American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Oct 1998
A national survey of end-of-life care for critically ill patients.
In some intensive care units (ICUs), fewer patients who die now undergo attempts at cardiopulmonary resuscitation (CPR), and many more have life support actively withdrawn prior to death than did a decade ago. To determine the frequency of withdrawal of life support, we contacted every American postgraduate training program with significant clinical exposure to critical care medicine, asking them prospectively to classify patients who died into one of five mutually exclusive categories. We received data from 131 ICUs at 110 institutions in 38 states. ⋯ Variation was not related to ICU type, hospital type, number of admissions, or ICU mortality. We conclude that limitation of life support prior to death is the predominant practice in American ICUs associated with critical care training programs. There is wide variation in end-of-life care, and efforts are needed to understand practice patterns and to establish standards of care for patients dying in ICUs.
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Am. J. Respir. Crit. Care Med. · Oct 1998
Airspace configuration at different transpulmonary pressures in normal and paraquat-induced lung injury in rats.
The aim of this study is to evaluate histoarchitecture of airspaces at different positive transpulmonary pressures, both during inflation and deflation of excised normal and paraquat-damaged rat lungs. Freshly excised lungs were placed in a plethysmograph connected to a graded pipette. Immediately after the achievement of the desired pressure level (5, 15, 25 cm H2O during inflation, and 15 and 5 cm H2O during deflation), the tracheal cannula was occluded and lungs were quick-frozen by immersion in liquid nitrogen, and fixed using Carnoy's solution. ⋯ Structural unevenness was minimized by massive recruitment followed by alveolar pressurization. In conclusion, this work demonstrates that morphological evidence of uneven distribution of inspired air may be partially reversed by applying larger alveolar pressures. These larger pressures applied at the end-expiration in vivo (positive end-expiratory pressure, PEEP) can minimize the distortion of lung microarchitecture during ventilation.