Articles: critical-care.
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Septic shock is a pathological process that is common to most intensive care units; however, despite major developments in intensive care and medicine, it continues to be one of the commonest causes of morbidity and mortality. This article describes the management of a patient admitted to intensive care with septic shock. Some of the principles regarding septic shock, including the pathophysiology, management and nursing care, are explored. Also included are some of the current theories and research into the sepsis syndrome.
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Case Reports
[Treatment reduction in intensive care. "Allowing the patient to die" by conscious withdrawal of medical procedures].
The conversion of an "attempt to treat" to "prolongation of dying" represents an important problem in modern intensive care. If the actual or presumed will of the patient is unknown, the physician has to decide about the extent of treatment in a paternalistic manner. In these difficult decisions the physician has to consider prognosis, and certainty of prognosis and has to carefully balance between the right to live and the right to die. ⋯ If the situation is hopeless and further medical interventions are futile, then allowing the patient to die by therapy reductions is not only a possibility but a mandatory act of humanity. In that case it does not matter whether new treatment modalities are abandoned or whether already instituted medical measures are withdrawn. In clinical practice, however, the "fine tuning" of therapy reduction has to be tailored to the individual case and largely depends on prognostic certainty.
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In a retrospective study, the authors analysed the clinical data of 38 patients who were admitted to a surgical intensive care unit (SICU) for mechanical ventilation lasted for at least 72 hours. The APACHE III score was calculated on the basis of clinical data documented during the first 24 hour of the treatment and the cost of drug administrations per patients per day was also determined by analysing all the drugs prescribed on the first 5 days of intensive care. ⋯ Antibiotic treatment, blood transfusions, and human plasma proteins caused the highest drug expenditure. There was no significant correlation between the APACHE III score and the cost of drug treatment.