RESUMEN
The process recommendations of the Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) for ethically based decision-making in intensive care medicine are intended to create the framework for a structured procedure for seriously ill patients in intensive care. The processes require appropriate structures, e.g., for effective communication within the treatment team, with patients and relatives, legal representatives, as well as the availability of palliative medical expertise, ethical advisory committees and integrated psychosocial and spiritual care services. If the necessary competences and structures are not available in a facility, they can be consulted externally or by telemedicine if necessary. The present recommendations are based on an expert consensus and are not the result of a systematic review or a meta-analysis.
Asunto(s)
Cuidados Críticos , Toma de Decisiones , Medicina de Emergencia , Humanos , Cuidados Críticos/normas , Medicina de Emergencia/normas , Telemedicina , AlemaniaRESUMEN
The treatment situation in intensive care is characterised by a specific asymmetry in the relationship between patients and the team: Patients are particularly dependent on their environment and often show impaired consciousness and capacity to consent. This facilitates the use of coercion or enables and/or provokes it. The aim of this recommendation is to show ways to recognise patients with their wishes and needs and to integrate them into treatment concepts in the intensive care unit in order to reduce and avoid coercion whenever possible. The recommendation shows the variety of possible forms of coercion and discusses the moral standards to be considered in the ethical weighing process as well as legal conditions for justifying its use. It becomes obvious that treatment measures which may involve the use of coercion always require a careful and self-critical review of the measures in relation to the indication and the therapeutic goal. The recommendation's intention therefore is not to disapprove the use of coercion by interprofessional teams. Instead, it aims to contribute to a sensitive perception of coercion and to a critical and caring approach to formal and especially informal (indirect) coercion.
Asunto(s)
Coerción , Medicina de Emergencia , Cuidados Críticos , Humanos , Unidades de Cuidados IntensivosRESUMEN
Analysis of the recovery period following physical exercise has gained importance in evaluating cardiopulmonary capacity, not only in athletes but also in patients with proven or suspected heart failure. The purpose of this study was to apply these methods to long-term survivors of acute lymphoblastic leukemia (ALL) in childhood, who are at risk of developing anthracycline-induced cardiomyopathy. Nine children (mean age 12 years) and 10 adults (mean age 24 years) were included in the study after treatment for childhood ALL. Recovery of oxygen uptake and heart rate following maximal spiroergometric exercise was compared to that in 29 trained and untrained age-matched controls. The change in oxygen uptake (DeltaVO2) and heart rate (DeltaHR) between maximal effort and 60 s of recovery did not differ significantly, either between children after oncological therapy (DeltaVO2: 14.95 ml/kg, DeltaHR: 35 bpm) and healthy children (DeltaVO2: 15.85 ml/kg, DeltaHR: 37 bpm), or between adult former oncological patients (DeltaVO2: 13.1 ml/kg, DeltaHR: 27 bpm) and untrained adults (DeltaVO2: 15.7 ml/kg, DeltaHR: 31 bpm). There was, however, a significant difference in DeltaVO2 between trained adults (DeltaVO2: 24.5 ml/kg) and both untrained adult controls (DeltaVO2: 15.7 ml/kg, p=0.004) and adult patients (DeltaVO2: 13.1 ml/kg, p=0.0002). This difference was not detected for heart rate. In conclusion, the recovery period did not reveal a discernible difference in cardiopulmonary capacity between former ALL patients and untrained age-matched controls. We did confirm that heart rate and oxygen uptake recovery serve as indicators of physical fitness.