Minerva anestesiologica
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Moral distress is a major concern among healthcare professionals (HCPs). In the Intensive Care Unit (ICU), moral distress can result from: 1) disagreements within the ICU team regarding life-sustaining treatments; 2) critical illnesses that result in tragic choices regarding treatment planning; 3) circumstances that require rapid decisions and actions without adequate consideration of all morally meaningful concerns; 4) tensions with administrators; and 5) legal standards that define the decisional authority that should be held by patients and families or which forms of end-of-life care are permissible. An impressive body of research literature has highlighted the prevalence of moral distress among HCPs (including ICU HCPs), health impacts of moral distress, as well as personal and contextual factors that are strong predictors of moral distress. ⋯ This article outlines strategies that could be used to help diminish moral distress, drawing on the available literature. These strategies include: 1) Listen attentively to your colleagues' moral distress; 2) shift the focus from moral distress to moral agency; 3) promote ethically-attuned discussion and education (drawing on discussion models that can help reconcile diverse ethical viewpoints or disagreements); and 4) provide personal supports for HCPs. Research is urgently needed to further examine which strategies are most effective for addressing moral distress in ICU settings as well as other clinical contexts.
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Minerva anestesiologica · Apr 2020
Methylene blue and the NO/cGMP pathway in solid organs transplants.
The nitric oxide/cyclic guanosine monophosphate (NO/cGMP) pathway has a significative influence in hemodynamic changes that occur in transplants. Classically, the ischemia-reperfusion syndrome (IRS) is characterized by hypotension and low vascular resistance, when cGMP and nitric oxide (NO) are increased, contributing to oxidative stress, within an inflammatory context. ⋯ This review aims to study the NO/cGMP pathway in solid organ transplants. Finally, we inquire whether physicians do not underestimate the NO/cGMP pathway.