Minerva anestesiologica
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Minerva anestesiologica · Jun 2018
ReviewForgoing life-sustaining treatments in the ICU. To withhold or to withdraw: is that the question?
In the last decades, mortality from severe acute illnesses has considerably declined thanks to the advances in intensive care medicine. Meanwhile, critical care physicians realized that life-sustaining treatments (LST) may not be appropriate for every patient, and end-of-life care in the Intensive Care Unit (ICU) started to receive growing attention. Most deaths occurring in the ICU now follow a decision to forgo life-sustaining treatments (DFLST), which can be implemented either by withdrawing (WDLST) or withholding (WHLST) life-sustaining treatments. ⋯ Secondly, the preferences of ICU physicians towards WDLST and WHLST are examined. Finally, some arguments are offered outlining pros and cons of WDLST and WHLST, stressing that the clinician's attention should focus on an early and thorough recognition of patients in need of a DFLST, rather than on the theoretical strength and weakness of the two practices. This approach will enable physicians to make informed decisions on how to implement the limitation of LSTs, considering the patients' clinical conditions and preferences, the circumstances and needs of their families.
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Minerva anestesiologica · Jun 2018
Meta AnalysisEffect of therapeutic hypothermia on survival and neurological outcome in adults suffering cardiac arrest: a systematic review and meta-analysis.
The aim of this review was to determine current evidence for the effect of therapeutic hypothermia (TH) on survival and neurological outcome in adults suffering cardiac arrest (CA). ⋯ Evidence from RCTs suggests TH does not improve survival or neurological outcome, while observational trials favor TH over normothermia. TH may be attended with higher risk for complications.