Critical Care Topics
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Higher Mortality Rates Among ICU Patients with Alzheimer’s Disease
Consider early and timely palliative care services instead of the ICU. Early exposure to palliative care may improve both survivability and quality of life, and may lower the risk of hospital-acquired infections.
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Ethics Consults Focus on the Criteria Used to Determine Death
Some families simply need more time to process strong emotional reactions and grief. Establishing trust can help resolve these cases. Particularly in critical care, it is important from the moment that clinicians meet a family to start to build a good therapeutic relationship with them.
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Intravenous vs. Nebulized Tranexamic Acid and Hemoptysis: Which Strategy Is Better?
A pragmatic, open-label, randomized, parallel, single-center pilot trial investigating nebulized vs. intravenous tranexamic acid in patients with non-massive hemoptysis showed that nebulized tranexamic acid may be more effective in reducing the amount of hemoptysis and the need for interventional procedures.
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Midline Catheters May Be a Safe Alternative to PICCS for Vasopressor Infusion
In this study evaluating safety outcomes of infusing vasopressors through a midline catheter, there was no increase in catheter-related complications when comparing administration of vasopressors through a midline to administration through a peripherally inserted central catheter (PICC) or when compared to midline use with vasopressor infusion via a different catheter. There was an overall greater risk of systemic thromboembolism when midlines were used for vasopressor administration vs. PICCs or midlines with vasopressors administered through a different catheter.
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Re-Evaluation of Dosing for Venous Thromboembolism Prophylaxis
Prevention of venous thromboembolism (VTE) is important for all hospitalized patients to prevent additional morbidity and costs during hospitalization. Critically ill patients in the intensive care unit (ICU) may have additional risk factors that predispose them to VTE.
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High-Intensity End-of-Life Care Remains the Default at Hospitals
Ethicists can help by assisting in developing hospital policies and crafting ethics committees in a way that does not pose unnecessary bureaucratic challenges or prevent physicians from acting in the patient’s best interest.
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Ethicists Often Called to Resolve Conflicts Over Aggressive Care
Quality, compassionate communication with families is critical to prevent further escalation of conflict and to preserve trust in the therapeutic relationship.
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Ethicists Hold Debriefings After Critical Patient Events
In the emotionally charged, fast-paced ICU, clinicians are faced with death and dying daily. Engaging in open, honest communication about these situations will help build a moral and ethical community.
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ICU Staff Report Severe Moral Distress, But Resources Are Underused
Unresolved ethical concerns not only cause individual moral distress, but can also change the staff relationships and clinical cohesiveness.
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Ethical Guidance for Research on Dying or Recently Deceased ICU Patients
There are no authoritative international ethical guidelines governing research on dying or recently deceased individuals. A group of investigators sought to start a conversation about challenges and potential solutions. They developed a preliminary framework for the ethical conduct of research with imminently dying patients.