Do-not-resuscitate orders for critically ill patients in intensive care

2010 ◽  
Vol 17 (4) ◽  
pp. 445-455 ◽  
Author(s):  
Yuanmay Chang ◽  
Chin-Feng Huang ◽  
Chia-Chin Lin
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Life Support ◽  
Adult Child ◽  
Do Not Resuscitate ◽  
Lack Of Information ◽  
Surrogate Decision ◽  
End Of Life Decision ◽  
To Receive

End-of-life decision making frequently occurs in the intensive care unit (ICU). There is a lack of information on how a do-not-resuscitate (DNR) order affects treatments received by critically ill patients in ICUs. The objectives of this study were: (1) to compare the use of life support therapies between patients with a DNR order and those without; (2) to examine life support therapies prior to and after the issuance of a DNR order; and (3) to determine the clinical factors that influence the initiation of a DNR order in ICUs in Taiwan. A prospective, descriptive, and correlational study was conducted. A total of 202 patients comprising 133 (65.8%) who had a DNR order, and 69 (34.1%) who did not, participated in this study. In the last 48 hours of their lives, patients who had a DNR order were less likely to receive life support therapies than those who did not have a DNR order. Older age, being unmarried, the presence of an adult child as a surrogate decision maker, a perceived inability to survive ultimate discharge from the ICU, and longer hospitalization in the ICU were significant predictors of issuing a DNR order for critically ill patients. This study will draw attention to how, when, and by whom, critically ill patients’ preferences about DNR are elicited and honored.

scholarly journals Experiences of the Intensive Care Unit of Hospital Raja PerempuanZainab II in handling the Massive Evacuation of Critically-Ill Patients during Flood Disaster.

2018 ◽  
Vol 2 (4) ◽  
pp. 224
Author(s):  
WI Wan Nasruddin ◽  
ZA Nor Hidayah ◽  
A Nazri ◽  
WI Wan Azzlan ◽  
I Ruwaida ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Life Support ◽  
The State ◽  
Flood Disaster ◽  
Water Levels ◽  
Tertiary Centre ◽  
Set Up

In December 2014, Malaysia had suffered nationwide floods after unprecedented monsoon rains overwhelmed several parts of the country. The East Coast areas of Malaysia were especially badly affected, specifically for the state of Kelantan, whereby a total of 170,000 victims were evacuated to the evacuation centres. This was the worst flood in the last 40 years and has been referred to by the locals as ‘Bah Kuning’. As a tertiary centre for the state of Kelantan with a total number of hospital beds of 937, HRPZ II was also badly compromised during this time. The electricity supply to the main hospital building was shut-down during this period and the hospital had managed to maintain its operations hUP_(ÛT_e power from a generator which had faced the risk of being shut down if the water levels had increased further. These issues might have caused a worse impact viaa possible loss of electrical and oxygen supply and non-functional life support systems. In relation to this flood disaster, the Anaesthesiology and Intensive Care Unit of HRPZ II would like to share the experiences of handling ventilated and critically ill-patients for evacuation during the massive floods in 2014 from the ICU of Hospital Raja Perempuan Zainab II to “an open stage with no facilities”. During this time, we had a total of 19 patients in our 21-bedded Intensive Care Unit. The challenge was the need to evacuate all the critically ill patients and to set-up a new ICU in a safer place immediately at the time.International Journal of Human and Health Sciences Vol. 02 No. 04 October’18. Page : 224-227

The Safety and Efficacy of Bedside Tracheotomy

1993 ◽  
Vol 109 (4) ◽  
pp. 707-711 ◽  
Author(s):  
Neal D. Futran ◽  
Paul O. Dutcher ◽  
Jay K. Roberts
Keyword(s):  
Intensive Care ◽  
Head And Neck ◽  
Operating Room ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Life Support ◽  
Safety And Efficacy ◽  
Patients Âgés ◽  
Perioperative Bleeding ◽  
The University

Many institutions require that tracheotomies be performed in the operating room. Movement of critically ill patients dependent on multiple life support systems is technically difficult, labor intensive, and potentially dangerous for the patients. Between 1983 and 1992, 1088 tracheotomies were performed on patients ages 1 week to 94 years at the University of Rochester affiliated hospitals on critically ill patients as isolated procedures. The procedure was performed in the Intensive Care Units (ICU) on 996 patients, (92.9%), whereas 92 patients (7.1%) had tracheotomies in the operating room (OR1). An additional 346 tracheotomies took place in the operating room in conjunction with other head and neck procedures (OR2). Incidence of perioperative bleeding (within 48 hours) was 2.3% in the ICU group, 2.1% in the ORI group, and 2.0% in the OR2 group. Incidence of stomal infection was also similar among the three groups at 1.8%, 2.1%, and 1.5%, respectively. Tube dislodgement in all groups was a complication. No statistical differences were noted among the three groups (ICU, OR1, OR2) at the p < 0.01 level. Criteria for performing the tracheotomy in the ICU are delineated and discussed.

scholarly journals Management of Critically Ill Patients with COVID-19: What We Learned and What We Do

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Ata Mahmoodpoor ◽  
Kamran Shadvar ◽  
Ali Akbar Ghamari ◽  
Mojtaba Mohammadzadeh Lameh ◽  
Roghayeh Asghari Ardebili ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Diagnosis ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Standard Care ◽  
Clinical Course ◽  
Diagnosis And Treatment ◽  
To Receive

: There are many unknown questions and puzzle pieces that should describe the clinical course of COVID-19 and its complications, especially ARDS. We provide the initial immediate surge response to allow every patient in need of an ICU bed to receive one. Till our knowledge is improved, the most important intervention in the treatment of critically ill patients with COVID-19 seems to be the level of standard care and appropriate and early diagnosis and treatment. It seems that each center should have its protocol on the management of critically ill COVID-19 patients regarding prevention, diagnosis, and treatment. This treatment should now be performed regardless of the reason which lies behind the pathophysiology of this disease, which is yet unknown. In this report, we share our experience in the management of critically ill COVID-19 patients during the 2 months in our intensive care unit.

Glutamine and Antioxidants in Critically Ill Patients

2018 ◽  
pp. 209-212
Author(s):  
Yuk Ming Liu ◽  
Jarone Lee
Keyword(s):  
Clinical Trial ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Supplementation ◽  
Trial Group ◽  
Final Study ◽  
Study Results ◽  
Large Randomized Clinical Trial ◽  
To Receive

The REDOXS trial evaluated whether supplementation with glutamine and antioxidants would be beneficial in critically-ill patients. Antioxidants included selenium, vitamin E, vitamin C and zinc. The REDOXS trial was a large randomized clinical trial that included over 40 intensive care units (ICU) in North American and Europe. An earlier study led the REDOXS trial group to hypothesize that there would be a mortality benefit with early nutritional supplementation. 1223 patients were enrolled and randomized to receive glutamine, antioxidants, both or placebo. The final study results demonstrated no clinical benefit from the nutritional supplementation and surprisingly indicated an increased mortality at 28 days for those patients given glutamine.

Care of the Family

2019 ◽  
pp. 313-321
Author(s):  
Michele Fiorentino
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Life Support ◽  
Family Presence ◽  
Dying Patients ◽  
Key Points ◽  
The Family ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Surgical Setting

This chapter discusses the key points of the care of the family in the surgical setting and palliative care. In critically ill patients, to provide the best possible care we must also care for the needs of the family. This chapter discusses the needs of the family in respect to the critically ill patients, dying patients, withdrawal of life support, and the death of a child. In the critically ill, family members are often placed in the role of surrogate decision maker. The need to identify surrogate decision makers, their role, and the challenges they face is discussed in detail. Family presence during resuscitation is also discussed, including benefits for patients, families, and the medical team. The keys elements of implementing family presence during resuscitation are described. Grief and bereavement are also discussed, along with the surgeon’s role in facilitating healthy grieving and recognizing complicated grief.

Moisture chamber versus lubrication for the prevention of corneal epithelial breakdown

1995 ◽  
Vol 4 (6) ◽  
pp. 425-428 ◽  
Author(s):  
D Cortese ◽  
L Capp ◽  
S McKinley
Keyword(s):  
Clinical Trial ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Randomized Clinical Trial ◽  
Critically Ill ◽  
Teaching Hospital ◽  
Critically Ill Patients ◽  
Blink Reflex ◽  
Corneal Epithelial ◽  
To Receive

BACKGROUND: Patients who are comatose or semicomatose are at risk of corneal dryness and ulceration. OBJECTIVE: To compare and evaluate the effectiveness of two treatments used for the prevention of corneal epithelial breakdown in critically ill patients. METHODS: A randomized clinical trial was used. The sample consisted of critically ill patients (age, 15-84 years) with a limited or absent blink reflex in a 14-bed general intensive care unit in a large metropolitan teaching hospital. Ninety-six eligible patients were studied; of these, 36 were excluded and data from the remaining 60 patients were analyzed. Patients were randomized to receive methylcellulose lubricating drops every 2 hours (n = 30) or to have their eyes covered with a polyethylene film to create a moisture chamber (n = 30). The patients' corneas were tested daily for epithelial breakdown using fluorescein drops. Patients were studied for a minimum of 48 hours and a maximum of 1 week. RESULTS: Eight of the 30 patients in the lubricating drop group had positive fluorescein staining, compared with one in the moisture chamber group. CONCLUSION: Our results suggest that a moisture chamber is more effective than lubricating drops in preventing corneal epithelial breakdown in critically ill patients with limited or absent blink reflex.

scholarly journals Report of the first AKI Round Table meeting: an initiative of the ESICM AKI Section

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
M. Ostermann ◽  
A. Schneider ◽  
T. Rimmele ◽  
I. Bobek ◽  
M. van Dam ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Critical Care ◽  
Intensive Care ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Future Research ◽  
Knowledge Gaps ◽  
Blood Pressure Targets

Abstract Purpose Critical Care Nephrology is an emerging sub-specialty of Critical Care. Despite increasing awareness about the serious impact of acute kidney injury (AKI) and renal replacement therapy (RRT), important knowledge gaps persist. This report represents a summary of a 1-day meeting of the AKI section of the European Society of Intensive Care Medicine (ESICM) identifying priorities for future AKI research. Methods International Members of the AKI section of the ESICM were selected and allocated to one of three subgroups: “AKI diagnosis and evaluation”, “Medical management of AKI” and “Renal Replacement Therapy for AKI.” Using a modified Delphi methodology, each group identified knowledge gaps and developed potential proposals for future collaborative research. Results The following key research projects were developed: Systematic reviews: (a) epidemiology of AKI with stratification by patient cohorts and diagnostic criteria; (b) role of higher blood pressure targets in patients with hypertension admitted to the Intensive Care Unit, and (c) specific clearance characteristics of different modalities of continuous renal replacement therapy (CRRT). Observational studies: (a) epidemiology of critically ill patients according to AKI duration, and (b) current clinical practice of CRRT. Intervention studies:( a) Comparison of different blood pressure targets in critically ill patients with hypertension, and (b) comparison of clearance of solutes with various molecular weights between different CRRT modalities. Conclusion Consensus was reached on a future research agenda for the AKI section of the ESICM.

Sign in / Sign up

Export Citation Format

Share Document