion of ventilator-associated pneumonia.
A seroconversion to mimivirus has been observed in patients with community-acquired or nosocomial pneumonia. The aim of this study was to determine whether a positive serology for mimivirus was associated with increased morbidity and mortality in patients with a suspicion of ventilator-associated pneumonia (VAP). ⋯ A positive serology for mimivirus is associated with a poorer outcome in mechanically ventilated ICU patients.