Critical care medicine
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Critical care medicine · Apr 1995
Physicians do not have a responsibility to provide futile or unreasonable care if a patient or family insists.
This article was written to argue that physicians are not ethically obligated to provide care which they consider futile, unreasonable, or both, either voluntarily or in response to patient or surrogate demands. ⋯ Although the issue of physician refusal of requested care has not been resolved by case law or legal statute, it is supported by compelling ethical principles. Physicians are not ethically required to provide futile or unreasonable care, especially to patients who are brain dead, vegetative, critically or terminally ill with little chance of recovery, and unlikely to benefit from cardiopulmonary resuscitation.
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Critical care medicine · Mar 1995
Randomized Controlled Trial Clinical TrialGastric emptying in critically ill patients is accelerated by adding cisapride to a standard enteral feeding protocol: results of a prospective, randomized, controlled trial.
To investigate the effect of cisapride, a relatively new prokinetic agent, on gastric emptying in critically ill patients. ⋯ The data indicate that gastric emptying in critically ill, sedated, and mechanically ventilated patients can be significantly improved by adding cisapride to a routine enteral feeding protocol.
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Critical care medicine · Mar 1995
Clinical Trial Controlled Clinical TrialPulmonary vascular resistance in infants after cardiac surgery: role of carbon dioxide and hydrogen ion.
The objective of this study was to describe the effects of altering arterial PCO2 and pH on pulmonary vascular resistance in infants after cardiopulmonary bypass for cardiac surgery. ⋯ Increasing the arterial pH by the administration of sodium bicarbonate both lowers the pulmonary arterial pressure and increases the cardiac index, resulting in a decrease in pulmonary vascular resistance. These changes were observed without alteration in PaCO2. Metabolic alkalosis may have a role in the treatment of increased pulmonary vascular resistance in infants after cardiopulmonary bypass for cardiac surgery.