Ethics roundtable debate: should a sedated dying patient be wakened to say goodbye to family?

Intensivists have the potential to maintain vital signs almost indefinitely, but not necessarily the potential to make moribund patients whole. Current ethical and legal mandates push patient autonomy to the forefront of care plans. When patients are incapable of expressing their preferences, surrogates are given proxy. It is unclear how these preferences extend to the very brink of inevitable death. Some say that patients should have the opportunity and authority to direct their death spiral. Others say it would be impossible for them to do so because an inevitable death spiral cannot be effectively palliated. Humane principles dictate they be spared the unrelenting discomfort surrounding death. The present case examines such a patient and the issues surrounding a unique end-of-life decision

Review Article - Role of ICU in the management of the acute abdomen

Patients with an AA often need to be admitted to an Intensive Care Unit peri-operitavely for monitoring and management of surgical and medical complications. Septic sequelae may necessitate repeated abdominal interventions, either percutaneous aspiration and drain placement or repeated laprotomies. Major systems may require support with fluids, inotropes, airway care, ventilation and renal replacement therapy. Other supportive care include nutrition, good nursing care and wound care. Newer evidence suggests that blood or packed red blood cells, albumin and anabolic steroids should be avoided or used sparingly. Early immune enhancing enteral nutrition and tight control of blood sugar may help decrease secondary infections and mortality. Low dose steroids may have a limited role in patients requiring inotropes support, and a novel therapy, the use of recombinant activated Protein C may decrease mortality in patients with severe sepsis. ICUs which offer consultant based structured services have lower mortality, lower complications, shorter duration of mechanical ventilation, shorter lengths of ICU and hospital stay and lower costs when caring for these critically ill patients

The cost implications of surveillance of ICU infections

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Effects of mobile phone use on specific intensive care unit devices

Background and Aims: To observe the effects of mobile phone use in the vicinity of medical devices used in a critical care setting. Subjects and Methods: Electromagnetic interference (EMI) was tested by using two types of mobile phones - GSM and CDMA. Mobile phones were placed at a distance of one foot from three medical devices - syringe pump, mechanical ventilator, and the bedside monitor - in switch off, standby, and talking modes of the phone. Medical devices were observed for any interference caused by the electromagnetic radiations (EMR) from the mobile phones. Results: Out of the three medical devices that were tested, EMI occurred while using the mobile phone in the vicinity of the syringe pump, in the ′talk mode.′ The mean variation observed in the calculated and delivered volume of the syringe pump was 2.66 ml. Mechanical ventilator did not show any specific adverse effects with mobile phone use in the one-foot vicinity. No other adverse effects or unexplained malfunctions or shutdown of the syringe pump, mechanical ventilator, or the bedside monitor was noted during the study period of 36 hours. Conclusion: EMI from mobile phones have an adverse effect on the medical devices used in critical care setup. They should be used at least one foot away from the diameter of the syringe pump