Current opinion in critical care
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Trauma is an increasingly significant health problem globally, especially in low-income and middle-income countries. Trauma care is often compromised by economic restrictions. Many capable individuals are attempting to meet this challenge in their own countries, however. This review summarizes such efforts and assesses how they might be expanded in a comprehensive, global fashion. ⋯ Individual efforts must be built upon to make progress in a comprehensive, global fashion. This review summarizes the background, achievements, and future potential of the Essential Trauma Care Project and several related efforts.
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Curr Opin Crit Care · Dec 2005
ReviewPrimary prevention of acute renal failure in the critically ill.
Acute renal failure is both common and highly lethal in the intensive care unit, with hospital mortality rates in excess of 50%. To date, no therapy apart from renal replacement therapy has been shown to improve survival or enhance recover. Thus, efforts to prevent acute renal failure are eagerly sought. ⋯ The best evidence suggests that nonpharmacologic strategies are more effective than drugs in reducing the risk of acute renal failure. Evidence also exists that strategies that improve survival in critically ill patients also reduce the incidence of organ failure, including acute renal failure.
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To review the medical literature for recent reports of the role of ethics consultations in the intensive care setting. ⋯ Ethics consultations seem to be useful in resolving conflicts that may be inappropriately prolonging nonbeneficial or unwanted treatments at the end of life. Further research on whether ethics consultations are beneficial in other settings is needed to establish the optimal scope of this intervention. Also, because these benefits were achieved by highly skilled and experienced consultants, it is not certain how successful other hospitals will be when adopting this intervention.
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Curr Opin Crit Care · Dec 2005
ReviewCare at the end of life in critically ill patients: the European perspective.
Care surrounding end-of-life has become a major topic in the intensive care medicine literature. Cultural and regional variations are associated with transatlantic debates about decisions to forego life-sustaining therapies and lead to recent international statements. The aim of this review is to provide insight into the decisions to forego life sustaining therapies and end-of-life care in Europe. ⋯ To optimize end-of-life care in the intensive care unit, there is an urgent need for the development of palliative and multidisciplinary care in Europe. Furthermore, it highlights the need for culturally competent care, adapted to needs and values of every single patient and family. In addition, a lack of communication with families and within the medical team, an uninformed public about end-of-life issues, and insufficient training of intensive care unit staff are crucial barriers to end-of-life care development. Special awareness of professionals and innovative research are needed to promote a high-standard of end-of-life care in the intensive care unit.
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Curr Opin Crit Care · Dec 2005
ReviewInformed consent in the intensive care unit: ensuring understanding in a complex environment.
Informed consent in the intensive care unit continues to receive marked attention. As greater numbers of patients enter into the intensive care unit with devastating illness, patients and families are faced with more complex medical problems and decisions regarding therapy. Furthermore, research investigations of critical illness add a level of complexity to informed consent and decision making that mandates a careful approach. ⋯ Quality of informed consent for the critically ill improves as attention is paid to standardizing indications and formalizing training for physicians. In research, conflicts of interest should be recognized and used to guide the investigator's dialogue on research benefits and risks. Patient safety must be maintained as the primary priority; however, waiver of consent may be considered in situations in which the benefit to medical knowledge far exceeds patient risk.