Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

Rocker, Graeme; Cook, Deborah J.; Shemie, Sam D.

doi:10.1007/bf03022799

Cited by 25 publications

(16 citation statements)

References 55 publications

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“…Common reasons for nonrelevance included a focus on decision making in end-of-life care, lack of quantitative observations of life-sustaining therapy withdrawal processes, and populations in PICU or neonatal ICUs. One review article and two articles based on similar study populations were excluded (16)(17)(18). Four articles were identified through a reference scan.…”

Section: Resultsmentioning

confidence: 99%

Variations in the Operational Process of Withdrawal of Life-Sustaining Therapy

Beinum

Hornby

Ward

et al. 2015

Critical Care Medicine

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Section: Resultsmentioning

confidence: 99%

Variations in the Operational Process of Withdrawal of Life-Sustaining Therapy

Beinum

Hornby

Ward

et al. 2015

Critical Care Medicine

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“…A belief that survival with severe disability and ⁄ or impairment of cognitive function is the likely outcome is one of the strongest factors driving a recommendation to limit or withdraw treatment [24]. However, clinicians tend to be overly pessimistic when assessing prognosis [25]. In a prospective study in a…”

Section: Editorialmentioning

confidence: 99%

Treatment withdrawal and acute brain injury: an integral part of care

Smith

2012

Anaesthesia

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“…Nonetheless, evidence from international studies suggests that institutions lack clear policies for the determination of death and that the use of tests during clinical examination varies [15][16][17][18][19] .…”

mentioning

confidence: 99%

Observations on the Ethical and Social Aspects of Disorders of Consciousness

Racine

Rodrigue

Bernat

et al. 2010

Can. j. neurol. sci.

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Disorders of consciousness such as coma, the vegetative state (VS), and the minimally conscious state (MCS) are neurological syndromes that disturb awareness or both wakefulness and awareness. Medical advances and neurotechnology have increased the probability of survival for patients suffering from severe neurological injury. Although coma rarely persists more than a few weeks, some patients remain in a VS or a MCS for years. The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. Our goals here are to update the principal controversies surrounding disorders of consciousness and to discuss how scientific developments and social factors have lead to changes in the ethical landscape of these disorders. ABSTRACT:The care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration -which had been considered "settled" by many in the medical, legal and ethical communities -have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.RÉSUMÉ: Observations sur les aspects éthiques et sociaux des troubles de la conscience. La prise en charge de patients inconscients chronique soulève des questions médicales, éthiques et sociales qui sont éprouvantes en ce qui concerne le diagnostic, le pronostic, la communication avec les membres de la famille et les décisions à prendre, dont le retrait des mesures de maintien en vie. Nous faisons une mise à jour des grandes controverses concernant les troubles de la conscience. Les controverses telles le retrait de la nutrition artificielle et de l'hydratation -qui étaient considérées comme résolues par plusieurs membres des communautés médicale, légale et éthique -ont refait surface sous la pression de groupes sociaux et d'autorités religieuses. Certaines notions au sujet du niveau de conscience et du pronostic de l'état végétatif et les patients minimalement conscients, qui étaient tenues pour acquises, sont remises en question à cause des progrès dans les soins cliniques découlant des techniques de recherche en neurosciences, particulièrement de l'imagerie fonc...

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Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

Cited by 25 publications

References 55 publications

Variations in the Operational Process of Withdrawal of Life-Sustaining Therapy

Variations in the Operational Process of Withdrawal of Life-Sustaining Therapy

Treatment withdrawal and acute brain injury: an integral part of care

Observations on the Ethical and Social Aspects of Disorders of Consciousness

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