Abstract:
:Left ventricular assist devices (LVADs) and total artificial hearts (TAHs) are surgically implanted as permanent treatment of unrecoverable heart failure. Both LVADs and TAHs are durable mechanical circulatory support (MCS) devices that can prolong patient survival but also alter end-of-life trajectory. The permissibility of discontinuing assisted circulation is controversial because device deactivation is a life-ending intervention. Durable MCS is intended to successfully replace native physiological functions in heart disease. We posit that the presence of new lethal pathophysiology (ie, a self-perpetuating cascade of abnormal physiological processes causing death) is a central element in evaluating the permissibility of deactivating an LVAD or a TAH. Consensual discontinuation of durable MCS is equivalent with allowing natural death when there is an onset of new lethal pathophysiology that is unrelated to the physiological functions replaced by an LVAD or a TAH. Examples of such lethal conditions include irreversible coma, circulatory shock, overwhelming infections, multiple organ failure, refractory hypoxia, or catastrophic device failure. In all other situations, deactivating the LVAD/TAH is itself the lethal pathophysiology and the proximate cause of death. We postulate that the onset of new lethal pathophysiology is the determinant factor in judging the permissibility of the life-ending discontinuation of a durable MCS.
journal_name
J Intensive Care Medjournal_title
Journal of intensive care medicineauthors
Rady MY,Verheijde JLdoi
10.1177/0885066611432415subject
Has Abstractpub_date
2014-01-01 00:00:00pages
3-12issue
1eissn
0885-0666issn
1525-1489pii
0885066611432415journal_volume
29pub_type
杂志文章,评审abstract:PURPOSE:To characterize physicians' stated practices in the treatment of patients with severe acute alcohol withdrawal syndrome (sAAWS) and to use intravenous (IV) phenobarbital as an adjuvant treatment for sAAWS. METHODS:A multidisciplinary, cross-sectional, self-administered survey at 2 large academic centers specia...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619847119
更新日期:2020-11-01 00:00:00
abstract:INTRODUCTION:Although magnesium plays an important role in aerobic metabolism and magnesium deficiency is a common phenomenon in critical illness, the association between magnesium deficiency and lactic acidosis in the intensive care unit (ICU) has not been defined. METHODS:This was a retrospective, cross-sectional st...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066614530659
更新日期:2016-03-01 00:00:00
abstract:PURPOSE:To use the 2010 to 2011 data collected by structured chart review to provide a detailed up-to-date description of the epidemiology and microbiology of the sepsis syndromes. METHODS:Prospective observational study conducted at a university-affiliated urban teaching hospital and level-1 trauma and burn center. A...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066615592851
更新日期:2017-05-01 00:00:00
abstract::The brain reacts to injury or disease by cascades of cellular and molecular responses. Evidence suggests that immune-inflammatory processes are key elements in the physiopathological processes associated with brain injury or damage. Cytokines are among major mediators implicated in these processes. Cytokine responses ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066608318458
更新日期:2008-07-01 00:00:00
abstract:PURPOSE:Conflicting data exists on the pharmacologic management of intensive care unit (ICU) delirium. This review appraises the current evidence of pharmacologic management of ICU delirium. MATERIALS AND METHODS:A systematic literature search of MEDLINE and Embase was conducted to answer the population, intervention,...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066618805965
更新日期:2020-02-01 00:00:00
abstract::Although the number of available donor hearts severely limits the epidemiologic impact of heart transplantation on patients with heart failure, patients with end-stage heart failure unresponsive to medical management currently have no other viable alternatives. Destination therapy with a ventricular assist device is t...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066603259012
更新日期:2004-01-01 00:00:00
abstract:PURPOSE:Timely recognition of critical illness is associated with improved outcomes, but is dependent on accurate triage, which is affected by system factors such as workload and staffing. We sought to first study the effect of delayed recognition on patient outcomes after controlling for system factors and then to ide...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620967901
更新日期:2020-10-29 00:00:00
abstract::Fever after cardiac surgery in children may be due to bacterial infection or noninfectious origin like systemic inflammatory response syndrome (SIRS) secondary to bypass procedure. A marker to distinguish bacterial from nonbacterial fever in these conditions is clinically important. The purpose of our study was to eva...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066610396642
更新日期:2012-05-01 00:00:00
abstract::Patients undergoing surgery for pituitary tumors represent a heterogeneous population each with unique clinical, biochemical, radiologic, pathologic, neurologic, and/or ophthalmologic considerations. The postoperative management of patients following pituitary surgery often occurs in the context of a dynamic state of ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066605275247
更新日期:2005-05-01 00:00:00
abstract::Sudden cardiac death (SCD) due to ventricular tachyarrhythmias is a leading cause of death in the United States. This phenomenon is associated with coronary artery disease, valvular heart disease, nonischemic cardiomyopathies, congenital heart disease, primary electrical abnormalities, autonomic nervous system abnorma...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066603258140
更新日期:2003-11-01 00:00:00
abstract::Antibacterial resistance is increasing throughout the world, while the development of new agents is slowly progressing. In addition, the increasing prevalence of fluoroquinolone resistance may force many practitioners to choose an aminoglycoside agent in gram-negative regimens. Aminoglycosides are bactericidal agents ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066610377968
更新日期:2010-11-01 00:00:00
abstract::We describe the case of a patient with hemolysis-associated Clostridium perfringens septicemia and review all similar cases published in the literature since 1990, with specific focus on the relationship between treatment strategy and survival. We searched PubMed for all published cases of C. perfringens-associated he...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066613498043
更新日期:2014-11-01 00:00:00
abstract::Respiratory complications before and after liver transplant are common, diverse, and potentially have a negative impact on patient outcomes. In this review, we discuss the most frequent respiratory conditions that patients may develop in the perioperative period. Their prevention and/or treatment may help to maximize ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066618781526
更新日期:2019-05-01 00:00:00
abstract::Realizing the vast medical benefits of validated protocols, recommendations and practice guidelines requires acceptance and implementation by frontline care providers. Knowledge translation is the science of accelerating the transfer of knowledge to practice by understanding and creatively addressing the barriers that...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,实务指引
doi:10.1177/0885066610387988
更新日期:2011-05-01 00:00:00
abstract::Transfusion-related acute lung injury (TRALI) refers to a clinical syndrome of acute lung injury that occurs in a temporal relationship with the transfusion of blood products. Because of the difficulty in making its diagnosis, TRALI is often underreported. Three not necessarily mutually exclusive hypotheses have been ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066607312994
更新日期:2008-03-01 00:00:00
abstract:PURPOSE:The aim of this study was to check if serum lactate was independently associated with mortality among critically ill patients. MATERIALS AND METHODS:This was a single-center, retrospective cohort study. All adult patients (>18 years of age) who had at least 1 measurement of lactate within 24 hours of admission...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619854355
更新日期:2020-11-01 00:00:00
abstract::Decision-making for the hospitalized dying and critically ill is often characterized by an understanding of autonomy that leads to clinical care and outcomes that are antithetical to patients' preferences around suffering and quality of life. A better understanding of autonomy will facilitate the ultimate goal of a pa...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619870458
更新日期:2020-11-01 00:00:00
abstract::We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians reque...
journal_title:Journal of intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1177/088506669601100107
更新日期:1996-01-01 00:00:00
abstract:BACKGROUND:Lactate clearance has become important in the management of sepsis. However, factors unrelated to sepsis-induced hyperlactatemia, including β-2 adrenergic agonists, can interfere with lactate clearance. OBJECTIVES:To investigate the association of inhaled albuterol with lactate clearance in patients with se...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619901095
更新日期:2020-01-22 00:00:00
abstract:INTRODUCTION:A 25-hydroxyvitamin D, 25(OH)D, deficiency is common among critically ill patients and correlated with increased mortality. Furthermore, deficiency is associated with advanced liver disease. However, there are no studies available comparing the dimensions and consequences of a 25(OH)D deficiency between pa...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066618803844
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVE:In the intensive care unit (ICU), prolonged inactivity is common, increasing patients' risk for adverse outcomes, including ICU-acquired weakness. Hence, interventions to minimize inactivity are gaining popularity, highlighting actigraphy, a measure of activity involving a wristwatch-like accelerometer, as a ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066619863654
更新日期:2020-11-01 00:00:00
abstract::This was a retrospective observational study in a pediatric intensive care unit, in which 19 patients received levosimendan. There were no adverse events attributable to levosimendan and no instances where the clinical condition worsened after administration. Arterial lactate levels decreased significantly following l...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066606287039
更新日期:2006-05-01 00:00:00
abstract::Acute brain injury (ABI) increases morbidity and mortality in patients with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). Optimal neurologic monitoring methods have not been well-explicated. We studied the use of Near-infrared Spectroscopy (NIRS) to monitor cerebral regional oxygenation tissue saturatio...
journal_title:Journal of intensive care medicine
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doi:10.1177/0885066620966962
更新日期:2020-10-15 00:00:00
abstract:BACKGROUND:Ischemic and hypoxic secondary brain insults are common and detrimental in traumatic brain injury (TBI). Treatment aims to maintain an adequate cerebral blood flow with sufficient arterial oxygen content. It has been suggested that arterial hyperoxia may be beneficial to the injured brain to compensate for c...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620944097
更新日期:2020-07-27 00:00:00
abstract::Despite an overall decline in the incidence of tuberculosis (TB), the percentage of cases representing miliary TB has remained stable. We report 2 cases of fatal miliary TB that remained unrecognized until autopsy, occurring within a 6-month period at 1 Detroit institution. These cases represent the wide range of pres...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066605279150
更新日期:2005-11-01 00:00:00
abstract::Combined poisoning with calcium-channel blockers and beta-blockers is usually associated with severe heart failure. This report shows the effectiveness of emergency extracorporeal life support in treating life-threatening simultaneous propranolol and verapamil intoxication. A 15-year-old girl presented in cardiogenic ...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066607307528
更新日期:2007-11-01 00:00:00
abstract:BACKGROUND:SARS-CoV2 can cause pulmonary failure requiring prolonged invasive mechanical ventilation (MV). Lung protective ventilation strategies are recommended in order to minimize ventilator induced lung injury. Whether patients with COVID-19 have the same risk for complications including barotrauma is still unknown...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066620954364
更新日期:2020-09-22 00:00:00
abstract::In the last 10 years, lung transplantation has become an increasingly common procedure for patients with end-stage respiratory disease. Although long-term survival can be achieved, there is still significant morbidity within the first year. Early postoperative problems that may be anticipated include respiratory insu...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/088506669100600305
更新日期:1991-05-01 00:00:00
abstract:BACKGROUND::While indirect calorimetry (IC) is the gold standard used to calculate specific calorie needs in the critically ill, predictive equations are frequently utilized at many institutions for various reasons. Prior studies suggest these equations frequently misjudge actual resting energy expenditure (REE) in med...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章
doi:10.1177/0885066617702077
更新日期:2019-05-01 00:00:00
abstract::Early predictors of prognosis in comatose patients post cardiac arrest help inform decisions surrounding continuation or withdrawal of treatment and provide a framework on which to better inform relatives of the likely outcome. Markers defined prior to the widespread use of therapeutic hypothermia post arrest may no l...
journal_title:Journal of intensive care medicine
pub_type: 杂志文章,评审
doi:10.1177/0885066613511045
更新日期:2018-04-01 00:00:00