Limits Of Intensive Care Research Articles

Intensivmedizinisches Management hämatologischer und onkologischer Patienten

Management of critically ill cancer patients warrants stringent admission criteria and clear concepts concerning duration and limits of intensive care. Recent developments in mechanical ventilation and sepsis therapy can easily be used to improve the outcome of critically ill cancer patients. The incidence and overall prognosis of cancer is constantly growing and, thus, the number of critically ill cancer patients is increasing. Furthermore, novel oncology drugs-in particular immune modulators-produce unexpected and substantial side effects. Therefore, the development of an interdisciplinary algorithm by oncologists and intensivists remains an important and dynamic challenge.

Die Zukunft der Neonatologie: Möglichkeiten und Grenzen

Neonatology is a form of general medicine which focuses on the beginning of life and lays its main emphasis on the conversion from intrauterine to extrauterine life. Over the last 50 years, the neonatal mortality in Switzerland dropped from 25 to 3 per one-thousand liveborns. Today, the greatest challenges are extremely preterm infants and infants with complex malformations. Highly specialized intensive care enables survival in both high-risk groups but a significant number of children surviving with severe sequelae remain. This calls for research aiming at better understanding and supporting the adaptational changes and may simultaneously lead to ethical dilemmas about the limitation of intensive care. Since 1996, the Swiss Neonatal Network & Follow-up Group documents in high-risk infants the initial hospitalization at birth as well as the psychomotor development and quality of life until school age and beyond.

Prognosis Following Cardiopulmonary Resuscitation: The Limits of Intensive Care

In addition to the usual neurological examinations, the investigations under discussion (EEG/somatosensible evoked potentials [SEP]/neutron-specific enolase [NSE]/MRI) should have been the gold standard in intensive care medicine since the initial investigations of anoxic coma (1, 2) after cardiopulmonary resuscitation (as per Safar). This is the only way in which the limits of treatment of anoxic coma can be recognized under controlled conditions and in a timely fashion. Timely prognosis in coma patients with severe cerebral damage requires intense interdisciplinary discussion. For example, in a patient with post-traumatic bulbar brain syndrome that is developing towards complete loss of cerebral function, diagnosis-based imaging, an isoelectric EEG, missing early SEP, and/or early acoustic evoked potentials hint at the limitations of intensive therapy – even before cerebral death is diagnosed. In this situation, which could be termed the terminal coma phase, the constellation of findings described above will predict an irreversible course if treatment is continued: the proximity of brain death on the one hand, and the later, permanent, postanoxic apallic syndrome (or death) on the other. Responsible clinicians should not try to avoid challenging decisions if there are still gaps in their diagnostic skills or delay these by passing them over to care structures further down the line. Each justified uncertainty will have to be worked through and feed into extended observation and diagnostics. If the findings are completed and clear, a clear decision should be made at an early stage – including a decision about stopping treatment. The article is published at a time where the limitations of intensive medical care are being redefined, which may limit access to the intensive care ward but are also intended to redefine the exit strategy, in order to formulate resource-adapted care pathways. Automatically basing crucial medical decisions on technical findings only is a serious danger. This contribution to intensive care medicine from an experienced neurologist and physician of internal medicine does not conjure up this danger, but it points at the integration of relatives into syndrome specific palliative intensive care – which is really stating the obvious.

集中治療の限界とその医療経済学 肝不全に対する治療限界とその経済的側面

集中治療の限界とその医療経済学 肝不全に対する治療限界とその経済的側面