Current opinion in critical care
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The purpose of this review is to evaluate the current state and recent developments of trauma systems in Europe. ⋯ There is little original research on trauma systems in Europe, although some positive effects on mortality of trauma system creation are reported. The level of trauma system development in Europe shows great country-by-country variation. It seems to be in a more advanced stage in the central European countries and less developed in other countries, including the Scandinavian countries, the Baltic states, the United Kingdom, and the Mediterranean countries. In general, specialized trauma surgery training is more advanced in countries with a higher level of trauma system development.
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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.
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Curr Opin Crit Care · Dec 2005
ReviewCare near the end-of-life in critically ill patients: a North American perspective.
End-of-life care for critically ill patients has emerged as an area in which significant quality improvement is possible. In this article, we present a North American perspective on recent research and quality improvement initiatives in this field. ⋯ This update presents a North American perspective on six topics of particular importance to end-of-life care in the intensive care unit: (a) The role of advance directives, (b) shared decision-making and the role of the family, (c) conflict and futility in the intensive care unit, (d) cultural aspects of end-of-life care, (e) multidisciplinary care in the intensive care unit, and (f) future directions for improving end-of-life care in the intensive care unit.
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Curr Opin Crit Care · Dec 2005
ReviewManagement of early acute renal failure: focus on post-injury prevention.
In this review, we describe our current understanding of various aspects of secondary renal injury and its prevention. Secondary renal injury indicates any injury to the kidney, which occurs after an initial event has already triggered injury to the organ. ⋯ The pillars of protection from secondary renal injury are similar to those needed to protect the kidney from primary injury: maintenance of adequate intravascular volume, cardiac output, and arterial blood pressure. Novel protective strategies such as intensive insulin therapy require further investigation.