Critical Care Topics
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Controversy Erupts Over Expansion of Medical Assistance in Dying
Ethical controversy has erupted over Canada’s expansion of eligibility criteria for medical assistance in dying.
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Family Members of Critically Ill Patients with SARS-CoV-2 Pneumonia Have a High Burden of Symptoms of PTSD
This multicenter cohort study found a high incidence of post-traumatic stress disorder symptoms among family members of COVID-19 patients at three months after the index intensive care unit admission.
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‘Informed Assent’ for CPR Is Reasonable Approach for Some Hospitalized Patients
This concept was developed to satisfy the right of physicians to initiate DNR orders in futile situations and their duty to communicate to patients and lawful surrogates. Through informed assent, physicians state they will write a DNR order because it would be futile and harmful to the patient to attempt CPR in their current serious illness.
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Adults with Developmental Disabilities at Risk for Poor End-of-Life Care
Policies should specify that the wishes of these patients should be known. They should be able to access all medically appropriate care, without bias, and have the right to avoid medical interventions they wish to refuse.
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Appropriate Oxygenation Targets in the Treatment of Hypoxemic Respiratory Failure
The care of critically ill patients in the ICU remains challenging. Recent studies support current protocols for the delivery of oxygen to patients who require supplemental oxygen due to respiratory failure of varying etiologies. Broad oxygenation targets of SpO2 between 88% to 97% continue to be supported by recent trials.
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Family Members of Critically Ill Patients with SARS-CoV-2 Pneumonia Have a High Burden of Symptoms of PTSD
This multicenter cohort study revealed a high incidence of PTSD symptoms among family members of COVID-19 patients at three months after the ICU admission.
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Limitation of Tidal Volume Is Cardioprotective Among Mechanically Ventilated Patients Undergoing Cardiac Surgery
In this experimental study, rising tidal volume increased right ventricular afterload.
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New Requirements Are Discouraging Physicians from Writing DNR Orders
Ethicists should help develop related protocols. For practitioners, code status conversations should be treated with the seriousness of surgery. That means involving the right people and taking the time to ensure medical understanding and prognosis, as well as patient values and goals, before talking about a care plan. When possible, practitioners should bring up DNR at the end of a meaningful conversation.
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Court-Appointed Guardians for Unrepresented Patients
Ethicists are seeing a range of issues arise during consults involving unrepresented patients, including conflicts over how aggressive treatment should be, whether to treat at all, how to discharge, and how to follow up with compliance with treatment. Creating a template for actions to take related to unrepresented persons who present to the hospital is a proactive first step.
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Updated Recommendations on Pediatric End-of-Life Care
A report includes a review of essential elements of care for patients and families. The authors covered discussions on goals of care, how to establish end-of-life care goals, advance care planning, and palliative and hospice involvement.