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ICU Futility

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https://www.readbyqxmd.com/read/30305132/validation-of-clif-c-aclf-score-to-define-a-threshold-for-futility-of-intensive-care-support-for-patients-with-acute-on-chronic-liver-failure
#1
Cornelius Engelmann, Karen Louise Thomsen, Nekisa Zakeri, Mohammed Sheikh, Banwari Agarwal, Rajiv Jalan, Rajeshwar P Mookerjee
BACKGROUND: Acute-on-chronic liver failure (ACLF) is a severe complication of cirrhosis and is defined by organ failure and high rates of short-term mortality. Patients with ACLF are managed with multiorgan support in the intensive care unit (ICU). Currently, it is unclear when this supportive care becomes futile, particularly in patients who are not candidates for liver transplant. The aim of this study was to determine whether the currently available prognostic scores can identify patients with ACLF in whom prolonged ICU care is likely to be futile despite maximal treatment efforts...
October 10, 2018: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/30304656/timing-of-renal-replacement-therapy-in-patients-with-acute-kidney-injury-and-sepsis
#2
Saber D Barbar, Raphaël Clere-Jehl, Abderrahmane Bourredjem, Romain Hernu, Florent Montini, Rémi Bruyère, Christine Lebert, Julien Bohé, Julio Badie, Jean-Pierre Eraldi, Jean-Philippe Rigaud, Bruno Levy, Shidasp Siami, Guillaume Louis, Lila Bouadma, Jean-Michel Constantin, Emmanuelle Mercier, Kada Klouche, Damien du Cheyron, Gaël Piton, Djillali Annane, Samir Jaber, Thierry van der Linden, Gilles Blasco, Jean-Paul Mira, Carole Schwebel, Loïc Chimot, Philippe Guiot, Mai-Anh Nay, Ferhat Meziani, Julie Helms, Claire Roger, Benjamin Louart, Remi Trusson, Auguste Dargent, Christine Binquet, Jean-Pierre Quenot
BACKGROUND: Acute kidney injury is the most frequent complication in patients with septic shock and is an independent risk factor for death. Although renal-replacement therapy is the standard of care for severe acute kidney injury, the ideal time for initiation remains controversial. METHODS: In a multicenter, randomized, controlled trial, we assigned patients with early-stage septic shock who had severe acute kidney injury at the failure stage of the risk, injury, failure, loss, and end-stage kidney disease (RIFLE) classification system but without life-threatening complications related to acute kidney injury to receive renal-replacement therapy either within 12 hours after documentation of failure-stage acute kidney injury (early strategy) or after a delay of 48 hours if renal recovery had not occurred (delayed strategy)...
October 11, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/30277672/withholding-and-withdrawing-life-sustaining-treatment-experiences-in-limiting-futile-therapy-from-three-polish-intensive-care-departments
#3
Jacek Siewiera, Dariusz Tomaszewski, Jacek Piechocki, Andrzej Kübler
BACKGROUND: In intensive care units (ICUs), a patient's vital functions may be maintained, regardless of the patient's chances of survival. A key issue is how to precisely determine the moment in which life-support treatment should be withheld. In many countries, the decision-making process is regulated by the guidelines of scientific societies. However, heuristic errors may influence this process. OBJECTIVES: The objective of this study was to assess factors involved in decisions to implement or withhold treatment in general ICUs in Poland...
October 2, 2018: Advances in Clinical and Experimental Medicine: Official Organ Wroclaw Medical University
https://www.readbyqxmd.com/read/30258552/the-relationship-between-futile-care-perception-and-moral-distress-among-intensive-care-unit-nurses
#4
Hamid Asayesh, Mojtaba Mosavi, Mohammad Abdi, Mohammad Parvaresh Masoud, Kurosh Jodaki
Moral distress is among the various types of distress that involves nurses and can lead to multiple complications. It is therefore rather important to identify the factors related to moral distress. The purpose of this study was to examine the relationship between futile care perception and moral distress among intensive care unit (ICU) nurses. This cross-sectional study used a descriptive-correlation method and was conducted on 117 ICU nurses of Qom hospitals in 2016. Data were collected using a 17-item futile care perception questionnaire, and Jameton's moral distress questionnaire containing 30 questions...
2018: Journal of Medical Ethics and History of Medicine
https://www.readbyqxmd.com/read/30242826/frailty-increases-mortality-among-patients-%C3%A2-80-years-old-treated-in-polish-icus
#5
Jakub Fronczek, Kamil Jurand Polok, Ilona Nowak-Kózka, Anna Włudarczyk, Jacek Górka, Mirosław Czuczwar, Paweł Krawczyk, Mirosław Ziętkiewicz, Łukasz R Nowak, Maciej Żukowski, Katarzyna Kotfis, Katarzyna Cwyl, Ryszard Gajdosz, Romuald Bohatyrewicz, Jowita Biernawska, Paweł Grudzień, Paweł Nasiłowski, Natalia Popek, Waldemar Cyrankiewicz, Katarzyna Wawrzyniak, Marek Wnuk, Dariusz Maciejewski, Dorota Studzińska, Szymon Bernas, Mariusz Piechota, Waldemar Machała, Marta Serwa, Maria Wujtewicz, Jan Stefaniak, Małgorzata Szymkowiak, Ryszard Gawda, Barbara Adamik, Natalia Kozera, Waldemar Goździk, Hans Flaatten, Wojciech Szczeklik
BACKGROUND: The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs' prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. METHODS: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected...
September 22, 2018: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/30237974/outcomes-of-extracorporeal-membrane-oxygenation-in-adult-patients-with-hypoxemic-respiratory-failure-refractory-to-mechanical-ventilation
#6
Elisabet Periche Pedra, Melinda Rita Koborzan, Fabrizio Sbraga, Arnau Blasco Lucas, David Toral Sepúlveda
Introduction: Extracorporeal membrane oxygenation (ECMO) is a mode of extracorporeal life support that has been used to support cardiopulmonary disease refractory to conventional therapy. The experience with the use of ECMO in acute hypoxemic respiratory failure is still limited. The aim of this study was to report clinical outcomes in adult patients with acute hypoxemic respiratory failure refractory to mechanical ventilation treated with ECMO. Methods: Between July 2011 and October 2017, 18 adult patients with hypoxemic respiratory failure refractory to mechanical ventilation were admitted to the Intensive Care Unit of an acute care tertiary hospital in Barcelona, Spain...
2018: Respiratory Medicine Case Reports
https://www.readbyqxmd.com/read/30225140/emergency-laparotomy-in-the-critically-ill-futility-at-the-bedside
#7
Niels D Martin, Sagar P Patel, Kristen Chreiman, Jose L Pascual, Benjamin Braslow, Patrick M Reilly, Lewis J Kaplan
Background: Critically ill patients are often evaluated for an intra-abdominal catastrophe. In the absence of a preoperative diagnosis, abdominal exploration may be offered despite desperate circumstances. We hypothesize that (1) abdominal exploration for such patients is associated with a high mortality and (2) commonly obtained physiologic measures at laparotomy anticipate mortality. Methods: All acute care surgery (ACS) patients undergoing emergency laparotomy at a quaternary referral center during a 3-year period were reviewed...
2018: Critical Care Research and Practice
https://www.readbyqxmd.com/read/30111299/palliative-care-in-intensive-care-units-why-where-what-who-when-how
#8
REVIEW
Sebastiano Mercadante, Cesare Gregoretti, Andrea Cortegiani
Palliative care is patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering when "curative" therapies are futile. In the Intensive Care Unit (ICU), critically ill patients receive life-sustaining therapies with the goal of restoring or maintaining organ function. Palliative Care in the ICU is a widely discussed topic and it is increasingly applied in clinics. It encompasses symptoms control and end-of-life management, communication with relatives and setting goals of care ensuring dignity in death and decision-making power...
August 16, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/30101529/re-evaluating-the-utility-of-stress-ulcer-prophylaxis-in-the-critically-ill-patient-a-clinical-scenario-based-meta-analysis
#9
Paul M Reynolds, Robert MacLaren
STUDY OBJECTIVE: Because recent studies have challenged the efficacy of stress ulcer prophylaxis (SUP) in the critically ill patient, our objective was to evaluate the efficacy of SUP with proton pump inhibitors (PPIs) or histamine2 -receptor antagonists (H2 RAs) against placebo, control, no therapy, or enteral nutrition alone in critically ill adults. DESIGN: Meta-analysis with trial sequential analysis (TSA) of 34 randomized controlled trials. PATIENTS: A total of 3220 critically ill adults who received PPIs or H2 RAs versus placebo, control, no therapy, or enteral nutrition...
August 13, 2018: Pharmacotherapy
https://www.readbyqxmd.com/read/30023100/elective-icu-admission-after-major-surgery-can-too-much-support-be-futile
#10
EDITORIAL
Fernando G Zampieri
No abstract text is available yet for this article.
June 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/30009119/importance-of-frontal-horn-ratio-and-optimal-csf-drainage-in-the-treatment-of-very-low-pressure-hydrocephalus
#11
Danielle Houlden, Dmitriy Khodorskiy, Sandra Miller-Portman, Maria Li
Introduction  Unlike low-pressure hydrocephalus, very low pressure hydrocephalus (VLPH) is a rarely reported clinical entity previously described to be associated with poor outcomes and to be possibly refractory to treatment with continued cerebrospinal fluid (CSF) drainage at subatmospheric pressures. 1, 2 We present four cases of VLPH following resection of suprasellar lesions and hypothesize that untreatable patients can be identified early, thereby avoiding futile prolonged external ventricular drainage in ICU...
August 2018: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/29731386/characteristics-and-outcomes-of-do-not-resuscitate-patients-admitted-to-the-emergency-department-intensive-care-unit
#12
An-Yi Wang, Hon-Ping Ma, Wei-Fong Kao, Shin-Han Tsai, Cheng-Kuei Chang
BACKGROUND: Appropriate utilization of intensive care unit (ICU) beds are essential. Patients with critical illness who have do not resuscitate (DNR) have a reduced priority of intensive care. However, the possibility of recovery/survival is ambiguous and multifactorial. OBJECTIVE: To deliberate the characteristics and outcomes of critical illness in patients with prior DNR who were admitted to the emergency department (ED)-ICU. METHOD: This was a retrospective cohort study conducted between April 2015 and November 2015 in a university-based hospital...
May 3, 2018: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/29707293/a-population-based-analysis-of-outcomes-after-radiotherapy-in-intensive-care-unit-patients-with-lung-cancer
#13
Alexander V Louie, Lihua Li, Krista Bray Jenkyn, Britney Allen, George B Rodrigues, Andrew Warner, David A Palma, Salimah Z Shariff
Background: As the value of radiotherapy (RT) in intensive care unit (ICU) patients with lung cancer is of uncertain efficacy, we evaluated characteristics, outcomes and RT utilization for such patients in Ontario, Canada. Methods: Multiple administrative databases were linked deterministically using unique encoded identifiers to identify eligible patients between April 1, 2007, and March 31, 2014. Differences in patient, treatment, institution and tumor characteristics between RT and non-RT groups at the level of episode of care were compared...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29466591/effect-of-haloperidol-on-survival-among-critically-ill-adults-with-a-high-risk-of-delirium-the-reduce-randomized-clinical-trial
#14
RANDOMIZED CONTROLLED TRIAL
Mark van den Boogaard, Arjen J C Slooter, Roger J M Brüggemann, Lisette Schoonhoven, Albertus Beishuizen, J Wytze Vermeijden, Danie Pretorius, Jan de Koning, Koen S Simons, Paul J W Dennesen, Peter H J Van der Voort, Saskia Houterman, J G van der Hoeven, Peter Pickkers, Margaretha C. E. van der Woude, Anna Besselink, Lieuwe S Hofstra, Peter E Spronk, Walter van den Bergh, Dirk W Donker, Malaika Fuchs, Attila Karakus, M Koeman, Mirella van Duijnhoven, Gerjon Hannink
Importance: Results of studies on use of prophylactic haloperidol in critically ill adults are inconclusive, especially in patients at high risk of delirium. Objective: To determine whether prophylactic use of haloperidol improves survival among critically ill adults at high risk of delirium, which was defined as an anticipated intensive care unit (ICU) stay of at least 2 days. Design, Setting, and Participants: Randomized, double-blind, placebo-controlled investigator-driven study involving 1789 critically ill adults treated at 21 ICUs, at which nonpharmacological interventions for delirium prevention are routinely used in the Netherlands...
February 20, 2018: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/29440801/a-retrospective-study-of-end-of-life-care-decisions-in-the-critically-ill-in-a-surgical-intensive-care-unit
#15
Yi Lin Lee, Yee Yian Ong, Sze Ying Thong, Shin Yi Ng
Aim: Progress in medical care and technology has led to patients with more advanced illnesses being admitted to the Intensive Care Unit (ICU). The practice of approaching end-of-life (EOL) care decisions and limiting care is well documented in Western literature but unknown in Singapore. We performed a retrospective cohort study to describe the practice of EOL care in patients dying in a Singapore surgical ICU (SICU). The surgical critical care population was chosen as it is unique because surgeons are frequently involved in the EOL process...
January 2018: Indian Journal of Palliative Care
https://www.readbyqxmd.com/read/29429570/outcomes-for-haematological-cancer-patients-admitted-to-an-intensive-care-unit-in-a-university-hospital
#16
Emine Alp, Tuğba Tok, Leylagül Kaynar, Fatma Cevahir, İsmail Hakkı Akbudak, Kürşat Gündoğan, Mustafa Çetin, Jordi Rello
BACKGROUND: Haematological cancer (HC) patients are increasingly requiring intensive care (ICUs). The aim of this study was to investigate the outcome of HC patients in our ICU and evaluate 5 days-full support as a breakpoint for patients' re-assessment for support. METHODS: Retrospective study enrolling 112 consecutive HC adults, requiring ICU in January-December 2015. Patients' data were collected from medical records and Infection Control Committee surveillance reports...
February 8, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29375057/the-abuse-of-futility
#17
Lawrence J Schneiderman, Nancy S Jecker, Albert R Jonsen
Two recent policy statements by major providers of critical care have rejected the concept and language of "medical futility," on the ground that there is no universal consensus on a definition. They recommend using "potentially inappropriate" or "inappropriate" instead. We argue that their proposed terms are vague-even misleading-in the ICU setting, where serious life-and-death decisions are made. Whatever specific meaning the exclusive world of critical care might wish to give to the word inappropriate, in the lay world the term is so broad it trivializes the activity...
2018: Perspectives in Biology and Medicine
https://www.readbyqxmd.com/read/29325753/induced-hypothermia-in-patients-with-septic-shock-and-respiratory-failure-cass-a-randomised-controlled-open-label-trial
#18
RANDOMIZED CONTROLLED TRIAL
Theis Skovsgaard Itenov, Maria Egede Johansen, Morten Bestle, Katrin Thormar, Lars Hein, Louise Gyldensted, Anne Lindhardt, Henrik Christensen, Stine Estrup, Henrik Planck Pedersen, Matthew Harmon, Uday Kant Soni, Silvia Perez-Protto, Nicolai Wesche, Ulrik Skram, John Asger Petersen, Thomas Mohr, Tina Waldau, Lone Musaeus Poulsen, Ditte Strange, Nicole P Juffermans, Daniel I Sessler, Else Tønnesen, Kirsten Møller, Dennis Karsten Kristensen, Alessandro Cozzi-Lepri, Jens D Lundgren, Jens-Ulrik Jensen
BACKGROUND: Animal models of serious infection suggest that 24 h of induced hypothermia improves circulatory and respiratory function and reduces mortality. We tested the hypothesis that a reduction of core temperature to 32-34°C attenuates organ dysfunction and reduces mortality in ventilator-dependent patients with septic shock. METHODS: In this randomised, controlled, open-label trial, we recruited patients from ten intensive care units (ICUs) in three countries in Europe and North America...
March 2018: Lancet Respiratory Medicine
https://www.readbyqxmd.com/read/29277163/criterion-validity-and-inter-rater-reliability-of-a-palliative-care-screening-tool-for-patients-admitted-to-an-emergency-department-intensive-care-unit
#19
Sabrina Corrêa da Costa Ribeiro, Ricardo Tavares de Carvalho, Juraci Aparecida Rocha, Roger Daglius Dias
OBJECTIVE: The use of palliative care (PC) screening criteria to trigger PC consultations may optimize the utilization of PC services, improve patient comfort, and reduce invasive and futile end-of-life care. The aim of the present study was to assess the criterion validity and inter-rater reliability of a PC screening tool for patients admitted to an emergency department intensive care unit (ED-ICU). METHOD: Observational retrospective study evaluating PC screening criteria based on the presence of advanced diagnosis and the use of two "surprise questions" (traditional and modified)...
December 26, 2017: Palliative & Supportive Care
https://www.readbyqxmd.com/read/29247307/attitudes-towards-end-of-life-issues-in-intensive-care-unit-among-italian-anesthesiologists-a-nation-wide-survey
#20
Andrea Cortegiani, Vincenzo Russotto, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano, Sebastiano Mercadante
BACKGROUND: The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs). METHODS: Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions. RESULTS: Eight hundred and five persons responded to the full list of questions...
June 2018: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
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