Articles: critical-care.
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This review focuses on how patients' recall of their stay in the ICU can be modified pharmacologically. ⋯ Patients may remember their stay in the ICU, depending on the type of injury and the drug therapy. Of the drugs presented, benzodiazepines most reliably provide anterograde amnesia, whereas ketamine and propofol exhibit dose-dependent effects on memory.
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Critical care medicine · May 1997
ReviewConsensus statement of the Society of Critical Care Medicine's Ethics Committee regarding futile and other possibly inadvisable treatments.
Society must always face the reality of limited medical resources and must find mechanisms for distributing these resources fairly and efficiently. One recent approach for distributing limited medical resources has been the development of policies that limit the availability of futile treatments. The objectives of this consensus statement are as follows: a) to define futility and thereby enable a clear discussion of the issues; and b) to identify principles and procedures for resolving cases in which life-sustaining treatment may be futile or inadvisable. ⋯ Treatments should be defined as futile only when they will not accomplish their intended goal. Treatments that are extremely unlikely to be beneficial, are extremely costly, or are of uncertain benefit may be considered inappropriate and hence inadvisable, but should not be labeled futile. Futile treatments constitute a small fraction of medical care. Thus, employing the concept of futile care in decision-making will not primarily contribute to a reduction in resource use. Nonetheless, communities have a legitimate interest in allocating medical resources by limiting inadvisable treatments. Communities should seek to do so using a rationale that is explicit, equitable, and democratic; that does not disadvantage the disabled, poor, or uninsured; and that recognizes the diversity of individual values and goals. Policies to limit inadvisable treatment should have the following characteristics: a) be disclosed in the public record; b) reflect moral values acceptable to the community; c) not be based exclusively on prognostic scoring systems; d) articulate appellate mechanisms; and e) be recognized by the courts. Healthcare organizations that control payment have a profound influence on treatment decisions and should formally address criteria for determining when treatments are inadvisable and should share accountability for those decisions.
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Semin. Vet. Med. Surg. Small Anim. · May 1997
ReviewManagement of pain in the critically ill patient.
In spite of growing evidence that effective pain management of critically ill human beings decreases their morbidity and mortality, pain is often undertreated in critically ill animals. Reasons for withholding analgesics in these animals have included fear of contributing to cardiopulmonary instability and difficulty in monitoring response to therapy. ⋯ Opioids are the most widely used analgesics but other options exist. Newer methods of analgesic administration include continuous infusions, epidural, local, regional, and transdermal administration.
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Nurses experience stress and suffering when they care for critically ill and dying patients. Moral distress occurs when nurses are unable to translate their moral choices into moral action. In response to this stress, nurses may experience burnout. ⋯ (1) Suffering among caregivers occurs and must be recognized, (2) measures must be taken to reduce the stress and distress of healthcare professionals as they provide care to patients who cannot recover, and (3) in addition to these measures, society must provide guidance to healthcare professionals, especially concerning the care of patients who are permanently unconscious.
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Critical care medicine · May 1997
Assessing the impact of patient characteristics and process performance on rural intensive care unit hospital mortality rates.
To examine the relationship between patient characteristics, processes of care, and risk of hospital mortality in rural intensive care units (ICU). ⋯ Most of the variation in mortality was explained by differences in patient physiologic and demographic characteristics at ICU admission. After adjusting for patient characteristics, better performance in some processes of care would have significant impact on reducing risk of mortality.