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Palliative care in the ICU

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https://www.readbyqxmd.com/read/29779802/feasibility-of-initiating-early-enteral-nutrition-after-congenital-heart-surgery-in-neonates-and-infants
#1
Rajat Kalra, Rohit Vohra, Malti Negi, Reena Joshi, Neeraj Aggarwal, Mridul Aggarwal, Raja Joshi
OBJECTIVE: To assess the feasibility of initiating enteral nutrition support with first 24 h of congenital heart repairs in neonates and Infants and its impact on outcomes following surgery. DESIGN: It is a prospective randomized control single blind study. SETTING: It is a single centre prospective study carried out in a tertiary care centre at Pediatric cardiac intensive care unit. PATIENTS: All patients with the cyanotic congenital heart disease with increase pulmonary blood flow, weighing less than 5 kg and undergoing congenital heart repair during the study period were included in the study...
June 2018: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/29774394/longitudinal-health-care-cost-in-hypoplastic-left-heart-syndrome-palliation
#2
Jesse E Hansen, Nicolas L Madsen, Laurie Bishop, David L S Morales, Jeffrey B Anderson
Management of hypoplastic left heart syndrome (HLHS) is resource intensive. Heath care systems are pressured to provide value to patients by improving outcomes while decreasing costs. A single-center retrospective cohort of infants with HLHS who underwent Norwood procedure or hybrid Norwood from 2004 to 2014 and survived to first outpatient follow up were studied. The primary outcome was total cost through 12 months with a sub-analysis of patients with 60 months of data. Costs were calculated using internal cost accounting system and reported by cost center...
May 17, 2018: Pediatric Cardiology
https://www.readbyqxmd.com/read/29756013/colonic-stent-versus-emergency-surgery-as-treatment-of-malignant-colonic-obstruction-in-the-palliative-setting-a-systematic-review-and-meta-analysis
#3
REVIEW
Igor Braga Ribeiro, Wanderley Marques Bernardo, Bruno da Costa Martins, Diogo Touriani Hourneau de Moura, Elisa Ryoka Baba, Iatagan Rocha Josino, Nelson Tomio Miyahima, Martin Andrés Coronel Cordero, Thiago Arantes de Carvalho Visconti, Edson Ide, Paulo Sakai, Eduardo Guimarães Hourneau de Moura
Background and study aims : Colorectal cancer (CRC) is the third most common malignancy and the third leading cause of cancer death worldwide. Malignant colonic obstruction (MCO) due to CRC occurs in 8 % to 29 % of patients.The aim of this study was to perform a systematic review and meta-analysis of RCTs comparing colonic SEMS versus emergency surgery (ES) for MCO in palliative patients. This was the first systematic review that included only randomized controlled trials in the palliative setting...
May 2018: Endoscopy International Open
https://www.readbyqxmd.com/read/29738925/derivation-of-data-driven-triggers-for-palliative-care-consultation-in-critically-ill-patients
#4
May S Hua, Xiaoyue Ma, Guohua Li, Hannah Wunsch
PURPOSE: To examine the ability of existing triggers for intensive care unit (ICU) palliative care consultation to predict 6-month mortality, and derive new triggers for consultation based on risk factors for 6-month mortality. MATERIALS AND METHODS: Retrospective cohort study of NY state residents who received intensive care, 2008-2013. We examined sensitivity and specificity of existing triggers for predicting 6-month mortality and used logistic regression to generate patient subgroups at high-risk for 6-month mortality as potential novel triggers for ICU palliative care consultation...
April 30, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29689120/acute-on-chronic-liver-failure-getting-ready-for-prime-time
#5
Jasmohan S Bajaj, Richard Moreau, Patrick S Kamath, Hugo E Vargas, Vicente Arroyo, K Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C Lai, Florence Wong
Acute on chronic liver failure (ACLF) is a culmination of chronic liver disease and extra-hepatic organ failures, which is associated with a high short-term mortality and immense healthcare expenditure. There are varying definitions for organ failures and ACLF in Europe, North America and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multi-factorial and related to interactions between the immuno-inflammatory system, microbiota and the precipitating factors...
April 24, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/29669430/providing-palliative-care-in-the-medical-icu-a-qualitative-study-of-micu-physicians-beliefs-and-practices
#6
Brittany Gatta, Jessica Turnbull
CONTEXT: With the current and projected shortage of palliative care (PC) specialists, an integrative model of PC will be needed to meet the needs of patients in intensive care units (ICUs). Prior studies of PC interventions suggest that success depends upon meeting the needs of individual institutions or ICUs. OBJECTIVE: The objective of this study was to qualitatively explore the beliefs and practices of one institution's medical ICU (MICU) physicians in regard to providing an integrative model of PC...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29663015/-palliative-care-challenges-in-the-intensive-care-unit
#7
REVIEW
H Lemm, J Hoeger-Schäfer, M Buerke
Intensive care unit (ICU) stays often result due to an acute, potentially life-threatening illness or aggravation of a chronic life-threatening illness. In many cases, ICU patients die after life-sustaining treatments are withdrawn or withheld. When patients are asked, they prefer to die at home, although logistic and medical problems often prevent this. Therefore, attention focuses on care at the end of life in the ICU. Despite many efforts to improve the quality of care, evidence suggests that the quality in hospitals varies significantly and that palliative care in the ICU has not significantly improved over time...
April 16, 2018: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/29596296/increasing-access-to-palliative-care-services-in-the-intensive-care-unit
#8
Caitlin Marie McCarroll
BACKGROUND: The Institute of Medicine's report, Dying in America, highlights the critical need for the widespread implementation of palliative care to improve end-of-life care. Approximately 20% of all deaths in America occur during or shortly after an intensive care unit (ICU) admission; therefore, it is important for critical care units to have systems in place to facilitate patient access to palliative care services. OBJECTIVES: The aim of this quality improvement (QI) project was to develop and implement a palliative care screening tool using evidence-based triggers to help increase the proportion of palliative care consultations in the ICU setting...
May 2018: Dimensions of Critical Care Nursing: DCCN
https://www.readbyqxmd.com/read/29582542/an-observational-cohort-study-of-outcomes-in-patients-admitted-to-the-intensive-care-unit-for-acute-exacerbation-of-chronic-obstructive-pulmonary-disease
#9
Sivanth Sivakumar, Angus McNally, Jonathan Tobin, Jonathan Williamson, A Anders Aneman
BACKGROUND: Patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are often referred to the intensive care unit (ICU) for non-invasive respiratory support. AIMS: To describe the characteristics of patients with AECOPD admitted to ICU focusing on the performance of ICU prognostic systems, decisions to limit medical therapy and mortality outcomes. METHODS: Retrospective review of patients admitted between 2009-16, separately in patients with active treatment and limitation or withdrawal of medical therapy...
March 27, 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29581681/robot-assisted-mckeown-esophagectomy-is-feasible-after-neoadjuvant-chemoradiation-our-initial-experience
#10
Ashish Goel, Swati H Shah, Veda Padma Priya Selvakumar, Shubha Garg, Kapil Kumar
Neoadjuvant chemoradiation has become the standard of care for esophageal cancer, especially for middle third esophageal lesions and those with squamous histology. Although more and more thoracic surgeons and surgical oncologists have now shifted to video-assisted and robot-assisted thoracoscopic esophagectomy; there is still limited experience for the use of minimal-assisted approaches in patients undergoing surgery after neoadjuvant chemoradiation. Most surgeons have concerns of feasibility, safety, and oncological outcomes as well as issues related to difficult learning curve in adopting robotic esophagectomy in patients after chemoradiation...
February 2018: Indian Journal of Surgery
https://www.readbyqxmd.com/read/29569126/palliative-care-is-associated-with-reduced-aggressive-end-of-life-care-in-patients-with-gastrointestinal-cancer
#11
Shaila J Merchant, Susan B Brogly, Craig Goldie, Christopher M Booth, Sulaiman Nanji, Sunil V Patel, Katherine Lajkosz, Nancy N Baxter
BACKGROUND: We examined the delivery of physician palliative care (PC) services and its association with aggressive end-of-life care (EOLC) in patients with gastrointestinal (GI) cancer in Ontario, Canada. METHODS: All patients with primary cause of death from esophageal, gastric, colon, and anorectal cancer from January 2003 to December 2013 were identified. PC services within 2 years of death were classified: (1) any PC; (2) timing of first PC (≤ 7, 8-90, 91-180, and 181-730 days before death); and (3) intensity of PC measured by number of days used (1st-25th, 26th-50th, 51st-75th, and 76th-100th percentiles)...
June 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29564855/-the-intentions-affecting-the-medical-decision-making-behavior-of-surrogate-decision-makers-of-critically-ill-patients-and-related-factors
#12
Szu-Huei Su, Li-Min Wu
BACKGROUND: The severity of diseases and high mortality rates that typify the intensive care unit often make it difficult for surrogate decision makers to make decisions for critically ill patients regarding whether to continue medical treatments or to accept palliative care. PURPOSE: To explore the behavioral intentions that underlie the medical decisions of surrogate decision makers of critically ill patients and the related factors. METHODS: A cross-sectional, correlation study design was used...
April 2018: Hu Li za Zhi the Journal of Nursing
https://www.readbyqxmd.com/read/29552894/development-of-a-risk-tool-to-support-discussions-of-care-for-older-adults-admitted-to-the-icu-with-pneumonia
#13
Nikhil Satchidanand, Timothy J Servoss, Ranjit Singh, Angela M Bosinski, Penny Tirpak, Linda L Horton, Bruce J Naughton
BACKGROUND: Early, data-driven discussion surrounding palliative care can improve care delivery and patient experience. OBJECTIVE: To develop a 30-day mortality prediction tool for older patients in intensive care unit (ICU) with pneumonia that will initiate palliative care earlier in hospital course. DESIGN: Retrospective Electronic Health Record (EHR) review. SETTING: Four urban and suburban hospitals in a Western New York hospital system...
January 1, 2018: American Journal of Hospice & Palliative Care
https://www.readbyqxmd.com/read/29550293/do-physicians-discuss-end-of-life-decisions-with-family-members-a-mortality-follow-back-study
#14
Maarten Vermorgen, Aline De Vleminck, Luc Deliens, Dirk Houttekier, Nele Spruytte, Chantal Van Audenhove, Joachim Cohen, Kenneth Chambaere
OBJECTIVE: Deaths from chronic illness are often preceded by a potentially life-shortening end-of-life decision (ELD). Involving family in these ELDs may have psychosocial benefits for them and the dying person. This study aims to examine how often ELDs are discussed with relatives of the dying person and which characteristics determine their involvement in those ELDs. METHODS: A questionnaire survey was conducted in 2013 among physicians attending a large, stratified and representative sample of deaths (n = 6188) in Flanders...
March 2, 2018: Patient Education and Counseling
https://www.readbyqxmd.com/read/29504128/the-use-of-acute-normovolemic-hemodilution-in-paediatric-cardiac-surgery
#15
W M Crescini, A Muralidaran, I Shen, A LeBlan, J You, C Giacomuzzi, M M Treggiari
BACKGROUND: Acute normovolemic hemodilution (ANH) is considered safe and effective in decreasing perioperative transfusion in paediatric populations undergoing high blood-loss surgeries. We determined the association between ANH and the intraoperative use of allogeneic blood products in paediatric cardiac surgery patients. METHODS: This is a single-centre retrospective cohort study including paediatric patients between 0 and 36 months of age undergoing surgical repair or palliation of their cardiac defect with the use of cardiopulmonary bypass between November 2013 and November 2014...
March 4, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29502379/-the-option-of-critical-patients-with-cancer-for-icu
#16
R Xia, D H Wang
With the improvement of diagnosis and treatment, tumor has become a chronic disease, and an increasing number of older patients will live with tumors. This change has led to an increase in demand for intensive care unit (ICU) and a challenge to the traditional ICU treatment concept. The option of ICU consists of two parts. The first is the option for admission. Since classic predictors of mortality are no longer relevant, we suggest broadening the criteria for ICU admission. Patients during the first course of cancer therapies should be treated with a full-code status similar to that of other patients without malignancy...
February 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
https://www.readbyqxmd.com/read/29500124/management-of-the-critically-ill-adult-with-congenital-heart-disease
#17
REVIEW
Wolf B Kratzert, Eva K Boyd, Johanna C Schwarzenberger
Survival of adults with congenital heart disease (CHD) has improved significantly over the last 2 decades, leading to an increase in hospital and intensive care unit (ICU) admissions of these patients. Whereas most of the ICU admissions in the past were related to perioperative management, the incidence of medical emergencies from long-term sequelae of palliative or corrective surgical treatment of these patients is rising. Intensivists now are confronted with patients who not only have complex anatomy after congenital cardiac surgery, but also complex pathophysiology due to decades of living with abnormal cardiac anatomy and diseases of advanced age...
November 16, 2017: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29480751/cancer-patients-dying-in-the-intensive-care-units-and-access-to-palliative-care
#18
Mathilde Ledoux, Colombe Tricou, Maxime Roux, Soazic Dreano-Hartz, Murielle Ruer, Marilène Filbet
BACKGROUND: In France, cancer has become the leading cause of death. Intensive care units (ICU) focus on survival, which may not be an appropriate setting to provide palliative care (PC) as needed by cancer patients and families. OBJECTIVE: To describe the cancer patients who died in the ICU in 2010 in a French academic medical center. DESIGN: Retrospective study Measurements: We reviewed medical records of all cancer patients who died in the ICU in 2010...
May 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29474938/differential-family-experience-of-palliative-sedation-therapy-in-specialized-palliative-or-critical-care-units
#19
Hui-Shan Shen, Szu-Yin Chen, Denise Shuk Ting Cheung, Shu-Yi Wang, Jung Jae Lee, Chia-Chin Lin
CONTEXT: No study has examined the varying family experience of palliative sedation therapy (PST) for terminally ill patients in different settings. OBJECTIVES: To examine and compare family concerns about PST use and its effect on the grief suffered by terminally ill patients' families in palliative care units (PCUs) or intensive care units (ICUs). METHODS: A total of 154 family members of such patients were recruited in Taiwan, of whom 143 completed the study, with 81 from the PCU and 62 from the ICU...
June 2018: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/29465177/end-of-life-care-in-the-icu-supporting-nurses-to-provide-high-quality-care
#20
Sarah Crowe
ICU care has traditionally focused on curative treatment, but making the decision to withdraw life-sustaining therapies, the there is an increasing awareness of the key role palliative and barriers to providing good end-of-life care, factors that support comfort care play. Through a review of recent literature on end- good end-of-life care, and specific guidelinesfor the withdrawal of-life care and withdrawal of life-sustaining therapies in the of life-sustaining therapies. Using this information, a checklist to intensive care unit, four themes have emerged: the challenges of support end-of-life care by critical care nurses was created...
May 2017: Canadian Journal of Critical Care Nursing
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