For Immediate Release:
Contact: Christina Shepherd
American Thoracic Society
Tel: 212 315-6440
Fax: 212 315-6455
ETHICS STATEMENT OF FAIR ALLOCATION OF ICU RESOURCES
A Bioethics Task Force of the American Thoracic Society published an
official statement providing an ethical framework for sound decision-making
in the intensive care unit (ICU). The statement was based on the premise
that current cost concerns limits health care services within the ICU when
the benefits to the patient would be marginal. Five principles and 12
position statements were set forth in the report. Among them: "Patient
should have equal access to ICU care regardless of their personal and
behavioral charcteristics. ICU care should provide the patient a certain
degree of potential benefit. When benefit is insufficient, those who are
permanently unscoscious or who suffer from severe irreversible lack of
cognitive function should generally be exluded from ICU care. Whenever
feasible, patients should give their informed consent for initiation and
continuation of ICU care. The statement was published in the October issue
of the American Journal of Respiratory and Critical Care Medicine.
PATIENTS SUFFER WORSENING QUALITY OF LIFE 15 MONTHS AFTER ORIGINAL ACUTE
LUNG INJURY
Researchers attempting to assess health-related quality of life in acute
lung injury survivors found that long after a lung injury occurs, survivors
have significantly lower quality of life than the general population. The
study was carried out at the University of Minnesota and Hennepin County
Medical Center in Minneapolis. Using generic and disease-specific
questionnaires, they found there were self-reported significant levels of
depression and functional limitations. Findings from focus groups revealed
patient concerns with amnesia, depression, avoidance behaviors, and
prlonged recovery period. After initially being inflicted with pneumonia,
sepsis or trauma, many of the acute lung injury patients spent days on
mechanical ventilation. Even after 15 months following the original
injury, they still had frequent and distressing pulmonary and pscychologic
symptoms. Investigators reported that the quality of life profiles of
these patients are significantly worse than the general population, and
resemble those of outpatients with serious, chronic medical conditions.
The report was carried in the October issue of the American Journal of
Respiratory and Critical Care medicine. (Dr. Craig R. Weinert et al,
University of Minnesota)
PHYSICIAN ATTEMPTS NOVEL WAYS TO AVOID MULTIPLE-DRUG RESISTANT BACTERIA IN
HOSPITAL PATIENTS
In an editorial on the need for critical care physicians to deal with the
emergence of multiple-drug resistant bacteria in seriously ill patients,
Dr. Michael Niederman describes approaches begun in his own institution,
including a "crop rotation" theory. He notes that the issues raised by
muti-drug resistant bacteria in the ICU require physicians to become
familiar with all available choices for empiric antibiotic therapy. At
Winthop-University Hospital, he said, staff receive monthly updates about
organisms in the ICU and the patterns of resistance among them. It was
found that antibiotic susceptiblity differs between the ICU and other parts
of the hospital. Thus, the ICU therapeutic choices often differ. If
empiric therapy choices are made with these data in mind, Dr. Neiderman
reasoned, the ICU can probably avoid an increase in resistance patterns.
Physicians, he added, might want to consider the "crop rotation" theory.
With this theory, doctors routinely would vary their "go-to" antibiotic to
minimize the emergence of resistance to a specific drug. In other words,
organisms are explosed to varying antimicrobials. Physicians would vary
the antibiotic used from among the available therapeutic options suggested
by senitivity patterns. He also said that doctors might want to explore
the option of changing the empiric antibiotic choice in a scheduled
fashion, using one type of antibiotics for the first six months and another
type for the next six months. Both types of antibiotic rotation might then
minimize the development of resistance over time. Even if newer and
potentially more expensive drugs had to be used, he said, this approach
might prove to be highly cost-effective in a longer time frame. Dr.
Niederman's editorial was carried in the October issue of the American
Journal of Respiratory and Critical Care Medicine.
For the complete text ov these articles or for more information, contact:
Christina Shepherd at the American Thoracic Society at (212) 315-6440 or
fax her at (212) 315-6455.
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