Journal of critical care
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Journal of critical care · Oct 2016
ReviewPalliative care in chronic obstructive pulmonary disease.
Chronic obstructive pulmonary disease (COPD) is the only major worldwide cause of mortality that is currently increasing in prevalence. Furthermore, COPD is incurable, and the only therapy that has been shown to increase survival is oxygen therapy in selected patients. Compared to patients with cancer, patients with COPD experience similar levels of pain, breathlessness, fatigue, depression, and anxiety and have a worse quality of life but have comparatively little access to palliative care. ⋯ A new paradigm for palliative care would introduce palliative treatments alongside, rather than at the exclusion of disease-modifying interventions. This integrated approach would circumvent the issue of difficult prognostication in COPD, as any patient would receive individualized palliative interventions from the time of diagnosis. These points will be covered in this review, which discusses the challenges in providing palliative care to COPD patients, the strategies to mitigate the challenges, management of common symptoms, and the evidence for integrated palliative care models as well as some suggestions for future development.
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Journal of critical care · Oct 2016
Developing triggers for the surgical intensive care unit for palliative care integration.
Despite the growing acceptance of palliative care as a component of high-quality care for patients with serious illness, it remains underutilized in the surgical critical care setting. This article provides insight into a model for palliative care integration into the surgical intensive care unit (SICU), using triggers. ⋯ A series of triggers can help identify patients who may benefit from palliative care consultation. This approach can be used in intensive care settings to facilitate palliative care integration.
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Journal of critical care · Oct 2016
Causes of moral distress in the intensive care unit: A qualitative study.
The purpose of the study is to examine the causes of moral distress in diverse members of the intensive care unit (ICU) team in both community and tertiary ICUs. ⋯ Causes of moral distress vary among ICU professional groups, but all are amenable to improvement.
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Journal of critical care · Oct 2016
Investigation of hemophagocytic lymphohistiocytosis in severe sepsis patients.
Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening condition characterized by uncontrolled inflammation and has common clinical and laboratory features with sepsis. The aim of this study was to investigate patients treated with severe sepsis who had bicytopenia for the presence of HLH. ⋯ This study emphasizes to consider the possibility of HLH and the need of rapid assessment of patients with severe sepsis who had bicytopenia and were resistant to treatment in intensive care.