Paper reports overview First do no harm the aftermath of intensive care 英文参考文献.docVIP

/content/4/4/235 Paper reports First do no harm: the aftermath of intensive care Adrian Mellor New South Wales Medical Retrieval Service, Westmead Hospital, Sydney, New South Wales, Australia Crit Care 2000,4:235–236 ? Current Science Ltd Intensivists may be unaware of the longer term conse- quences of intensive therapies for their patients, and several paper reports in the present issue focus on the post-intensive care unit (ICU) hospital and community morbidity and mortality. This of course encompasses ethical issues concerning the futility of intensive care in certain circumstances, and the elderly population is high- lighted in this context. Avoidance of toxic or invasive thera- pies may reduce the need for ICU treatment, or at least reduce the time spent in the ICU, and is the subject of several paper reports. Hopefully, this may impact positively on post-ICU morbidity and mortality. scant, it appears that only 50% of the patients discharged were alive after 2 years. Unfortunately, the mortality figure for the patients who required haemodialysis was not quoted in the paper. These two reports raise the contentious issue of resource use and whether surgery for ruptured AAA and haemodial- ysis should be considered in elderly patients. With the ever present pressure on ICU beds and the seemingly hopeless outcome, it would not appear to be in the patien- t’s (or institution’s) best interests to perform emergency AAA repair in this age group. More data should be forth- coming from the Vascular Anaesthetic Society audit. Milner et al examined the 5-year mortality from emergency abdominal aortic aneurysm (AAA) repair. That retrospec- tive study examined the records of 99 patients, and found an ICU survival rate of 40.4% and a rate of survival to hos- pital discharge of 31.3%. Eleven patients required hae