Raising awareness for time-limited trial discussion upon ICU triage and admission

Cheung, Emmanuel Hei-Lok; Cheung, Jonathan Chun-Hei; Yip, Yu-Yeung

doi:10.1007/s00134-021-06590-0

Cited by 15 publications

(11 citation statements)

References 5 publications

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“…193 194 195 196 197 198 Time-limited treatment trials may also play a central role in settings of uncertainty. 199…”

Section: Acute Care Phasementioning

confidence: 99%

“…[193][194][195][196][197][198] Time-limited treatment trials may also play a central role in settings of uncertainty. 199 In further efforts to inform and harmonize practice standards on decision-making, clinical guidelines also contain evidence-based recommendations for prognostication following severe brain injury and discussion with families. 140,141 Advanced neuroimaging and electrophysiologic techniques are recommended in select cases, as well as discussing prognosis with families with evidence-based language.…”

Section: Acute Care Phasementioning

confidence: 99%

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Neuroethics across the Disorders of Consciousness Care Continuum

Young

Peterson

2022

Semin Neurol

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This review provides an ethical analysis of disorders of consciousness (DoC) along the care continuum, from preinjury to injury, acute care to subacute care and early rehabilitation, and finally transitioning to chronic rehabilitation and societal reintegration. We provide an actionable, chronological assessment of ethical issues related to DoC care. This expands upon established ethics literature, which focuses almost exclusively on the clinical encounter for DoC. Our goal is to broaden the aperture of ethical analysis to address how social and environmental conditions predispose some persons to brain injury, and how such conditions might also pose barriers to meaningful societal reintegration after recovery.

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“…193 194 195 196 197 198 Time-limited treatment trials may also play a central role in settings of uncertainty. 199…”

Section: Acute Care Phasementioning

confidence: 99%

Section: Acute Care Phasementioning

confidence: 99%

Neuroethics across the Disorders of Consciousness Care Continuum

Young

Peterson

2022

Semin Neurol

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“…It has been proposed that, in the context of a pandemic, all admissions to the ICU and interventions that are started should be considered as “time-limited trials” based on pre-defined treatment goals [ 18 ], as has been suggested outside of COVID-19 when patient outcomes are not certain [ 19 , 20 ]. If the treatment goals are not met within a set time, and it is considered that further or continued intervention is futile or disproportionate, supportive therapies could then be withdrawn and/or the patient discharged from the ICU so that resources can be re-allocated to give others a chance to benefit [ 21 ].…”

Section: Resource Allocation and Triagementioning

confidence: 99%

Ethical Lessons from an Intensivist’s Perspective

Vincent

2022

JCM

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Intensive care units (ICUs) around the world have been hugely impacted by the SARS-CoV-2 pandemic and the vast numbers of patients admitted with COVID-19, requiring respiratory support and prolonged stays. This pressure, with resulting shortages of ICU beds, equipment, and staff has raised ethical dilemmas as physicians have had to determine how best to allocate the sparse resources. Here, we reflect on some of the major ethical aspects of the COVID-19 pandemic, including resource allocation and rationing, end-of-life decision-making, and communication and staff support. Importantly, these issues are regularly faced in non-pandemic ICU patient management and useful lessons can be learned from the discussions that have occurred as a result of the COVID-19 situation.

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“…We thank Donaldson [ 1 ] for his tremendous interest in our discussion of time-limited trial (TLT) of intensive care [ 2 , 3 ]. We are grateful that Donaldson concurred with us that “the clinical uncertainty inherent in ICU triage will, in many contexts, make exact prognostication impossible” [ 1 ].…”

mentioning

confidence: 99%

“…While Donaldson questioned whether the patient would be able to provide an adequately informed consent in the context of uncertain survival benefit, we would like to reiterate our stance on TLT: it acknowledges the inherent clinical uncertainties faced by the patient and medical team and intends to prevent invasive interventions in intensive care unit (ICU) from being extended until the appropriateness of such treatment can be more accurately assessed [ 2 ]. It involves shared decision-making, requiring the clinicians to communicate with the patient and family, identifying their values, and weighing them against the possible harm associated with invasive organ support [ 3 ].…”

mentioning

confidence: 99%