Review
Anesthesiology
M. Tanaka Gutiez, N. Efstathiou, R. Innes, V. Metaxa
Summary: The transition from active, invasive interventions to comfort care for critical care patients often leads to misunderstandings, conflicts, and moral distress. This article aims to address common questions and provide practical guidance, using the best available evidence, to critical care clinicians in the UK. It clarifies the distinctions between withdrawing or withholding treatment and euthanasia, offers suggestions for sedation and analgesia use, and advocates for including family in decision-making when the patient lacks capacity. It also proposes a step-escalation approach for resolving family conflicts and emphasizes the importance of communication skills training in medical and nursing education.
Review
Health Care Sciences & Services
Jean-Philippe Rigaud, Fiona Ecarnot, Jean-Pierre Quenot
Summary: In this paper, the ethical issues surrounding information provision and consent in the intensive care unit are reviewed. The obligations of physicians in treating vulnerable patients are discussed, along with the challenges of providing clear information in critical illness situations. The specificities of intensive care, including the selection of a contact person and the considerations for the family of critically ill patients, are explored. Additionally, the cases of consent to research and patients who refuse care are discussed.
Article
Critical Care Medicine
Lena Palmryd, Asa Rejno, Tove E. Godskesen
Summary: Integrity is seen as a fundamental ethical concept and a core value in nursing, but nurses often struggle to define and explain it in the context of daily care for dying patients in the ICU. Protecting patients from harm and reducing patient vulnerability are important ways to maintain patient integrity in the ICU setting. The study highlights the importance of providing opportunities for ICU nurses to reflect on and discuss ethical issues in decision-making and behavior.
ANNALS OF INTENSIVE CARE
(2021)
Article
Health Care Sciences & Services
Katherine Guttmann, John Flibotte, Holli Seitz, Matthew Huber, Sara B. DeMauro
Summary: This study investigated the relationship between quality of Goals of Care (GOC) conversations and moral distress among neonatal intensive care unit (NICU) providers. The findings showed that most providers experienced an increase in moral distress following GOC discussions, and that different elements of discussions and provider roles had varying effects on moral distress levels.
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT
(2021)
Article
Nutrition & Dietetics
Matthew F. Mart, Timothy D. Girard, Jennifer L. Thompson, Hannah Whitten-Vile, Rameela Raman, Pratik P. Pandharipande, Daren K. Heyland, E. Wesley Ely, Nathan E. Brummel
Summary: Higher nutritional risk at ICU admission is associated with disability in survivors of critical illness, but the long-term follow-up did not show significant correlation. The mNUTRIC scores are related to discharge destination and disability in basic ADLs but not consistently associated with cognition and health-related quality of life.
CLINICAL NUTRITION
(2021)
Review
Critical Care Medicine
Victoria Metaxa, Despina Anagnostou, Savvas Vlachos, Nishkantha Arulkumaran, Sherihane Bensemmane, Ingeborg van Dusseldorp, Rebecca A. Aslakson, Judy E. Davidson, Rik T. Gerritsen, Christiane Hartog, J. Randall Curtis
Summary: The study evaluated various types of palliative care interventions implemented in ICUs and their impact on practice, finding that strategies to enhance palliative care involvement were associated with beneficial effects on common outcomes for ICU patients. However, the majority of studies were from North America, limiting the generalisability to other healthcare systems.
INTENSIVE CARE MEDICINE
(2021)
Article
Pediatrics
Lauren Imai, Megan M. Gray, Brennan J. H. Kim, Allison N. J. Lyle, Amber Bock, Elliott Mark Weiss
Summary: Care for neonates at the end of life is challenging and requires experienced and compassionate clinicians. Existing literature mostly focuses on adult and pediatric end of life care, with limited studies on neonatal care.
FRONTIERS IN PEDIATRICS
(2023)
Article
Medicine, General & Internal
Francois Lamontagne, Marie-Helene Masse, Julie Menard, Sheila Sprague, Ruxandra Pinto, Daren K. Heyland, Deborah J. Cook, Marie-Claude Battista, Andrew G. Day, Gordon H. Guyatt, Salmaan Kanji, Rachael Parke, Shay P. McGuinness, Bharath-Kumar Tirupakuzhi Vijayaraghavan, Djillali Annane, Dian Cohen, Yaseen M. Arabi, Brigitte Bolduc, Nicole Marinoff, Bram Rochwerg, Tina Millen, Maureen O. Meade, Lori Hand, Irene Watpool, Rebecca Porteous, Paul J. Young, Frederick D'Aragon, Emilie P. Belley-Cote, Elaine Carbonneau, France Clarke, David M. Maslove, Miranda Hunt, Michael Chasse, Martine Lebrasseur, Francois Lauzier, Sangeeta Mehta, Hector Quiroz-Martinez, Oleksa G. Rewa, Emmanuel Charbonney, Andrew J. E. Seely, Demetrios J. Kutsogiannis, Remi LeBlanc, Armand Mekontso-Dessap, Tina S. Mele, Alexis F. Turgeon, Gordon Wood, Sandeep S. Kohli, Jason Shahin, Pawel Twardowski, Neill K. J. Adhikari
Summary: A study on the use of intravenous vitamin C in adult sepsis patients receiving vasopressor therapy in the ICU showed that there is a higher risk of death or persistent organ dysfunction compared to placebo.
NEW ENGLAND JOURNAL OF MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Antonio Fagundes, David D. Berg, Erin A. Bohula, Vivian M. Baird-Zars, Christopher F. Barnett, Anthony P. Carnicelli, Sunit-Preet Chaudhry, Jianping Guo, Ellen C. Keeley, Benjamin B. Kenigsberg, Venu Menon, P. Elliott Miller, L. Kristin Newby, Sean van Diepen, David A. Morrow, Jason N. Katz
Summary: In contemporary CICUs, a significant portion of patients choose comfort measures before death, often without involvement of palliative care. The high utilization of advanced intensive care therapies and lengthy decision-making process for comfort measures highlight the potential opportunity for early engagement of palliative care teams in CICUs.
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
(2022)
Article
Pediatrics
Mark R. Mercurio, Lynn Gillam
Summary: The unexpected birth of a critically ill baby raises ethical questions for neonatologists, such as whether to attempt resuscitation or continue life-sustaining interventions. This essay presents the story of a newborn with profound hypoxic-ischemic encephalopathy, discussing decisions regarding resuscitation, withdrawal of interventions, and euthanasia, as well as guidance for discussions with parents throughout the process. It serves as a helpful guide for ethical deliberation and scripting for parental discussion in similar cases.
SEMINARS IN FETAL & NEONATAL MEDICINE
(2023)
Article
Nursing
Kurosh Jodaki, Maryam Esmaeili, Mohammad Ali Cheraghi, Monir Mazaheri
Summary: This study aimed to explore the conditions that accompany conflict of conscience experienced by nurses in intensive care units. Through qualitative content analysis, the study identified two main themes: conflict of conscience in relation to the structure and conflict of conscience based on context. These findings are important for healthcare managers to develop strategies that reduce negative consequences.
NURSING & HEALTH SCIENCES
(2022)
Article
Critical Care Medicine
Celine Gelinas, Melanie Berube, Kathleen A. Puntillo, Madalina Boitor, Melissa Richard-Lalonde, Francis Bernard, Virginie Williams, Aaron M. Joffe, Craig Steiner, Rebekah Marsh, Louise Rose, Craig M. Dale, Darina M. Tsoller, Manon Choiniere, David L. Streiner
Summary: The study showed that the CPOT-Neuro is valid for brain-injured ICU patients across different levels of consciousness, with no significant differences in CPOT-Neuro scores between LOC groups. Additionally, the tool demonstrated moderate correlations with self-reported pain intensity.
Review
Pediatrics
Siti Nur Hanim Buang, Sin Wee Loh, Yee Hui Mok, Jan Hau Lee, Yoke Hwee Chan
Summary: Palliative care is an important component of critical care practice for pediatric patients facing life-threatening illness. Integrating palliative care early alongside disease-directed and curative therapies can effectively improve patients' quality of life. A multidisciplinary approach, effective communication, and family support are key in integrating palliative care. This narrative review aims to evaluate the integration of palliative care in pediatric critical care and its impact on patient- and family-centered outcomes.
FRONTIERS IN PEDIATRICS
(2022)
Article
Nursing
Mu-Hsing Ho, Hui-Chen (Rita) Chang, Megan F. Liu, Kee-Hsin Chen, Shu-Tai Shen Hsiao, Victoria Traynor
Summary: This study investigated the level of knowledge about delirium care among critical care nurses in Taiwan. The results showed that critical care nurses had relatively high levels of knowledge in areas such as symptoms, high-risk groups, and predisposing factors, but there were significant gaps in their knowledge regarding the assessment and detection of delirium.
JOURNAL OF NURSING RESEARCH
(2022)
Article
Environmental Sciences
Jin Hee Yang, Gisoo Shin
Summary: A mobile end-of-life care program was developed for intensive-care unit nurses in this study, aimed at improving competence factors such as knowledge, self-efficacy, and compassion. Results showed a significant improvement in self-efficacy and compassion for nurses after using the mobile app, indicating its effectiveness for nurses with less than 3 years of experience in an intensive-care unit. Further development of educational programs considering the impact of the fourth industrial revolution is necessary to enhance the quality of end-of-life care.
INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH
(2021)
Editorial Material
Microbiology
Jean-Louis Vincent
FUTURE MICROBIOLOGY
(2021)
Letter
Critical Care Medicine
Jean-Louis Vincent, Jacques Creteur
INTENSIVE CARE MEDICINE
(2021)
Article
Critical Care Medicine
Wasineenart Mongkolpun, Peter Bakos, Jean-Louis Vincent, Jacques Creteur
Summary: This study included 42 patients with shock, and found that baseline skin blood flow and its early reduction after initiation of fluid removal using CVVH can predict worsened tissue perfusion, reflected by an increase in blood lactate levels.
ANNALS OF INTENSIVE CARE
(2021)
Review
Medicine, General & Internal
Jean-Louis Vincent, Jacques Creteur
Summary: With increasing life expectancy, more elderly patients are being admitted to ICU, representing a unique subgroup with changes in organ function, reduced daily living activities, decreased mobility, and cognitive decline. Ethical decisions regarding intensive care, life-sustaining interventions, life support withdrawal/withholding, and terminal sedation are more common in elderly patients, and should be personalized to consider individual beliefs and wishes.
JOURNAL OF INTERNAL MEDICINE
(2022)
Article
Medicine, General & Internal
Jean-Louis Vincent
Summary: Intensive care units (ICUs) worldwide have faced significant challenges due to the COVID-19 pandemic, such as resource shortages and ethical dilemmas. Through the discussions prompted by the COVID-19 situation, valuable lessons can be learned about resource allocation, end-of-life decision-making, and staff support.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Biochemistry & Molecular Biology
Fabio Silvio Taccone, Fuhong Su, Xinrong He, Lorenzo Peluso, Katia Donadello, Sabino Scolletta, Daniel De Backer, Jean-Louis Vincent
Summary: The effects of correcting hypotension with vasopressors in septic shock may improve cerebral oxygenation but do not reverse the alterations in brain microcirculation or cerebral metabolism.
Review
Virology
Maya Hites, Jean-Louis Vincent
Summary: This article reviews the clinical studies conducted in Belgium on hospitalized patients with COVID-19, showing a limited participation of hospitals, low international collaboration, and a lack of adaptive platform trials.
Article
Neurosciences
Katia Donadello, Fuhong Su, Filippo Annoni, Sabino Scolletta, Xinrong He, Lorenzo Peluso, Leonardo Gottin, Enrico Polati, Jacques Creteur, Olivier De Witte, Jean-Louis Vincent, Daniel De Backer, Fabio Silvio Taccone
Summary: This study investigated the effects of cooling on cerebral microcirculation, oxygenation and metabolism in a healthy swine model. The results showed that during the cooling phase, cerebral functional capillary density and proportion of small-perfused vessels decreased, while oxygenation increased and metabolism decreased. After rewarming, all variables returned to normal values, except for an increased metabolism in the two groups subjected to hypothermia during the rewarming phase compared to the normothermia group.
Review
Biochemistry & Molecular Biology
Jean-Louis Vincent, Tom van der Poll, John C. Marshall
Summary: Sepsis, a life-threatening organ dysfunction caused by an uncontrolled host response to infection, remains a major challenge for clinicians and trialists. The evaluation of therapeutics targeting components of host response anomalies in sepsis patients is complicated by the inability to identify those who are more likely to benefit from a specific intervention. Furthermore, the existence of multiple and diverse host response aberrations in sepsis and limited knowledge of the dysregulated biological organ system or pathway driving sepsis-induced pathology in individual patients further complicate the development of effective therapies.
Article
Infectious Diseases
Jean-Louis Vincent
Summary: Sepsis is an infection associated with organ dysfunction, and early recognition and assessment of severity are crucial.
Correction
Critical Care Medicine
Alberto Fogagnolo, Fabio Silvio Taccone, Jean Louis Vincent, Giulia Benetto, Elaine Cavalcante, Elisabetta Marangoni, Riccardo Ragazzi, Jacques Creteur, Carlo Alberto Volta, Savino Spadaro
Review
Critical Care Medicine
Carlos A. Santacruz, Jean-Louis Vincent, Andres Bader, Luis A. Rincon-Gutierrez, Claudia Dominguez-Curell, David Communi, Fabio S. Taccone
Summary: Studies suggest that altered CSF concentrations of protein biomarkers related to cytoskeletal damage, inflammation, apoptosis, and oxidative stress may predict worse neurological outcomes in patients with acute brain injuries.
Article
Critical Care Medicine
Jean-Louis Vincent, Nicole P. Juffermans, Karen E. A. Burns, V. Marco Ranieri, Chryssa Pourzitaki, Francesca Rubulotta
Summary: There is a significant gender gap in critical care medicine, with women being underrepresented, but gender diversity has beneficial effects. The article discusses the reasons behind gender imbalance and proposes solutions, emphasizing the need to address and eliminate this issue.
Article
Critical Care Medicine
Jean-Louis Vincent, Julia Wendon, Greg S. Martin, Nicole P. Juffermans, Jacques Creteur, Maurizio Cecconi
Summary: The current coronavirus pandemic has heavily impacted ICUs worldwide, putting immense pressure on healthcare systems and staff. It is important to learn from both the positive and negative aspects of the response to improve organization and patient care in the future.
Review
Critical Care Medicine
Nicole P. Juffermans, Cecile Aubron, Jacques Duranteau, Alexander P. J. Vlaar, Daryl J. Kor, Jennifer A. Muszynski, Philip C. Spinella, Jean-Louis Vincent
INTENSIVE CARE MEDICINE
(2020)