Critical Care Topics
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Ethical End-of-Life Care for Homeless Patients
Clinicians should acknowledge their own potential bias and avoid using language in the medical record that is stigmatizing. Also, they can request an ethics consult before making any decision to not provide care for a patient experiencing homelessness.
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Is Death Imminent? Conflicts Occur if Clinicians Do Not Make It Clear
Poor communication on prognosis prevents the family from making decisions based on the true situation. If surrogates do not realize death is imminent, they cannot plan for hospice care or contact family members to be there for the patient’s last moments.
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Advance Care Planning Can Lower Odds of Aggressive End-of-Life Treatment
Advance care planning was associated with significantly lower odds of indicators of aggressive end-of-life care (i.e., hospital death, hospital admissions, intensive care, delayed hospice referrals, and chemotherapy). Cancer patients who engaged in advance care planning were 50% more likely to complete Do Not Resuscitate orders compared to cancer patients without an advance directive.
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American Heart Association Urges Improvement in Stroke Care
In a scientific statement, the group offered tactics to eliminate the racial and ethnic inequities that exist in stroke incidence, prevalence, treatment, and outcomes.
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Do Race and Ethnicity Affect the Likelihood of ICU Admission?
Patients who identify with racial or ethnic minority groups and present with sepsis or acute respiratory failure are more likely to be admitted to the ICU when compared to white patients.
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Steroids and Pneumonia — So Meta?
In a multicenter, randomized, placebo-controlled trial, hydrocortisone reduced mortality in patients with severe community-acquired pneumonia.
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Adjuvant Systemic Corticosteroid Therapy in Hospitalized Patients with Community-Acquired Pneumonia
This systematic review and meta-analysis of 16 randomized controlled trials (RCTs) studied the use of adjunctive corticosteroid therapy in community-acquired pneumonia. All-cause mortality, intensive care unit admission, and incidence of adverse events were similar in patients who received corticosteroids compared to standard care. However, the corticosteroid therapy group had a lower incidence of progression to mechanical ventilation.
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Wrongful Prolongation of Life Suits Persist, Even When a Patient’s Status Was DNR
Regardless of training or good intentions to preserve life, at the end of the day, this is the patient's choice.
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Ethicists’ Role if Clinicians Disregard Documented End-of-Life Wishes
Early involvement of the ethics team can be helpful. After an initial assessment, the healthcare team should arrange a family meeting with surrogates, clinicians, the ethics team, social workers, and other appropriate individuals (e.g., clergy). This should happen as soon as possible, no later than the following day. The ethics team should facilitate an honest and compassionate discussion about the plan to best honor the patient’s end-of-life decisions.
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Ethicists Can Resolve Conflicts Over Nutrition Therapy at End of Life
When deciding whether to administer, withhold, or withdraw end-of-life nutrition and hydration therapy, ethicists can help clinicians, patients, and families reach an equitable agreement.