Ethics roundtable: 'Open-ended ICU care: Can we afford it?'

Diagnosis of Invasive Fungal Diseases in Hematological Malignancies: A Critical Review of Evidence and Turkish Expert Opinion (TEO-2)

“…A systematic review, evaluating 14 studies (13 retrospective, 1 prospective) including a total of 1220 patients (453 invasive candidiasis cases, 767 controls), reported that when performed separately the sensitivity of Mn and A-Mn tests was 58% and 59%, respectively, whereas the specificity was 93% for Mn and 83% for A-Mn. However, if the positivity of one of these tests (Mn/A-Mn combination) is considered to be sufficient for diagnosis, sensitivity reaches 83% without a significant decrease in specificity (86%) [ 70 ]. In 73% of 45 patients with candidemia, at least one of the tests yielded positive results 6-7 days before the culture results were available, and in 21 patients who developed hepatosplenic candidiasis, a positive result was achieved approximately 16 days before the culture results [ 71 , 72 ].…”

“…In 73% of 45 patients with candidemia, at least one of the tests yielded positive results 6-7 days before the culture results were available, and in 21 patients who developed hepatosplenic candidiasis, a positive result was achieved approximately 16 days before the culture results [ 71 , 72 ]. Among Candida spp., the highest sensitivity was achieved for Candida albicans [ 70 ]. Seven of the studies evaluated in this review were performed in cancer patients, while the other 7 studies were carried out in intensive care units and surgery clinics.…”

“…The heterogeneity of the methods used in the studies is intriguing. When the hematology-oncology patients were evaluated as a subgroup, the sensitivity of the test was 71-100% and the specificity ranged between 53% and 92% [ 70 ]. It was reported that response to Mn was especially significant after resolution of neutropenia [ 73 ].…”

Modern Treatment of Status Epilepticus in Adults

“…What is ethical for other patients also requiring the often limited ICU resources in most hospitals? These considerations and questions have been excellently discussed by Crippen et al (130). One major challenge is to distinguish at an early stage between patients with a good prognosis and potential for a worthy life, versus those patients expecting severe brain damage or death.…”

Can we afford open-ended ICU care? Yes we can, but ...

“…The question whether we can afford open-ended intensive care unit (ICU) care should be answered with 'yes we can, but ...' [ 1 ]. The discussion is polarized.…”