C Schimmer1, K Hamouda2, M Oezkur2, S-P Sommer2, M Leistner2, R Leyh2. 1. Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland. schimmer_c@klinik.uni-wuerzburg.de. 2. Zentrum Operative Medizin, Klinik und Poliklinik für Thorax-, Herz- und Thorakale Gefäßchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Deutschland.
Abstract
BACKGROUND: Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically ill patients present a great challenge in intensive care medicine. OBJECTIVES: The purpose of this work was to assess medical and ethical criteria that influence the decision-making process for changing the aim of therapy in critically ill cardiac surgery patients. MATERIALS AND METHODS: A questionnaire was distributed to all German cardiac surgery centers (n = 79). All clinical directors, intensive care unit (ICU) consultants and ICU head nurses were asked to complete questionnaires (n = 237). RESULTS: In all, 86 of 237 (36.3 %) questionnaires were returned. Medical reasons which influence the decision-making process for changing the aim of therapy were cranial computed tomography (cCT) with poor prognosis (91.9 %), multi-organ failure (70.9 %), and failure of assist device therapy (69.8 %). Concerning ethical reasons, poor expected quality of life (48.8 %) and the presumed patient's wishes (40.7 %) were reported. There was a significant difference regarding the perception of the three different professional groups concerning medical and ethical criteria as well as the involvement in the decision-making process. CONCLUSION: In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.
BACKGROUND: Ethical and medical criteria in the decision-making process of withholding or withdrawal of life support therapy in critically illpatients present a great challenge in intensive care medicine. OBJECTIVES: The purpose of this work was to assess medical and ethical criteria that influence the decision-making process for changing the aim of therapy in critically ill cardiac surgery patients. MATERIALS AND METHODS: A questionnaire was distributed to all German cardiac surgery centers (n = 79). All clinical directors, intensive care unit (ICU) consultants and ICU head nurses were asked to complete questionnaires (n = 237). RESULTS: In all, 86 of 237 (36.3 %) questionnaires were returned. Medical reasons which influence the decision-making process for changing the aim of therapy were cranial computed tomography (cCT) with poor prognosis (91.9 %), multi-organ failure (70.9 %), and failure of assist device therapy (69.8 %). Concerning ethical reasons, poor expected quality of life (48.8 %) and the presumed patient's wishes (40.7 %) were reported. There was a significant difference regarding the perception of the three different professional groups concerning medical and ethical criteria as well as the involvement in the decision-making process. CONCLUSION: In critically ill cardiac surgery patients, medical reasons which influence the decision-making process for changing the aim of therapy included cCT with poor prognosis, multi-organ failure, and failure of assist device therapy. Further studies are mandatory in order to be able to provide adequate answers to this difficult topic.
Authors: Edouard Ferrand; François Lemaire; Bernard Regnier; Khaldoun Kuteifan; Michel Badet; Pierre Asfar; Samir Jaber; Jean-Luc Chagnon; Anne Renault; René Robert; Frédéric Pochard; Christian Herve; Christian Brun-Buisson; Philippe Duvaldestin Journal: Am J Respir Crit Care Med Date: 2003-01-24 Impact factor: 21.405
Authors: Elie Azoulay; Barbara Metnitz; Charles L Sprung; Jean-François Timsit; François Lemaire; Peter Bauer; Benoît Schlemmer; Rui Moreno; Philipp Metnitz Journal: Intensive Care Med Date: 2008-10-10 Impact factor: 17.440