Journal of critical care
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Journal of critical care · Aug 2014
EditorialBiophilosophical basis for identifying the death of a person.
The capacity for consciousness and self-awareness is uniquely synonymous with human life and personhood, and its absence is necessary and sufficient to identify that death has occurred. The presence of these functions is uniquely synonymous with human life. Ongoing organ function, response to infection, growth, wound healing, or the ability to sustain an unborn fetus do not alone constitute the unique experience of life and personhood. ⋯ Progressive hypoxia that is seen in many patients after withdrawal of advanced physiologic support leads to apnea and then circulatory arrest. The outward sign of apnea that is then followed by circulatory arrest is the basis for inferring that irreversible loss of capacity for consciousness and self-awareness has occurred and that death can be identified has having occurred. The capacity for consciousness and self-awareness is the only irreplaceable emergent phenomenon—arising from physiologic function of the brain—that is necessary and sufficient to define the life of a person.
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Journal of critical care · Aug 2014
Review Meta AnalysisCorrelation of left ventricular systolic dysfunction determined by low ejection fraction and 30-day mortality in patients with severe sepsis and septic shock: A systematic review and meta-analysis.
The prognostic implications of myocardial dysfunction in patients with sepsis and its association with mortality are controversial. Several tools have been proposed to evaluate cardiac function in these patients, but their usefulness beyond guiding therapy is unclear. We review the value of echocardiographic estimate of left ventricular ejection fraction (LVEF) in the setting of severe sepsis and/or septic shock and its correlation with 30-day mortality. ⋯ The presence of new LV systolic dysfunction associated with sepsis and defined as low LVEF is neither a sensitive nor a specific predictor of mortality. These findings are limited because of the heterogeneity and underpower of the studies. Further research into this method is warranted.
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Journal of critical care · Aug 2014
ReviewFrom data patterns to mechanistic models in acute critical illness.
The complexity of the physiologic and inflammatory response in acute critical illness has stymied the accurate diagnosis and development of therapies. The Society for Complex Acute Illness was formed a decade ago with the goal of leveraging multiple complex systems approaches to address this unmet need. ⋯ We suggest that the next decade holds the potential to merge these approaches, connecting patient diagnosis to treatment via mechanism-based dynamical system modeling and feedback control and allowing extrapolation from physiologic signals to biomarkers to novel drug candidates. As a predicate example, we focus on the role of data-driven and mechanistic models in neuroscience and the impact that merging these modeling approaches can have on general anesthesia.
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Noninvasive ventilation (NIV) has well-recognized benefits in acute exacerbation of chronic obstructive pulmonary disease and pulmonary edema. Its utilization in acute asthma, however, remains controversial. In this review, we describe the physiological basis to justify NIV use in acute asthma and contribute a critical appraisal of the available literature relating to this practice. ⋯ Evidence suggestive of any improvement in mortality, intubation rate, or hospital/intensive care unit length of stay, however, is lacking. Studies to date have been hampered by small numbers and a lack of demonstrable meaningful clinical outcomes. Data relating to mortality, endotracheal intubation rates, and hospital length of stay/admission should be sought in future large clinical trials.