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advanced directive among ICU

Federica Stretti, Stephanie Klinzing, Ulrike Ehlers, Peter Steiger, Reto Schuepbach, Tanja Krones, Giovanna Brandi
BACKGROUND: No standards exist regarding decision making for comatose patients, especially concerning life-saving treatments. The aim of this retrospective, single-center study was to analyze outcomes and the decision-making process at the end of life (EOL) in patients with traumatic brain injury (TBI) in a Swiss academic tertiary care hospital. METHODS: Consecutive admissions to the surgical intensive care unit (ICU) with stays of at least 48 hours between January 1, 2012 and June 30, 2015 in patients with moderate to severe TBI and with fatality within 6 months after trauma were included...
April 11, 2018: Anesthesia and Analgesia
Ovidiu Chioncel, Sean P Collins, Stephen J Greene, Peter S Pang, Andrew P Ambrosy, Elena-Laura Antohi, Muthiah Vaduganathan, Javed Butler, Mihai Gheorghiade
Acute Heart Failure (AHF) is a " multi-event disease" and hospitalisation is a critical event in the clinical course of HF. Despite relatively rapid relief of symptoms, hospitalisation for AHF is followed by an increased risk of death and re-hospitalisation. In AHF, risk stratification from clinically available data is increasingly important in evaluating long-term prognosis. From the perspective of patients, information on the risk of mortality and re-hospitalisation would be helpful in providing patients with insight into their disease...
November 2017: Cardiac Failure Review
L Firet, W A C Koekkoek, C Savelkoul, A W Harringhuizen, D H T Tjan
- 5-10% of all oncological patients will be admitted to ICU at some point.- Medical oncological patients are usually admitted due to respiratory insufficiency or sepsis.- Mortality among medical-oncological ICU patients has decreased to an average of 40%, with a wide spread per tumour type.- The main prognostic factors for ICU survival are: clinical condition, severity of the acute condition, tumour type, and some specific oncological conditions.- This article describes directive ICU admission criteria, subdivided into three categories of medical oncological patients...
2017: Nederlands Tijdschrift Voor Geneeskunde
Pascal Andreu, Auguste Dargent, Audrey Large, Nicolas Meunier-Beillard, Sandrine Vinault, Uriel Leiva-Rojas, Fiona Ecarnot, Sébastien Prin, Pierre-Emmanuel Charles, Isabelle Fournel, Jean-Philippe Rigaud, Jean-Pierre Quenot
BACKGROUND: Our objective was to assess, through a qualitative, exploratory study, the thought processes of patients regarding the formulation of advance directives (AD) after a stay in the ICU. METHODS: The study was conducted from May to July 2016 using telephone interviews performed by four senior ICU physicians. Inclusion criteria were: patients discharged from ICU to home>3 months earlier. Semi-directive interviews with patients focused on 5 main points surrounding AD...
April 2018: Anaesthesia, Critical Care & Pain Medicine
Manfred Weiss, Andrej Michalsen, Anke Toenjes, Franz Porzsolt, Thomas Bein, Marc Theisen, Alexander Brinkmann, Heinrich Groesdonk, Christian Putensen, Friedhelm Bach, Dietrich Henzler
BACKGROUND: Structural aspects and current practice about end-of-life (EOL) decisions in German intensive care units (ICUs) managed by anesthesiologists are unknown. A survey among intensive care anesthesiologists has been conducted to explore current practice, barriers and opinions on EOL decisions in ICU. METHODS: In November 2015, all members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthesiologists (BDA) were asked to participate in an online survey to rate the presence or absence and the importance of 50 items...
July 11, 2017: BMC Anesthesiology
Muneer Abu Snineh, Richard Camicioli, Janis M Miyasaki
INTRODUCTION: Physician Orders for Life Sustaining Therapies (POLST) or Goals of Care (GOC) are legal documents to guide intensity of interventions (ICU, resuscitation, hospitalization or comfort care) completed by healthcare professionals following counseling of patients or their designated medical decision makers. Capacity (understanding, appreciation, reasoning and expressing a choice) to consent to POLST or GOC has not been determined among Parkinson's disease (PD) patients. We sought to assess GOC PD decisional capacity for those with cognitive complaints but not dementia...
June 2017: Parkinsonism & related Disorders
Jennifer Needle, Angela R Smith
BACKGROUND: Little is known about the role of advance directives (AD) in end-of-life (EOL) care for adolescents and young adults (AYA) undergoing hematopoietic stem cell transplant (HSCT). OBJECTIVE: The study objective was to describe the frequency, type, and influence of AD on the use of life-sustaining treatment (LST) in AYA patients undergoing HSCT. METHODS: We performed a retrospective chart review of 96 patients aged 14-26 undergoing HSCT between April 2011 and January 2015 at the University of Minnesota...
March 2016: Journal of Palliative Medicine
Yusuf Alper Kılıç, Ali Konan, Volkan Kaynaroğlu
INTRODUCTION: Gastrointestinal bleeding is a common life-threatening problem, causing significant mortality, costs and resource allocation. Its management requires a dynamic multidisciplinary approach that directs diagnostic and therapeutic priorities appropriately. MATERIALS AND METHODS: Articles published within the past 15 years, related to gastrointestinal bleeding, were reviewed through MEDLINE search, in addition to current guidelines and standards. RESULTS: Decisions of ICU admission and blood transfusion must be individualized based on the extent of bleeding, hemodynamic profile and comorbidities of the patient and the risk of rebleeding...
August 2011: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Emma Larsson, Erik Zettersten, Gabriella Jäderling, Anna Ohlsson, Max Bell
BACKGROUND: We assume that critically ill patients are admitted to an intensive care unit (ICU) based on their illness severity coupled with their co-morbidities. Patient attributes such as religion, nationality, socioeconomic class or gender are not relevant in this setting. We aimed to explore the association of patient gender with admission to the ICU amongst hospital physicians working in Sweden. METHODS: Primary outcome assessed was gender bias among respondents...
2015: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Colin Scibetta, Kathleen Kerr, Joseph Mcguire, Michael W Rabow
BACKGROUND: Palliative care is recommended along with oncologic care for patients with advanced cancer. However, there are limited data about how the timing of palliative care affects quality and costs. OBJECTIVE: Comparison of health care utilization and care quality for patients with cancer who died having received early versus late palliative care. DESIGN: Analysis of cancer registry, administrative, and billing databases. SETTING/SUBJECTS: Patients with cancer who died having received specialty palliative care consultation...
January 2016: Journal of Palliative Medicine
Liz Flannery, Lucie Michelle Ramjan, Kath Peters
BACKGROUND: End-of-life decision making in the Intensive Care Unit (ICU), can be emotionally challenging and multifaceted. Doctors and nurses are sometimes placed in a precarious position where they are required to make decisions for patients who may be unable to participate in the decision-making process. There is an increasing frequency of the need for such decisions to be made in ICU, with studies reporting that most ICU deaths are heralded by a decision to withdraw or withhold life-sustaining treatment...
May 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
Hamidreza Eftekharian, Barbad Zamiri, Shamseddin Ahzan, Mohamad Talebi, Kamal Zarei
STATEMENT OF THE PROBLEM: Due to shortage of ICU beds in hospitals, knowing what kind of orthognathic surgery patients more need ICU care after surgery would be important for surgeons and hospitals to prevent unnecessary ICU bed reservation. PURPOSE: The aim of the present study was to determine what kinds of orthognathic surgery patients would benefit more from ICU care after surgery. MATERIALS AND METHOD: 210 patients who were admitted to Chamran Hospital, Shiraz, for bimaxillary orthognathic surgery (2008-2013) were reviewed based on whether they had been admitted to ICU or maxillofacial surgery ward...
March 2015: Journal of Dentistry
Olivier Lesieur, Maxime Leloup, Frédéric Gonzalez, Marie-France Mamzer
BACKGROUND: In France, decisions to limit treatment fall under the Leonetti law adopted in 2005. Leading figures from the French world of politics, science, and justice recently claimed for amendments to the law, considering it incomplete. This study, conducted before any legislative change, aimed to investigate the procedural aspects of withholding/withdrawing treatment in French ICUs and their adequacy with the existing law. METHODS: The characteristics of patients qualified for a withholding/withdrawal procedure were prospectively collected in 43 French ICUs...
December 2015: Annals of Intensive Care
Joanna L Hart, Michael O Harhay, Nicole B Gabler, Sarah J Ratcliffe, Caroline M Quill, Scott D Halpern
IMPORTANCE: Although the end-of-life care patients receive is known to vary across nations, regions, and centers, these differences are best explored within a group of patients with presumably similar care preferences. OBJECTIVE: To examine the proportions of patients admitted to the intensive care unit (ICU) with limitations on life-sustaining treatments and the proportions of such patients who receive aggressive care across individual ICUs. DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective cohort study using the Project IMPACT database (from April 1, 2001, to December 31, 2008) including 141 ICUs in 105 hospitals in the United States and 277,693 ICU patient visits...
June 2015: JAMA Internal Medicine
Jared Chiarchiaro, Rachel A Schuster, Natalie C Ernecoff, Amber E Barnato, Robert M Arnold, Douglas B White
RATIONALE: Although medical simulation is increasingly being used in healthcare education, there are few examples of how to rigorously design a simulation to evaluate and study important communication skills of intensive care unit (ICU) clinicians. OBJECTIVES: To use existing best practice recommendations to develop a medical simulation to study conflict management in ICUs, then assess the feasibility, acceptability, and realism of the simulation among ICU clinicians...
April 2015: Annals of the American Thoracic Society
B Champigneulle, F Bellenfant-Zegdi, A Follin, C Lebard, A Guinvarch, F Thomas, R Pirracchio, D Journois
AIM: Neuroprotective effects of hypothermia may explain surprisingly high survival rates reported after drowning in cold water despite prolonged submersion. We described a cohort of refractory hypothermic cardiac arrests (CA) due to drowning treated by extracorporeal life support (ECLS) and aimed to identify criteria associated with 24-h survival. METHODS: Eleven-year period (2002-2012) retrospective study in the surgical intensive care unit (ICU) of a tertiary hospital (European Hospital Georges Pompidou, Paris, France)...
March 2015: Resuscitation
Cristina Gutierrez, William Hsu, Qin Ouyang, Haijun Yao, Simcha Pollack, Cynthia X Pan
BACKGROUND: The literature describing the attitude of Asians toward palliative care in the intensive care unit (ICU) is scarce. AIM: The purpose of this study was to compare outcomes of Asians and people of other ethnicities after palliative care intervention in the ICU. METHODS: A retrospective chart review was conducted of all ICU patients evaluated by palliative care; the outcomes measured were incidence of life-sustaining treatments, institution of advance care directives, and preferences for end-of-life care...
2014: Journal of Palliative Care
Bertrand Guidet, Eric Hodgson, Charles Feldman, Fathima Paruk, Jeffrey Lipman, Younsuck Koh, Jean Louis Vincent, Elie Azoulay, Charles L Sprung
INTRODUCTION: Life-sustaining treatment (LST) limitation for elderly patients is highly controversial. In that context, it is useful to evaluate the attitudes to LST in the elderly among experienced intensive care unit (ICU) physicians with different backgrounds and cultures. METHODS: A panel of 22 international ICU physicians from 13 countries responded to a questionnaire related to withholding (WH) and withdrawing (WD) LST in elderly patients using a semi-Likert scale...
December 2014: Journal of Critical Care
Caroline M Quill, Sarah J Ratcliffe, Michael O Harhay, Scott D Halpern
BACKGROUND: The magnitude and implication of variation in end-of-life decision-making among ICUs in the United States is unknown. METHODS: We reviewed data on decisions to forgo life-sustaining therapy (DFLSTs) in 269,002 patients admitted to 153 ICUs in the United States between 2001 and 2009. We used fixed-effects logistic regression to create a multivariable model for DFLST and then calculated adjusted rates of DFLST for each ICU. RESULTS: Patient factors associated with increased odds of DFLST included advanced age, female sex, white race, and poor baseline functional status (all P < ...
September 2014: Chest
Júlia Kefalás Troncon, Dácio Leonel de Quadros Netto, Patrícia Moretti Rehder, José Guilherme Cecatti, Fernanda Garanhani Surita
PURPOSE: To describe the prevalence of maternal mortality at a tertiary care hospital and to assess its preventability. METHODS: This study, through the analysis of maternal deaths that occurred during the period from 1999 to 2010 at a reference in Campinas--Brazil, CAISM/ UNICAMP, discusses some of the factors associated with the main causes of death and some structural problems of structure of the health services. It is a retrospective descriptive study with evaluation of sociodemographic variables and the medical and obstetric history of women, and the causes of death...
September 2013: Revista Brasileira de Ginecologia e Obstetrícia
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