Critical care medicine
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Critical care medicine · May 2011
ReviewPatient and healthcare professional factors influencing end-of-life decision-making during critical illness: a systematic review.
The need for better understanding of end-of-life care has never been greater. Debate about recent U.S. healthcare system reforms has highlighted that end-of-life decision-making is contentious. Providing compassionate end-of-life care that is appropriate and in accordance with patient wishes is an essential component of critical care. Because discord can undermine optimal end-of-life care, knowledge of factors that influence decision-making is important. We performed a systematic review to determine which factors are known to influence end-of-life decision-making among patients and healthcare providers. DATA SOURCES, SELECTION, AND ABSTRACTION: We conducted a structured search of Ovid Medline for interventional and observational research articles incorporating critical care and end-of-life decision-making terms. ⋯ Patients and clinicians may approach end-of-life discussions with different expectations and preferences, influenced by religion, race, culture, and geography. Appreciation of those factors associated with more and less technologically intense care may raise awareness, aid communication, and guide clinicians in end-of-life discussions.
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Critical care medicine · May 2011
Comparative StudyEfficacy of portable and percutaneous cardiopulmonary bypass rewarming versus that of conventional internal rewarming for patients with accidental deep hypothermia.
Since 2001, at our institution, a portable and percutaneous cardiopulmonary bypass system has been used for rewarming of patients with accidental deep hypothermia. Before 2001, a conventional internal rewarming technique was used. The aim of this research is to examine the efficacy of portable and percutaneous cardiopulmonary bypass for rewarming of patients with accidental severe hypothermia and compare it with that of conventional rewarming methods. ⋯ Portable and percutaneous cardiopulmonary bypass rewarming can improve the mortality rates and Glasgow Outcome Scale scores of accidental deep hypothermia patients.
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Critical care medicine · May 2011
Comparative StudyClinician blood pressure documentation of stable intensive care patients: an intelligent archiving agent has a higher association with future hypotension.
To compare invasive blood pressure measurements recorded using an automated archiving method against clinician-documented values from the same invasive monitor and determine which method of recording blood pressure is more highly associated with the subsequent onset of hypotension. ⋯ During periods of hemodynamic stability in an intensive care unit patient population, clinician-documented blood pressure values were inferior to values from an intelligent automated archiving method as early indicators of hemodynamic instability. Human oversight may not be necessary for creating a valid archive of vital sign data within an electronic medical record. Furthermore, if clinicians do have a tendency to disregard early indications of instability, then an automated archive may be a preferable source of data for so-called early warning systems that identify patients at risk of decompensation.
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Critical care medicine · May 2011
Comparative StudyOutcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support.
Myocarditis is a rare disease that may progress rapidly to refractory cardiogenic shock and death. In such situations, emergent initiation of mechanical circulatory assistance is the only therapeutic option to rescue these dying patients. This study was designed to evaluate the outcomes, health-related quality of life and frequencies of anxiety, depression and posttraumatic stress disorder symptoms in fulminant myocarditis patients rescued by mechanical circulatory assistance, since these major components of outcome evaluation after serious illnesses have not yet been assessed in this setting. ⋯ Mechanical circulatory assistance rescued 68% of patients with refractory circulatory failure due to fulminant myocarditis. Greater disease severity and higher troponin Ic levels at extracorporeal membrane oxygenation initiation predicted poorer prognosis. Because up to one-third of the patients reported anxiety, depression, and/or posttraumatic stress disorder symptoms, strategies aimed at attenuating their emotional and psychologic distress might significantly improve their long-lasting well-being.
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Critical care medicine · May 2011
Comparative StudyIs worsening multiple organ failure the cause of death in patients with severe sepsis?
Although the mortality of severe sepsis is easily quantified, the actual cause and timing of death from severe sepsis are less defined. We used the INDEPTH (International Integrated Database for the Evaluation of Severe Sepsis and Drotrecogin alfa activated) database to investigate the reported cause of death in patients with severe sepsis. ⋯ Patients with severe sepsis typically die of multiple organ failure, refractory shock, or respiratory failure. Persistent, more than worsening, organ failure is the more common pattern before death.