Year in review in Intensive Care Medicine 2009. Part III: Mechanical ventilation, acute lung injury and respiratory distress syndrome, pediatrics, ethics, and miscellanea

Impact of an intensive communication strategy on end-of-life practices in the intensive care unit

“…The second period of our study, after the new French legislation of 2005, saw the rate of deaths after limiting of life-sustaining therapy increase to 85% in our department, which is coherent with the rates reported in other studies conducted after 2005 [2,[16][17][18]. It should be noted that studies conducted in different religious or geographic contexts, particularly within Europe, can give differing results.…”

“…Several studies assessing the collegial nature of decisions to forego lifesustaining therapy mention the lack of communication and interaction between the caregivers and the patient's close family members when discussing the patient's future [19][20][21]. Indeed, Stricker et al [16,22] highlighted the need for improved emotional support, coordination of care and communication in their study of family satisfaction among the relatives of 996 Swiss ICU patients. Therefore, it is of particular importance to have an intensive communication strategy involving all staff members as well as the patient's family and/or appointed surrogates.…”

“It Hurts To Know…And It Helps”: Exploring How Surrogates in the ICU Cope with Prognostic Information

“…5,6 At the same time, family members find it difficult to hear bad news and may respond in ways that undercut their desire to hear prognostic information. [7][8][9] Some surrogates ask not to be given bad news. Others accept prognostic information yet retain alternate beliefs, for example, by remaining optimistic that a patient will recover in the face of a grim outlook.…”

Discontinuation of prolonged infusions of dexmedetomidine in critically ill children with heart disease

“…Nevertheless, it is used extensively in the pediatric population in general critical care [6–9], cardiac critical care [10–14], cardiac anesthesia [15], general anesthesia [16], and ambulatory anesthesia [17] due its ability to produce sedation, anxiolysis and analgesia while minimally affecting respiratory function [2–5]. Despite the widespread use of dexmedetomidine, current literature contains little information regarding experience with prolonged infusions and few case reports describe possible rebound or withdrawal symptoms after its discontinuation [18–21].…”