Abstract:
OBJECTIVE:To characterize the withholding or withdrawing of life support from patients with severe head injury. SETTING:San Francisco General Hospital, a city and county hospital with a Level I trauma center. DESIGN:A standardized questionnaire was used to collect data on demographics and functional outcome of severely head-injured (Glasgow Coma Score of < or = 7) patients admitted to the medical-surgical intensive care unit, and to interview the patients' physician and family members. PATIENTS:Forty-seven patients who were admitted to a medical-surgical intensive care unit over a 1-yr period. INTERVENTIONS:Twenty-four patients had life support withheld or withdrawn, and 23 patients did not. MEASUREMENTS AND MAIN RESULTS:Physician and family separately assessed patient's probable functional outcome, degree of communication between them, reasons important in recommending or deciding on discontinuation of life support, and the result of action taken. Six months later, the families reviewed the process of their decision, how well physician(s) had communicated, and what might have improved communication. Of 24 patients with life support discontinued, 22 died; two were discharged from the hospital. Twenty-three of the 24 patients had a poor prognosis on admission. Of the 23 patients who were continued on life support for the duration of their hospitalization, ten had a poor (p < .001) prognosis on admission. Prognosis improved for two patients from the first group and five from the latter. Family's assessment of prognosis agreed with physician's assessment in 22 of the 24 patients from whom life support was discontinued (p < .001). Physicians' ability to convey the prognosis appeared to influence families' assessments. Physicians' considerations in recommending limitation of care and families' considerations in making decisions were the same, primarily an inevitably poor prognosis. Neither physician nor families cited cost or availability of care as a deciding factor. Two families disagreed with the recommendation to limit care after initial agreement because the patients' prognosis improved from "likely death" to "vegetative." Care was therefore continued, and both patients remained vegetative 6 months after admission to the hospital and discharge to chronic care facilities. CONCLUSIONS:Life support is commonly withheld or withdrawn from patients with severe head injury at San Francisco General Hospital, and usually it is accompanied by death. A reciprocal consideration exists in most cases between the physician and family making the difficult decision to limit care. Care is provided for patients whose families request it despite physician recommendations.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
O'Callahan JG,Fink C,Pitts LH,Luce JMdoi
10.1097/00003246-199509000-00018subject
Has Abstractpub_date
1995-09-01 00:00:00pages
1567-75issue
9eissn
0090-3493issn
1530-0293journal_volume
23pub_type
杂志文章abstract::The acute effects of controlled O2 therapy on hemodynamics and blood gases were investigated in 22 patients with decompensated chronic obstructive pulmonary disease (COPD). An inspired O2 fraction (FIO2) of 0.24 and 0.28 given to the first 12 patients markedly improved arterial and mixed-venous blood oxygenation with ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198412000-00006
更新日期:1984-12-01 00:00:00
abstract:OBJECTIVES:There is growing recognition that high-quality care for patients and families in the ICU requires exemplary interprofessional collaboration and communication. One important aspect is how the ICU team makes complex decisions. However, no recommendations have been published on interprofessional shared decision...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003870
更新日期:2019-09-01 00:00:00
abstract:OBJECTIVES:To determine the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients. DESIGN:Analysis of International Nutrition Survey database col...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004712
更新日期:2021-01-01 00:00:00
abstract::Reproducibility of thermal-dye extravascular lung water (EVLW) estimation by a lung water computer was studied by performing ten consecutive measurements in 45 critically ill patients. EVLW ranged over a wide spectrum from 187 to 1163 ml (2.4 to 18.6 ml/kg). The mean coefficient of variation of ten consecutive measure...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198706000-00014
更新日期:1987-06-01 00:00:00
abstract:OBJECTIVES:The objectives of this article are to introduce and explore a novel paradigm based on complex nonlinear systems, and to evaluate its application to critical care research regarding the systemic host response and multiple organ dysfunction syndrome (MODS). DATA SOURCES:Published original work, review article...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200007000-00003
更新日期:2000-07-01 00:00:00
abstract:OBJECTIVE:Although misperceptions about prognosis by surrogates in ICUs are common and influence treatment decisions, there is no validated, practical way to measure the effectiveness of prognostic communication. Surrogates' subjective ratings of quality of communication have been used in other domains as markers of ef...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000000719
更新日期:2015-03-01 00:00:00
abstract::Because determining cardiac output is difficult in premature infants, little is known about the hemodynamic effects of PEEP in this age group. We used pulsed-wave Doppler echocardiography to assess the hemodynamic effects of PEEP increments in ten premature infants with respiratory distress syndrome. At a PEEP of 4 cm...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198707000-00007
更新日期:1987-07-01 00:00:00
abstract:OBJECTIVE:Peripheral perfusion in critically ill patients frequently is assessed by use of clinical signs. Recently, the pulse oximetry signal has been suggested to reflect changes in peripheral perfusion. A peripheral perfusion index based on analysis of the pulse oximetry signal has been implemented in monitoring sys...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200206000-00006
更新日期:2002-06-01 00:00:00
abstract:OBJECTIVE:Neutrophils are an important component of the inflammatory response that characterizes acute lung injury (ALI). This discussion aims to review the contribution of neutrophils to the development and progression of ALI and to highlight the major intracellular signaling pathways that are involved in neutrophil a...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000057843.47705.E8
更新日期:2003-04-01 00:00:00
abstract:OBJECTIVES:To identify and appraise articles describing criteria used to prioritize or withhold a critical care admission. DATA SOURCES:PubMed, Embase, Medline, EBM Reviews, and CINAHL Complete databases. Gray literature searches and a manual review of references were also performed. Preferred Reporting Items for Syst...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004624
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVES:To compare sleep, work hours, and behavioral alertness in faculty and fellows during a randomized trial of nighttime in-hospital intensivist staffing compared with a standard daytime intensivist model. DESIGN:Prospective observational study. SETTING:Medical ICU of a tertiary care academic medical center du...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003773
更新日期:2019-07-01 00:00:00
abstract:OBJECTIVES:Augmented renal clearance might lead to subtherapeutic plasma levels of drugs with predominant renal clearance. Early identification of augmented renal clearance remains challenging for the ICU physician. We developed and validated our augmented renal clearance predictor, a clinical prediction model for augm...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004667
更新日期:2020-12-01 00:00:00
abstract::Intravenous dobutamine was used in ten patients requiring aggressive therapy for massive pulmonary embolism with circulatory failure. Except in one patient who rapidly died, a 30-min dobutamine infusion (8.3 +/- 2.7 micrograms/kg . min) increased both cardiac index (from 1.7 +/- 0.4 to 2.3 +/- 0.6 L/min . m2, p less t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198512000-00004
更新日期:1985-12-01 00:00:00
abstract:OBJECTIVE:Initial success with chimeric antigen receptor-modified T cell therapy for relapsed/refractory acute lymphoblastic leukemia is leading to expanded use through multicenter trials. Cytokine release syndrome, the most severe toxicity, presents a novel critical illness syndrome with limited data regarding diagnos...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002053
更新日期:2017-02-01 00:00:00
abstract:OBJECTIVE:Heatstroke requires active body cooling and organ failure supportive care. Although heat waves are expected to recur over the next decades, little is known about the risk factors for mortality in heatstroke patients. We examined the prognosis and risk factors for hospital mortality in patients with heatstroke...
journal_title:Critical care medicine
pub_type: 评论,杂志文章,多中心研究
doi:10.1097/01.CCM.0000206469.33615.02
更新日期:2006-04-01 00:00:00
abstract:OBJECTIVE:To determine whether a correlation exists between concentrations of intracellular and extracellular potassium and to determine the frequency of ventricular ectopy in patients after cardiac operations. DESIGN:Prospective, observational clinical evaluation. SETTING:Surgical-respiratory intensive care unit of ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199911000-00018
更新日期:1999-11-01 00:00:00
abstract::Doppler ultrasound was used to study cerebral hemodynamics in the pericallosal artery of 21 newborn infants undergoing extracorporeal membrane oxygenation (ECMO) for intractable respiratory failure. Cerebral blood flow velocity waveforms were obtained pre-ECMO, after every major change in cardiopulmonary bypass flow d...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199001000-00003
更新日期:1990-01-01 00:00:00
abstract:OBJECTIVE:Resuscitation of hemorrhagic hypotension after traumatic brain injury is challenging. A hemoglobin-based oxygen carrier may offer advantages. The novel therapeutic hemoglobin-based oxygen carrier, polynitroxylated pegylated hemoglobin (PNPH), may represent a neuroprotective hemoglobin-based oxygen carrier for...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e318206b1fa
更新日期:2011-03-01 00:00:00
abstract:OBJECTIVES:Endovascular treatment for acute ischemic stroke with a large vessel occlusion was recently shown to be effective. We aimed to develop a score capable of predicting large vessel occlusion eligible for endovascular treatment in the early hospital management. DESIGN:Retrospective, cohort study. SETTING:Two t...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001630
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:The requirement for a blood transfusion after trauma is associated with an increased risk of acute lung injury. Residual leukocytes contaminating red cells are potential mediators of this syndrome. The goal of this trial was to test our hypothesis that prestorage leukoreduction of blood would reduce rates of ...
journal_title:Critical care medicine
pub_type: 杂志文章,随机对照试验
doi:10.1097/CCM.0b013e318170a9ce
更新日期:2008-05-01 00:00:00
abstract:OBJECTIVES:To evaluate the methodological quality and thematic completeness of existing clinical practice guidelines, addressing early mobilization of adults in the ICU. DATA SOURCES:Systematic review of Medline, Embase, CINAHL, Cochrane, and grey literature from January 2008 to February 2020. STUDY SELECTION:Two rev...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004574
更新日期:2020-11-01 00:00:00
abstract:OBJECTIVES:: To determine the relationship between intra-abdominal sepsis-induced high mobility group-box 1 and diaphragm contractile performance and to determine the inhibitory effects of antibodies for high mobility group-box 1 and receptor for advanced glycation end-products on septic peritonitis-induced diaphragmat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181a930f7
更新日期:2009-09-01 00:00:00
abstract::A new iridium/iridium-oxide electrode heated to 42 degrees C was used to monitor transcutaneous carbon dioxide levels during surgery in 27 adult patients. The purpose of this study was to compare arterial and transcutaneous CO2 values. This metal electrode performed similarly to glass CO2 electrodes. In addition, its ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198510000-00015
更新日期:1985-10-01 00:00:00
abstract:OBJECTIVE:To assess the effect of a helium-oxygen mixture on intubation rate and clinical outcomes during noninvasive ventilation in acute exacerbation of chronic obstructive pulmonary disease. DESIGN:Multicenter, prospective, randomized, controlled trial. SETTING:Seven intensive care units. PATIENTS:A total of 204 ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0b013e3181b78abe
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:The equipment, monitor alarms, and acuity of patients in ICUs make it one of the loudest patient care areas in a hospital. Increased sound levels may contribute to worsened outcomes in these particularly vulnerable patients. Our objective was to determine whether ambient sound levels in surgical ICUs comply w...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001378
更新日期:2016-01-01 00:00:00
abstract:OBJECTIVE:We hypothesized that deficiency in 25-hydroxyvitamin D before hospital admission would be associated with all-cause mortality in the critically ill. DESIGN:Multicenter observational study of patients treated in medical and surgical intensive care units. SETTING:A total of 209 medical and surgical intensive ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318206ccdf
更新日期:2011-04-01 00:00:00
abstract:OBJECTIVE:When a patient is incompetent, the family is often considered to be a natural surrogate. The doctors' responsiveness to family wishes may vary. We explored if doctors' personal characteristics were associated with responsiveness to the relatives' wishes when admission to the intensive care unit (ICU) is consi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181958409
更新日期:2009-02-01 00:00:00
abstract:OBJECTIVES:Severe coronavirus disease 2019 is associated with an extensive pneumonitis and frequent coagulopathy. We sought the true prevalence of thrombotic complications in critically ill patients with severe coronavirus disease 2019 on the ICU, with or without extracorporeal membrane oxygenation. DESIGN:We undertoo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004890
更新日期:2021-01-06 00:00:00
abstract::In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infect...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-198803000-00005
更新日期:1988-03-01 00:00:00
abstract:OBJECTIVE:The objectives of this study were to evaluate safety (primary) and clinical efficacy (secondary) of the humanized monoclonal anti-L-selectin antibody aselizumab in severely injured patients. DESIGN:Prospective phase II, parallel group, double-blind, randomized, placebo-controlled clinical trial. SETTING:Fou...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.ccm.0000142396.59236.f3
更新日期:2004-10-01 00:00:00