Ceiling Of Treatment Research Articles

Expert review of cardiopulmonary resuscitation (CPR) in hospital

The recent NCEPOD report (2012a) on patients undergoing CPR following cardiorespiratory arrest in hospital raises a number of important care quality and patient safety issues related to CPR. Some examples include the taking of an adequate patient medical history during the initial admission process, healthcarer recognition of patients’ deteriorating condition, adequacy of patient monitoring and proper documentation. Fundamentally important legal and ethical issues are also raised, such as patients’ informed consent to CPR, the need to agree the ‘ceilings of treatment’ with the patient, the poor patient survival rate after CPR in hospital, and the need to avoid futile CPR attempts during the patient’s dying process. Do nurses and doctors think that they have a duty to do everything that they can to prolong the process of dying? There is a need for nurses, doctors and managers to accept that death does not always represent a failure of health care, and that enabling people to die as well as possible is one of the core functions of the NHS.

Bringing in care planning conversations for patients whose recovery is uncertain: learning from the AMBER care bundle

60 per cent of people in our inner city area die in an acute hospital. The hospital provides good care to patients known to be dying through the Liverpool Care...

Management of acute exacerbations of chronic obstructive pulmonary disease:the first 24 hours

Successful outcome is more likely with early treatment and lesser degrees of acidosis. While aiming for maximum treatment for the first 24 hours, some patients improve so rapidly that they can discontinue after a shorter time. Most patients need a full face mask and oxygen, and nebulised bronchodilators can be incorporated. If radiological consolidation, excessive secretions and/or confusion are present, the chance of failure is increased but is not an absolute contraindication. The presence of a pneumothorax necessitates intercostal drainage. A useful summary statement has recently been published. Patients who are obtunded and peri-arrest require immediate intubation and mechanical ventilation. There is some evidence that intensivists are reluctant to accept COPD exacerbators to the intensive care unit because of the perceived low survival rates or concerns about weaning delays after intubation. In fact, the prognosis may be better than in many other patients with multi-organ failure. Patients can often be quickly weaned on to NIV and returned to the ward after an initial period of invasive support and secretion management. Initial assessment and the past history should identify those markedly disabled patients with recurrent admissions who are likely to be entering the terminal stages of their illness in whom intubation is inappropriate. Here, NIV may be the ceiling of treatment, providing useful symptom palliation while waiting for treatment to