tailieunhanh - Báo cáo y học: " Endothelial Respiratory support withdrawal in intensive care units: international differences stressed and straightene"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Endothelial Respiratory support withdrawal in intensive care units: international differences stressed and straightened! | Epker et al. Critical Care 2011 15 405 http content 15 2 405 CRITICAL CARE LETTER L_ Respiratory support withdrawal in intensive care units international differences stressed and straightened Jelle L Epker Yorick J de Groot and Erwin J Kompanje See related research by Fumis and Deheinzelin http content 14 6 R235 We read with great interest the article by Fumis and Deheinzelin 1 in a previous issue of Critical Care. We are convinced that the subject - the withdrawal of respiratory support in intensive care units ICUs - is of interest to the ICU community but think that some of the conclusions are somewhat disputable. First we agree with the authors that family involvement in the withdrawal process is important however this does not necessarily imply that relatives should join in the withdrawal decision-making. This point was already demonstrated by Azoulay and colleagues 2 who showed that direct participation in the withdrawal decision of family members is directly associated with feelings of guilt and the development of post-traumatic stress reactions PTSRs . Second Fumis and Deheinzelin state that European ICU physicians are in comparison with their North American colleagues less inclined to withdraw treatment. This statement is not in concordance with our own experience. The withdrawal rate in our Dutch ICU is 83 of the patients who died in the ICU 3 . This result is fully supported by the ETHICUS Ethics in European Intensive Care Units study which reported that withdrawal of treatment is a generally accepted form of end-of-life care in Europe especially in Northern Europe 4 . Finally in our opinion it is the treating physician who after consultation with colleagues has the knowledge and experience to make a clear and fair judgment concerning the prognosis of a patient. In case of a poor prognosis it is the duty of that physician to make the withdrawal decision clear and acceptable to the patient the relatives and the nurses. Authors