Critical care medicine
-
Critical care medicine · Aug 2010
ReviewA history of resolving conflicts over end-of-life care in intensive care units in the United States.
To present a case of conflict over end-of-life care in the intensive care unit (ICU) and to describe how such conflicts have been resolved in the United States since the inception of ICUs. ⋯ Conflict at the end of life in ICUs in the United States is relatively rare because most families and physicians agree about how patients should be treated. Nevertheless, conflict still exists over some patients whose families insist on care that physicians consider inappropriate and hence inadvisable, and over other patients whose families object to care that physicians prefer to provide. When such conflict occurs, mediation between families and physicians is usually successful in resolving it. Consultation from ethics committees also may be helpful in achieving resolution, and one state actually allows such committees to adjudicate disputes. Physicians who act unilaterally against family wishes run the risk of malpractice suits, although such suits usually are unsuccessful because the physicians are not shown to have violated standards of care.
-
Critical care medicine · Aug 2010
ReviewDeveloping information technology for infection prevention surveillance.
The potential to automate at least part of the surveillance process for health care-associated infections was seen as soon as hospitals began to implement computer systems. Progress toward automated surveillance has been ongoing for the last several decades. ⋯ Although true fully automated surveillance is not here yet, significant progress is being made at a number of centers for electronic surveillance of central catheter-associated bloodstream infections, ventilator-associated pneumonia, and other healthcare-associated infections. We review the progress that has been made in this area and issues that need to be addressed as surveillance systems are implemented, as well as promising areas for future development.
-
Critical care medicine · Aug 2010
Comparative StudyCerebral effects of hyperglycemia in experimental cardiac arrest.
To investigate the effects of cardiac arrest on cerebral perfusion and oxidative stress during hyperglycemia and normoglycemia. ⋯ The responses to 12-min cardiac arrest and cardiopulmonary resuscitation share large similarities during hyperglycemia and normoglycemia. The higher cerebral tissue oxygenation observed in the hyperglycemia needs to be confirmed and the phenomenon needs to be addressed in future studies.