Critical Care
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New Diagnostic Tools Expected to Revamp Sepsis Care
An expert panel agreed a test is needed to indicate the severity of dysregulated host immune response. Although there was some uncertainty over which patients would benefit most from such a test, the panel agreed the sepsis test should be conducted at triage and produce results in less than 30 minutes.
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Fewer Delays in Sepsis Treatment via Provider in Triage Model
However, more research is needed to identify which key elements of this process can be reliably replicated using cost-effective resources to balance liabilities and risks.
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Quality Improvement Project Aims to Decelerate Aggressive Hypertension Treatment
Although there might be good intentions behind administering intravenous antihypertensive medication, staff should remain mindful of possible consequences.
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Some Hospice Medical Aid in Dying Policies Require Staff to Leave Room
Ethicists recommend hospices consider revising policies so nurses can support their patients clinically and emotionally at a critical moment.
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The Complicated Ethics of Medical Aid in Dying
Some patients and staff alike do not know what the process is, which can lead to misconceptions. Others might not want to ask about it, while some might object on moral grounds. Researchers are working on better education.
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Ethicists Debate Withdrawing ECMO Over Patient’s Objections
The commonly used ethical justifications for unilateral withdrawal over the objection of a patient with decision-making capacity are problematic. The ethicists’ task is to help stakeholders examine the underlying assumptions in light of the available empirical evidence or potential counterarguments.
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Many Seriously Ill Older Adults Lack Documented Goals-of-Care Discussions
Benign nudges may advance those discussions. These conversations do not need to be lengthy. A few short inquiries asked by a respectful, attentive provider is all that is needed to help many patients share concerns and preferences for care.
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Adjuvant Systemic Corticosteroid Therapy in Hospitalized Patients with Community-Acquired Pneumonia
In this meta-analysis, all-cause mortality, ICU admission, and incidence of adverse events were similar in patients who received corticosteroids compared to standard care. However, the corticosteroid therapy group recorded a lower incidence of progression to mechanical ventilation.
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Direct Oral Anticoagulants vs. Warfarin When Treating Renal Dysfunction
A patient-level meta-analysis of five pivotal trials of direct oral anticoagulants (DOACs) vs. warfarin for patients with atrial fibrillation and creatinine clearance levels ranging from normal to 25 mL/min revealed standard-dose DOACs exhibit superior safety and efficacy compared to adjusted-dose warfarin and lower-dose DOACs.
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Patients with COVID-19 on ECMO Therapy Benefit from Early Guided Palliative Care Communication
Patients with severe COVID-19 acute respiratory distress syndrome that require extracorporeal membrane oxygenation support can benefit from implementing palliative care communication early in their treatment course.