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Ethics roundtable: 'Open-ended ICU care: Can we afford it?'

Crippen, D and Burrows, D and Stocchetti, N and Mayer, SA and Andrews, P and Bleck, T and Whetstine, L (2010) Ethics roundtable: 'Open-ended ICU care: Can we afford it?'. Critical Care, 14 (3). ISSN 1364-8535

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The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months, he has been in status epilepticus (SE) on high doses of barbiturates, benzodiazepines, and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on continuous electroencephalography (EEG). He is trached and has a percutaneous endoscopic gastrostomy (PEG) feeding tube. He has been treated several times for pneumonia, and he is on a warming blanket and is on vasopressors to maintain his blood pressure. His vitals are stable and his lab work is within limits. The sedation is decreased under EEG guidance every 72 hours, after which he goes back into SE and heavy sedation is resumed. The latest magnetic resonance imaging (MRI) shows edema but otherwise no obvious permanent cortical damage. The family wants a realistic assessment of the likely outcome. The neurologist tells them the literature suggests the outlook is poor but not 100% fatal. As long as all of his other organs are functioning on life support, there is always a chance the seizures will stop at some time in the future, and so the neurologist recommends an open-ended intensive care unit (ICU) plan and hopes for that outcome. © 2010 BioMed Central Ltd.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Crippen, Dcrippen@pitt.eduCRIPPEN
Burrows, D
Stocchetti, N
Mayer, SA
Andrews, P
Bleck, T
Whetstine, L
Date: 21 July 2010
Date Type: Publication
Journal or Publication Title: Critical Care
Volume: 14
Number: 3
DOI or Unique Handle: 10.1186/cc8962
Schools and Programs: School of Medicine > Critical Care Medicine
Refereed: Yes
ISSN: 1364-8535
Article Type: Review
Date Deposited: 10 Nov 2016 18:29
Last Modified: 04 Feb 2019 15:58


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