Decisions about resuscitation: inequities among patients with different diseases but similar prognoses

Article Abstract:

The equitability of the decision for 'do-not-resuscitate' (DNR) orders was assessed among patients with different diseases, but similar prognoses. The patients consisted of 100 individuals with acquired immunodeficiency syndrome (AIDS); 51 patients with lung cancer; 51 patients with cirrhosis of the liver; and 115 patients with severe congestive heart failure. DNR orders were written for 52 percent of the patients with AIDS, 47 percent of the patients with cancer, 16 percent of the patients with cirrhosis, and five percent of the patients with congestive heart failure. The decision concerning DNR orders was associated with functional and mental status of the patient, reason for admission, severity of illness, and disease category. Housestaff discussed DNR orders more frequently with patients who had AIDS or lung cancer, than with patients who had cirrhosis or congestive heart failure. The results show that despite similar prognoses, DNR orders are written more often for patients with AIDS or lung cancer compared with patients with cirrhosis or congestive heart failure. It is not clear whether this trend can be attributed to too few DNR orders for patients with heart failure and patients with cirrhosis, or if too many DNR orders for AIDS patients and lung cancer patients are being issued. Consistent and equitable judgement should be exercised when considering life-sustaining measures for patients with different diseases, but with similar prognoses. (Consumer Summary produced by Reliance Medical Information, Inc.)

Analysis, Management, Ethical aspects, Resuscitation, Prognosis, Diagnosis

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Update in critical care medicine

Article Abstract:

Researchers have highlighted the results of studies that examine several aspects of intensive care medicine including mechanical ventilation issues, ethical issues, and adult respiratory distress syndrome (ARDS) issues. Some studies have examined ventilation strategies that may reduce lung damage or alternative strategies to eliminate or reduce the need for ventilation. Three studies have shown that doctors often independently make decisions regarding continued treatment without regard for patient or family wishes. Other studies have described ARDS conditions and ARDS-associated death rate trends.

Care and treatment, Acute respiratory distress syndrome, Adult respiratory distress syndrome

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Update in critical care

Article Abstract:

Important research in critical care published in 2001 and 2002 is reviewed. Topics include cardiac arrest, pulmonary embolism, acute respiratory distress syndrome, aspergillosis, sepsis, septic shock, bacterial meningitis, carbon monoxide poisoning, and methanol poisoning.

Science & research, Research

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