Critical care medicine
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Critical care medicine · Mar 2009
Deciding in the dark: advance directives and continuation of treatment in chronic critical illness.
Chronic critical illness is a devastating syndrome for which treatment offers limited clinical benefit but imposes heavy burdens on patients, families, clinicians, and the health care system. We studied the availability of advance directives and appropriate surrogates to guide decisions about life-sustaining treatment for the chronically critically ill and the extent and timing of treatment limitation. ⋯ Most chronically critically ill patients fail to designate a surrogate decision-maker or express preferences regarding life-sustaining treatments. Despite burdensome symptoms and poor outcomes, limitation of such treatments was rare and occurred late, when patients were near death. Opportunities exist to improve communication and decision-making in chronic critical illness.
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Critical care medicine · Mar 2009
Hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis.
To evaluate the hospital-wide impact of a standardized order set for the management of bacteremic severe sepsis on processes of medical care and patient outcomes. ⋯ The implementation of a hospital-wide standardized order set for the management of bacteremic severe sepsis was associated with greater fluid administration, improved antibiotic therapy, decreased incidence of organ failure, and improved survival.
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Critical care medicine · Mar 2009
Anti-inflammatory adjuvant in resuscitation fluids improves survival in hemorrhage.
Severe hemorrhage is a common cause of death despite the recent advances in critical care. Conventional resuscitation fluids are designed to reestablish tissue perfusion, but they fail to prevent lethal inflammatory responses. Our previous studies indicate that ethyl pyruvate (EP) inhibits tumor necrosis factor (TNF) production from macrophages. Here, we analyze whether EP can provide a therapeutic anti-inflammatory value to resuscitation fluids. ⋯ EP may be a promising anti-inflammatory supplement to improve survival during resuscitation in critical care.
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Critical care medicine · Mar 2009
Developing guidelines that identify patients who would benefit from palliative care services in the surgical intensive care unit.
The convergence of end-of-life care and surgical practice often occurs in the surgical intensive care unit (SICU). Because many patients who encounter difficult end-of-life issues in the SICU do not receive palliative care services, there is a need to educate surgeons on how to better identify those patients. ⋯ We offer a set of consensus guidelines derived from expert opinion that identifies critically ill surgical patients who would benefit from palliative care consultation. These criteria can be used to educate surgeons at large on the variety of clinical scenarios where palliative care specialists can offer support.