Millions of patients are discharged from intensive care units annually. These intensive care survivors and their families frequently report a wide range of impairments in their health status which may last for months and years after hospital discharge.To report on a 2-day Society of Critical Care Medicine conference aimed at improving the long-term outcomes after critical illness for patients and their families.Thirty-one invited stakeholders participated in the conference. Stakeholders represented key professional organizations and groups, predominantly from North America, which are involved in the care of intensive care survivors after hospital discharge.Invited experts and Society of Critical Care Medicine members presented a summary of existing data regarding the potential long-term physical, cognitive and mental health problems after intensive care and the results from studies of postintensive care unit interventions to address these problems. Stakeholders provided reactions, perspectives, concerns and strategies aimed at improving care and mitigating these long-term health problems.Three major themes emerged from the conference regarding: (1) raising awareness and education, (2) understanding and addressing barriers to practice, and (3) identifying research gaps and resources. Postintensive care syndrome was agreed upon as the recommended term to describe new or worsening problems in physical, cognitive, or mental health status arising after a critical illness and persisting beyond acute care hospitalization. The term could be applied to either a survivor or family member.Improving care for intensive care survivors and their families requires collaboration between practitioners and researchers in both the inpatient and outpatient settings. Strategies were developed to address the major themes arising from the conference to improve outcomes for survivors and families.
Purpose: A pilot study to ascertain awareness and understanding of palliative care among parents of pediatric patients at a single academic medical center. Methods: This study was given Institutional Review Board approval as an exempt study. It was conducted over a 3 week period in July 2015 at three subspecialty ambulatory care clinics in New York City. A convenience sample of 100 subjects was selected. Participation was voluntary and subjects were randomly selected. Inclusion criteria included being a patient’s parent or legal guardian and the ability to speak and …
Informed consent constitutes one of the important considerations included in the myriad ethical dilemmas in the pediatric intensive care unit. Traditionally, the law has viewed children as incompetent to make medical decisions, and society has authorized parents or guardians to act on behalf of children. Empirical evidence has revealed that children may be more capable of participating in their medical decisions than previously thought. Some scholars now think that parents have the right to give informed permission and that professionals should seek the child's assent in many circumstances. Physicians in the intensive care unit should seriously consider consulting adolescent patients about the direction of their care and may wish to seek the input of younger patients in appropriate circumstances.
Background: End-of-life care (EOLC) discussions and decisions are common in pediatric oncology. Interracial differences have been identified in adult EOLC preferences, but the relation of race to EOLC in pediatric oncology has not been reported. We assessed whether race (white, black) was associated with the frequency of do-not-resuscitate (DNR) orders, the number and timing of EOLC discussions, or the timing of EOLC decisions among patients treated at our institution who died. Methods: We reviewed the records of 380 patients who died between July 1, 2001 and February 28, 2005. χ2 and Wilcoxon rank-sum tests were used to test the association of race with the number and timing of EOLC discussions, the number of DNR changes, the timing of EOLC decisions (i.e., DNR order, hospice referral), and the presence of a DNR order at the time of death. These analyses were limited to the 345 patients who selfidentified as black or white. Results: We found no association between race and DNR status at the time of death (p = 0.57), the proportion of patients with DNR order changes (p = 0.82), the median time from DNR order to death (p = 0.51), the time from first EOLC discussion to DNR order (p = 0.12), the time from first EOLC discussion to death (p = 0.33), the proportion of patients who enrolled in hospice (p = 0.64), the time from hospice enrollment to death (p = 0.2) or the number of EOLC discussions before a DNR decision (p = 0.48). Conclusion: When equal access to specialized pediatric cancer care is provided, race is not a significant factor in the presence or timing of a DNR order, enrollment in or timing of enrollment in hospice, or the number or timing of EOLC discussions before death.
Organ transplantation is one of the groundbreaking achievements in medicine in the 20th century. In the early days of transplantation, organs were obtained from non-heartbeating (NHB) cadavers. With time, better options for organ sources became available (for example, living-related and "brain dead" donors), and the practice of obtaining organs from NHB cadavers fell out of favor. Improvements in the field of transplantation have led to an increased demand for organs. Various strategies have been employed recently to increase the supply, one of them being non-heartbeating organ donation (NHBOD). NHBOD can take place in controlled or uncontrolled circumstances. Recently, national organizations have supported and proposed guidelines for NHBOD and to aid clinicians in identifying potential donors. Outcomes of organs obtained from NHB cadavers are comparable to those obtained from heartbeating donors. The practice of NHBOD is increasing and has proven that it can contribute to increasing organ availability.
SOCIETY OF CRITICAL CARE MEDICINE 32ND CRITICAL CARE CONGRESS SAN ANTONIO, TEXAS, USA JANUARY 28-FEBRUARY 2, 2003: ORAL/SANDWICH PRESENTATIONS: Poster Presentation: Ethics and End of Life: PDF Only
20004 Background: Clinicians and parents report that end-of-life (EoL) care discussions and decision making are complex, difficult and affected by personal, family, and disease and treatment factors. The influence of race on EoL discussions and decision making has not been carefully examined in a large pediatric oncology study. The purpose of this study was to assess if race (white, black, Hispanic) influenced the quantity or timing of end-of-life care discussions and decisions. Methods: This abstract represents a retrospective chart review leading to the creation of an EoL database of pediatric oncology patients at St Jude Children’s Research Hospital who died during the time period of July 01, 2001 to February 28, 2005. Eligibility criteria were oncologic diagnosis, and patient age less than 21.99 years of age at the time of death. After strict application of the eligibility criteria, a total of 380 patients met study inclusion criteria. The effect of race on the quantity and timing of EoL discussions and decision making was then analyzed from the database. All extracted data were validated by a different team member as was the accuracy of all entered data. The association of race with other factors was assessed using regression analysis and chi-squared testing statistics. Results: None of the following differed by race: the total number of EoL discussions before an EoL decision was made (p=0.58); the total time from the first such discussion to a specific EoL decision (p=0.23–0.68), the total time from the first discussion to the patient’s death (p=0.105), or having a DNR in place at the time of death (p=0.55). Conclusions: In this cohort of patients from a tertiary referral center, race is not a significant factor on the quantity and timing of EoL discussions and decision making in pediatric oncology patients. [Table: see text] No significant financial relationships to disclose.
