ABSTRACT
El Grupo de Trabajo de Bioética de la SEMICYUC ha elaborado las recomendaciones en la toma de decisiones de limitación de tratamientos de soporte vital con la aspiración de disminuir la variabilidad en la práctica clínica observada y de contribuir a la mejora de los cuidados al final de la vida del paciente crítico. Además de abordar el marco conceptual de la limitación de tratamientos de soporte vital y de la futilidad, desarrolla las nuevas formas de limitación extendiéndola a la adecuación de otros tratamientos y métodos diagnósticos, además de planificar los posibles cursos evolutivos tras la decisión de limitación de tratamientos de soporte vital. Se enfatiza la importancia de la planificación compartida de la asistencia sanitaria en la toma de decisiones, se presentan los cuidados intensivos orientados a la donación y se promueve la integración de los cuidados paliativos en el tratamiento del paciente crítico en estadios del final de la vida en UCI
The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Bioethics Working Group has developed recommendations on the Limitation of Advanced Life Support Treatment (LLST) decisions, with the aim of reducing variability in clinical practice and of improving end of life care in critically ill patients. The conceptual framework of LLST and futility are explained. Recommendations referred to new forms of LLST encompassing also the adequacy of other treatments and diagnostic methods are developed. In addition, planning of the possible clinical courses following the decision of LLST is commented. The importance of advanced care planning in decision-making is emphasized, and intensive care oriented towards organ donation at end of life in the critically ill patient is described. The integration of palliative care in the critical patient treatment is promoted in end of life stages in the Intensive Care Unit
Subject(s)
Humans , Decision Making , Life Support Care/standards , Critical Care/standards , Life Support Care/statistics & numerical data , Hospice Care/ethics , Hospice Care/standards , Intensive Care UnitsABSTRACT
The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Bioethics Working Group has developed recommendations on the Limitation of Advanced Life Support Treatment (LLST) decisions, with the aim of reducing variability in clinical practice and of improving end of life care in critically ill patients. The conceptual framework of LLST and futility are explained. Recommendations referred to new forms of LLST encompassing also the adequacy of other treatments and diagnostic methods are developed. In addition, planning of the possible clinical courses following the decision of LLST is commented. The importance of advanced care planning in decision-making is emphasized, and intensive care oriented towards organ donation at end of life in the critically ill patient is described. The integration of palliative care in the critical patient treatment is promoted in end of life stages in the Intensive Care Unit.
Subject(s)
Clinical Decision-Making/methods , Decision Making, Shared , Life Support Care/methods , Terminal Care/methods , Airway Extubation , Burnout, Professional/prevention & control , Communication , Critical Illness , Humans , Medical Futility , Palliative Care , Quality Indicators, Health Care , Resuscitation Orders , Tissue and Organ Procurement/ethics , Treatment Refusal , Withholding TreatmentABSTRACT
No disponible
Subject(s)
Humans , Critical Care/trends , Hospice Care , Interdisciplinary Communication , Palliative Care/organization & administration , Intensive Care Units/standards , Societies, Medical/organization & administrationSubject(s)
Palliative Care/methods , Patient Care Team , Terminal Care/methods , Critical Illness , HumansABSTRACT
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Arteriovenous Fistula/physiopathology , Arteriovenous Fistula/surgery , Arteriovenous Fistula , Carotid Artery, Internal/physiopathology , Carotid Artery, Internal , Radionuclide Angiography/methods , Aortic Valve Stenosis/complications , Diverticulitis/complications , Systolic Murmurs/complications , Vertebral Artery/injuries , Vertebral ArteryABSTRACT
No disponible
Subject(s)
Humans , Compression Bandages , Decompressive Craniectomy , Life Support Care/ethics , Bioethical IssuesABSTRACT
No disponible
Subject(s)
Humans , Hospice Care/ethics , /ethics , Compression Bandages , Decompressive Craniectomy , Tissue and Organ Procurement/ethicsABSTRACT
La mayoría de los órganos trasplantados proceden de donantes fallecidos en muerte encefálica (ME). En pacientes neurocríticos con lesiones catastróficas y craniectomía descompresiva (CD) que tienen una pésima evolución a pesar de todo el tratamiento, la CD puede llegar a ser una medida fútil que impida la evolución natural hacia la ME. Planteamos si realizar un vendaje compresivo pericraneal (craneoplastia con vendaje) puede ser una práctica éticamente correcta y comparable a otras formas habituales de limitación del tratamiento de soporte vital (LTSV).A partir de un caso clínico, realizamos una consulta al Comité de Ética Asistencial y a expertos bioéticos, formulando las siguientes cuestiones: 1) En pacientes que se decide la LTSV ¿es éticamente correcto realizar una craneoplastia con vendaje? 2) ¿Es preferible esta opción considerando una posible donación de órganos? Conclusiones 1) La craneoplastia con vendaje puede ser considerada una forma de LTSV éticamente aceptable y similar a otros procedimientos 2) Facilita la donación de órganos para trasplante, lo que aporta valor añadido por el bien social correspondiente 3) En estos casos, es necesario conocer las instrucciones previas del paciente y en su ausencia, obtener el consentimiento familiar por delegación tras un informe detallado del procedimiento (AU)
Most of transplanted organs are obtained from brain death (BD) donors. In neurocritical patients with catastrophic injuries and decompressive craniectomy (DC), which show a dreadful development in spite of this treatment, DC could be a futile tool to avoid natural progress to BD. We propose if cranial compressive bandage (cranioplasty with bandage) could be an ethically correct practice, similar to other life-sustaining treatment limitation (LSTL) common methods. Based on a clinical case, we contacted with the Assistance Ethics Committee and some bioethics professionals asking them two questions: 1) Is ethically correct to perform acranioplasty with bandage in those patients with LSTL indication? 2) Thinking in organ donation possibility, is this option preferable? Conclusions 1) Cranioplasty with bandage could be considered an ethically acceptable LSTL practice, similar to other procedures. 2) It facilitates organ donation for transplant, which provides value-added because of its own social good. 3) In these cases, it is necessary to know previous patient's will or, in absentia, to obtain family consent after a detailed procedure report (AU)
Subject(s)
Humans , Advanced Cardiac Life Support , Brain Death , Decompressive Craniectomy , Tissue and Organ Procurement/ethics , Tissue Donors/ethicsABSTRACT
Most of transplanted organs are obtained from brain death (BD) donors. In neurocritical patients with catastrophic injuries and decompressive craniectomy (DC), which show a dreadful development in spite of this treatment, DC could be a futile tool to avoid natural progress to BD. We propose if cranial compressive bandage (cranioplasty with bandage) could be an ethically correct practice, similar to other life-sustaining treatment limitation (LSTL) common methods. Based on a clinical case, we contacted with the Assistance Ethics Committee and some bioethics professionals asking them two questions: 1) Is ethically correct to perform a cranioplasty with bandage in those patients with LSTL indication? 2) Thinking in organ donation possibility, is this option preferable? Conclusions 1) Cranioplasty with bandage could be considered an ethically acceptable LSTL practice, similar to other procedures. 2) It facilitates organ donation for transplant, which provides value-added because of its own social good. 3) In these cases, it is necessary to know previous patient's will or, in absentia, to obtain family consent after a detailed procedure report.
Subject(s)
Brain Injuries/surgery , Decompressive Craniectomy/ethics , Decompressive Craniectomy/statistics & numerical data , Life Support Care/ethics , Tissue and Organ Procurement/ethics , Tissue and Organ Procurement/methods , Adult , Humans , MaleABSTRACT
No disponible
Subject(s)
Humans , Tissue Donors/supply & distribution , Tissue and Organ Procurement/methods , Informed Consent/ethicsABSTRACT
La Resucitación Cardiopulmonar (RCP) se debe aplicar si está indicada, omitirse si no está o no ha sido previamente aceptada por el paciente y suspenderse si es inefectiva. Si la RCP se previera fútil, se registrará una Orden de No Intentar la Resucitación, que deberá ser conocida por los profesionales sanitarios que atienden al enfermo. Es aceptable limitar el soporte vital a los supervivientes con encefalopatía anóxica, si se descarta la posibilidad de que evolucionen a muerte encefálica. Tras la RCP se debe informar y apoyar a la familia del paciente, y revisar el procedimiento realizado para mejorarlo. Previa limitación del soporte vital se podría plantear cierto tipo de donación de órganos a corazón parado. Adquirir competencia en RCP precisa practicar con simuladores y, en ocasiones, sobre cadáveres recientes, siempre con permiso. La investigación sobre RCP es imprescindible, respetando leyes y normas éticas de excelencia (AU)
Cardiopulmonary Resuscitation (CPR) must be attempted if indicated, not done if it is not indicated or if the patient does not accept or has previously rejected it and withdrawn it if it is ineffective. If CPR is considered futile, a Do-Not-Resuscitate Order (DNR) will be recorded. This should be made known to all physicians and nurses involved in patient care. It may be appropriate to limit life-sustaining-treatments for patients with severe anoxic encephalopathy, if the possibility of clinical evolution to brain death is ruled out. After CPR it is necessary to inform and support families and then review the process in order to make future improvements. After limitation of vital support, certain type of non-heart-beating-organ donation can be proposed. In order to acquire CPR skills, it is necessary to practice with simulators and, sometimes, with recently deceased, always with the consent of the family. Research on CPR is essential and must be conducted according to ethical rules and legal frameworks (AU)
Subject(s)
Humans , Cardiopulmonary Resuscitation/ethics , Heart Arrest/therapy , Advanced Cardiac Life Support/ethics , Resuscitation Orders/ethics , Tissue Donors/ethicsABSTRACT
Cardiopulmonary Resuscitation (CPR) must be attempted if indicated, not done if it is not indicated or if the patient does not accept or has previously rejected it and withdrawn it if it is ineffective. If CPR is considered futile, a Do-Not-Resuscitate Order (DNR) will be recorded. This should be made known to all physicians and nurses involved in patient care. It may be appropriate to limit life-sustaining-treatments for patients with severe anoxic encephalopathy, if the possibility of clinical evolution to brain death is ruled out. After CPR it is necessary to inform and support families and then review the process in order to make future improvements. After limitation of vital support, certain type of non-heart-beating-organ donation can be proposed. In order to acquire CPR skills, it is necessary to practice with simulators and, sometimes, with recently deceased, always with the consent of the family. Research on CPR is essential and must be conducted according to ethical rules and legal frameworks.
Subject(s)
Cardiopulmonary Resuscitation/ethics , Aftercare , Cardiopulmonary Resuscitation/education , Decision Making/ethics , Euthanasia, Passive , Family , Forms and Records Control , Humans , Hypoxia, Brain/therapy , Medical Futility , Medical Records , Professional-Family Relations , Research , Resuscitation Orders , Spain , Third-Party Consent , Tissue and Organ Harvesting/ethics , Tissue and Organ Harvesting/legislation & jurisprudence , Withholding TreatmentABSTRACT
No disponible
Subject(s)
Humans , Clinical Trials as Topic/ethics , Confidentiality/ethics , Confidentiality/standards , Bioethical Issues , Societies, Medical , SpainABSTRACT
El objetivo fundamental de la Medicina Intensiva es la atenciónal paciente crítico, es decir, personas con una enfermedad ocondición amenazante para su vida pero con posibilidades derecuperación; a pesar de los tratamientos, incluidos los de soportevital, con frecuencia no se consigue la curación y es entoncescuando se plantea la retirada de los mismos por criterios de futilidad.Una vez adoptada esa decisión los esfuerzos deben dirigirsea aplicar los cuidados necesarios para conseguir un final de lavida sin dolor ni sufrimiento, procurando que el paciente estéacompañado de sus seres queridos. Estudios realizados muestranlas lagunas formativas y asistenciales que existen en la atención alos pacientes en el final de la vida dentro del ámbito de las Unidadesde Medicina Intensiva. El presente artículo revisa la aportaciónque los Cuidados Paliativos pueden ofrecer para mejorar laasistencia a los enfermos que fallecen en UMI y a sus familiares.La ontología de cuidados paliativos tiene como objetivos la mejoríasintomática, la prevención de las posibles complicaciones,conocer y respetar los criterios de bienestar del paciente y laatención a la familia en el proceso final y en el duelo. Por tanto,implica a diversas disciplinas del campo de la salud y las impelena trabajar con objetivos comunes. En situaciones de final de lavida el conocimiento y la sensibilidad de los profesionales tienenque estar al servicio del compromiso de fidelidad con el pacienteque permita reorientar los esfuerzos terapéuticos hacia los objetivospropuestos
The basic aim of Intensive Care Medicine is care for thecritical patient, that is, persons with a disease or condition thatis life-threatening but with possibilities of recovery. In spite ofthe treatments, even those involving life support, cure isfrequently not achieved and this is when the question is raisedof withdrawing treatment due to criteria of futility. Once thatdecision is taken, efforts must be directed towards applying thenecessary care to achieve an end to life without pain orsuffering, endeavouring to ensure that the patient isaccompanied by his loved ones. Studies show the shortcomingsin training and health care that exist in caring for patients at theend of their lives within the sphere of the Intensive Care Units.This article reviews the contribution that can be made byPalliative Care in improving care for patients that die in the ICUand for their relatives. The ontology of palliative care aims toachieve an improvement of symptoms, the prevention ofpossible complications, to determine and respect the welfare ofthe patient, and to help the family in the final process and inmourning. It therefore involves different disciplines from thehealth field which must work with common aims. In situations ofthe end of life the knowledge and sensitivity of the professionalsmust be at the service of faithful commitment to the patient,making it possible to redirect therapeutic efforts towards theproposed aims
Subject(s)
Humans , Intensive Care Units , Palliative Care/ethics , Palliative Care/methods , Intensive Care Units/ethicsABSTRACT
No disponible
