Crit Care Resusc
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To evaluate outcomes of patients admitted to an intensive care unit with idiopathic pulmonary fibrosis (IPF) and acute respiratory deterioration. ⋯ Outcomes of patients with IPF admitted to the ICU are poor. Indications for mechanical ventilation appear uncertain.
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Despite government encouragement for patients to make advance plans for medical treatment, and the increasing numbers of patients who have done this, there is little research that examines how doctors regard these plans. ⋯ Many intensive care doctors believe end-oflife decisions remain medical decisions, and MEPAs and ACPs need only be respected when they accord with the doctor's treatment decision. This study suggests a need for further education of doctors, particularly those working in intensive care, who are responsible for initiating and maintaining life support treatment.
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Editorial Comment
Treating intracranial hypertension: time to abandon mannitol?
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Biography Historical Article
19th century pioneering of intensive therapy in North America. Part 3: the Fell-O'Dwyer apparatus and William P Northrup.
Two previous articles in this series have described the reintroduction of forced respiration for ventilatory difficulties, particularly in opiate poisoning (by George Fell), and successful use of intralaryngeal tubes designed for treating airway obstruction in diphtheritic acute laryngitis (by Joseph O'Dwyer). In 1891, O'Dwyer extended the applications of Fell's system, introducing a longer orolaryngeal tube, replacing Fell's methods of inflating the lungs, which had been with a somewhat unsatisfactory facemask or through a tracheotomy tube. ⋯ Although the apparatus was used beyond New York (eg, in New Orleans by J D Bloom, especially for neonatal apnoea), it is difficult to find other than nonspecific references. Matas and Bloom improved O'Dwyer's original system, but after the clinical success of Charles Elsberg's continuous insufflation anaesthesia for thoracic surgery, 1909, American anaesthetists came to prefer that.