Articles: critical-care.
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The withholding and withdrawal of life support are processes by which various medical interventions either are not given to or are taken away from patients, with the expectation that they will die as a result. The propriety of withholding and withdrawal of life support has been supported by ethical statements from groups such as the Task Force on Ethics of the Society of Critical Care Medicine, and by a series of legal decisions beginning with the Quinlan case. ⋯ Observational studies show that: withholding and withdrawal of life support occur frequently, the frequency has increased over the past several years in some ICUs, patients and families generally agree with physician recommendations to limit care or request such limitation, disagreements sometimes occur on this issue, withdrawal of life support occurs more commonly than withholding of life support in most ICUs, cardiopulmonary resuscitation is the therapy most frequently withheld, mechanical ventilation is the therapy most frequently withdrawn, this withdrawal process usually is gradual, and it usually is facilitated by the administration of sedatives and analgesics. Clinical information such as this is helping to define a standard of care in the area of withholding and withdrawal of life support.
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Critical care physicians are frequently called on to negotiate issues of medical management with patients, their families, and other physicians. These decisions frequently revolve around end-of-life care. Recent data suggest that such discussions are manageable. ⋯ Since the alternative to aggressive ICU care is usually the death of the patient, it seems difficult to reconcile a physician's refusal to treat with patient autonomy. The concept of a fiduciary offers a model of the physician-patient relationship in which the physician commits himself to the patient's best interests but retains a role in defining those interests. This model offers significant benefits over medical futility in negotiating conflicts over end-of-life care.
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Critical care medicine · Feb 1997
Intensive care physicians' insufficient knowledge of right-heart catheterization at the bedside: time to act?
To evaluate French, Swiss, and Belgian intensive care physicians' knowledge about the pulmonary artery catheter. ⋯ Knowledge of right-heart pulmonary artery catheterization is not uniformly good among ICU physicians. Accreditation policies and teaching practices concerning this technique need urgent revision.
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To analyze the actual cost of pediatric intensive care and its different components, particularly the differences between various patient groups, with special reference to the variable cost and the elements included in it. ⋯ The cost of personnel was the biggest factor in intensive care costs: 62.4% of the total costs. Nonsurvivors generated 3 times the mean variable daily expenditure on survivors and had longer stays in the PICU. The increase in PSI score on the first day was associated with a global increase in variable costs. The cost of treatment techniques significantly increased as the illness became more severe but consumption of antibiotics and parenteral nutrition and use of bacteriologic tests and radiology did not.
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Anasthesiol Intensivmed Notfallmed Schmerzther · Feb 1997
Comparative Study[Diagnosis of pleural effusion in intensive care patients with supine digital thoracic imaging. A study of CT validated cases].
The significance of the recumbent chest x-ray using digital luminescence radiography was to be assessed in respect of diagnosis of pleural effusions. ⋯ Recumbent chest x-ray with digital luminescence radiography is an imaging method of limited accuracy in respect of diagnosis of pleural effusions. Supplementary diagnostic methods are recommended, as the present results show, especially in such cases where the recumbent chest x-ray does not reveal an effusion or if the volume must be determined accurately. Digital recumbent chest x-ray ranks equal with conventional x-ray in the diagnosis of pleural effusions.