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Báo cáo y học: " Ethics roundtable: ‘Open-ended ICU care: Can we afford it"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Ethics roundtable: ‘Open-ended ICU care: Can we afford it?’ | Crippen et al. Critical Care 2010 14 222 http ccforum.eom content 14 3 222 CRITICAL CARE REVIEW L_ Ethics roundtable Open-ended ICU care Can we afford it David Crippen 1 Dick Burrows2 Nino Stocchetti3 Stephan A Mayer4 Peter Andrews5 Tom Bleck6 7 and Leslie Whetstine8 The case The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months he has been in status epilepticus SE on high doses of barbiturates benzodiazepines and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on continuous electroencephalography EEG . He is trached and has a percutaneous endoscopic gastrostomy PEG feeding tube. He has been treated several times for pneumonia and he is on a warming blanket and is on vasopressors to maintain his blood pressure. His vitals are stable and his lab work is within limits. The sedation is decreased under EEG guidance every 72 hours after which he goes back into SE and heavy sedation is resumed. The latest magnetic resonance imaging MRI shows edema but otherwise no obvious permanent cortical damage. The family wants a realistic assessment of the likely outcome. The neurologist tells them the literature suggests the outlook is poor but not 100 fatal. As long as all of his other organs are functioning on life support there is always a chance the seizures will stop at some time in the future and so the neurologist recommends an open-ended intensive care unit ICU plan and hopes for that outcome. David Crippen A fundamental tenet of legal justice is that it is better to let ten guilty men go free than convict one innocent man. The reciprocal in medicine is that it is better to artificially maintain life in ten death spirals than miss one expected survivor. Physicians are famous for ignoring impediments Correspondence crippen@pitt.edu department of Critical Care Medicine University of Pittsburgh Medical Center 644a Saife Hall