Critical care medicine
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Critical care medicine · May 1992
Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment.
Medical decisions concerning the prolongation of life, the right to die, and euthanasia are among the most extensively discussed decisions within medicine and law today. The responses of 360 physicians, housestaff, and medical students to a questionnaire were analyzed to identify attitudes toward these issues. ⋯ Socially and legally created "shades of gray" have blurred the distinctions between withholding or withdrawing therapies and euthanasia and have left physicians without guidelines. Health ethics education should focus on case-based teaching and on reducing the uncertainty at the bedside.
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Critical care medicine · May 1992
Process of forgoing life-sustaining treatment in a university hospital: an empirical study.
The difficult decision to forgo (withhold or withdraw) life-sustaining treatment has received extensive commentary. Little attention has been paid to how physicians do, and should, care for dying patients once this decision is made. This study describes the characteristics of patients who forgo treatment, determines the range and sequential process of forgoing treatment, and suggests ethical and public policy implications. ⋯ Forgoing life-sustaining treatment is not a single decision but it often occurs in a sequential manner over several days. A strict analysis of the benefits and burdens of various interventions may be inadequate in deciding what interventions are appropriate in the care of the dying patient.
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Critical care medicine · May 1992
Increased sensitivity to mechanical ventilation after surfactant inactivation in young rabbit lungs.
To study the individual and combined effects of surfactant inactivation and mechanical ventilation on pulmonary microvascular permeability and lung compliance. ⋯ These data suggest that ventilation after surfactant inactivation is more injurious to the pulmonary microvasculature than ventilation alone, and that generalized lung overdistention is not the primary mechanism for microvascular injury in the diseased, noncompliant lung. The increases seen in the capillary filtration coefficient in postventilated surfactant inactivated lungs, even at low-ventilation pressures, suggest that low peak inspiratory pressures do not overdistend the dioctyl succinate-treated lung.
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To determine the effects of disseminated intravascular coagulation (DIC) and head injury on posttrauma coagulation and fibrinolysis. ⋯ a) Fibrinolytic shut-down and its reactivation cannot be confirmed after trauma. b) Head injury does not lead to an increase in posttrauma coagulation or fibrinolytic activity. c) DIC enhances posttrauma coagulation and fibrinolytic activity and plasminogen activator inhibitor activity can be inferred in DIC patients. d) Increase in tissue plasminogen activator antigen concentration without tissue plasminogen activator activation may be a prognostic factor indicative of DIC and its chances of improvement, and fibrinopeptide A as an assessment criterion for the effectiveness of anticoagulant treatment.