The Durban World Congress Ethics Round Table: III. Withdrawing Mechanical ventilation-the approach should be individualized
Ethics; Life-sustaining treatments; Mechanical ventilation; Withdrawing; Withholding
PURPOSE: The purpose of this study is to determine the approaches used in withdrawing mechanical ventilator support. MATERIALS AND METHODS: Speakers from the invited faculty of the World Federation of Societies of Intensive and Critical Care Medicine Congress in 2013 with an interest in ethics were asked to provide a detailed description of individual approaches to the process of withdrawal of mechanical ventilation. RESULTS: Twenty-one participants originating from 13 countries, responded to the questionnaire. Four respondents indicated that they do not practice withdrawal of mechanical ventilation, and another 4 indicated that their approach is highly variable depending on the clinical scenario. Immediate withdrawal of ventilation was practiced by a large number of the respondents (7/16; 44%). A terminal wean was practiced by just more than a third of the respondents (6/16; 38%). Extubation was practiced in more than 70% of instances among most of the respondents (9/17; 53%). Two of the respondents (2/17; 12%) indicated that they would extubate all patients, whereas 14 respondents indicated that they would not extubate all their patients. The emphasis was on tailoring the approach used to suit individual case scenarios. CONCLUSIONS: Withdrawing of ventilator support is not universal. However, even when withdrawing mechanical ventilation is acceptable, the approach to achieve this end point is highly variable and individualized.
2014-06
Paruk F; Kissoon N; Hartog CS; Feldman C; Hodgson ER; Lipman J; Guidet B; Du Bin; Argent A; Sprung CL
Journal Of Critical Care
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.jcrc.2014.05.022" target="_blank" rel="noreferrer">10.1016/j.jcrc.2014.05.022</a>
Death in the ICU: When Comfort Is Therapeutic*
2014-09
Kissoon N; d’Agincourt-Canning Lori
Critical Care Medicine
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/CCM.0000000000000538" target="_blank" rel="noreferrer">10.1097/CCM.0000000000000538</a>
Pediatric out-of-hospital deaths following hospital discharge: a mixed-methods study
Child Mortality; Infant Mortality; Caregivers/psychology; Child; Communicable Diseases/ mortality; Educational Status; Female; Health Services Accessibility/ statistics & numerical data; Humans; infant; infectious diseas; Length of Stay; Logistic Models; Male; Patient Acceptance of Health Care/psychology; Patient Discharge/ statistics & numerical data; Pediatrics; post-discharge mortality; Preschool; qualitative interviews; Time Factors; Uganda; Uganda/epidemiology; Water Supply
BACKGROUND: Out-of-hospital death among children living in resource poor settings occurs frequently. Little is known about the location and circumstances of child death following a hospital discharge. OBJECTIVES: This study aimed to understand the context surrounding out-of-hospital deaths and the barriers to accessing timely care for Ugandan children recently discharged from the hospital. METHODS: This was a mixed-methods sub-study within a larger cohort study of post-discharge mortality conducted in the Southwestern region of Uganda. Children admitted with an infectious illness were eligible for enrollment in the cohort study, and then followed for six months after discharge. Caregivers of children who died outside of the hospital during the six month post-discharge period were eligible to participate in this sub-study. Qualitative interviews and univariate logistic regression were conducted to determine predictors of out-of-hospital deaths. RESULTS: Of 1,242 children discharged, 61 died during the six month post-discharge period, with most (n=40, 66%) dying outside of a hospital. Incremental increases in maternal education were associated with lower odds of out-of-hospital death compared to hospital death (OR: 0.38, 95% CI: 0.19 - 0.81). The qualitative analysis identified health seeking behaviors and common barriers within the post-discharge period which delayed care seeking prior to death. For recently discharged children, caregivers often expressed hesitancy to seek care following a recent episode of hospitalization. CONCLUSION: Mortality following discharge often occurs outside of a hospital context. In addition to resource limitations, the health knowledge and perceptions of caregivers can be influential to timely access to care. Interventions to decrease child mortality must consider barriers to health seeking among children following hospital discharge.
2016-12
English L; Kumbakumba E; Larson CP; Kabakyenga J; Singer J; Kissoon N; Ansermino JM; Wong H; Kiwanuka J; Wiens MO
African Health Sciences
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.4314/ahs.v16i4.2" target="_blank" rel="noreferrer">10.4314/ahs.v16i4.2</a>
Body mass index and the risk of acute injury in adolescents
adolescent; Obesity; Body Mass Index; Overweight; Paediatrics; Wound and injuries
OBJECTIVE: To evaluate the relationship between body mass index (BMI) and acute injury in adolescents. METHODS: An analysis of cross-sectional data from the Canadian Community Health Survey (CCHS) Cycle 3.1 collected by Statistics Canada in 2005 was conducted. The CCHS is a population-based survey that collects information pertaining to the Canadian population health status, health care use and health determinants. The CCHS Cycle 3.1 included 132,221 respondents, of whom 12,317 were 12 to 17 years of age. Multivariate logistic regression was used to estimate the odds of injury occurrence by BMI categories (obese, overweight and neither). RESULTS: The association between overweight and obese BMI levels and injury occurrence in the bivariate model was not significant after adjusting for sex, health status, activity levels and socioeconomic status (OR=1.10 [95% CI 0.97 to 1.24] for overweight and OR=1.12 [95% CI 0.92 to 1.37] for obesity). A subanalysis of those with an injury in the past 12 months found an elevated odds of experiencing multiple injuries in the overweight group, after adjusting for age, health status and physical activity level (OR=1.43 [95% CI 1.16 to 1.77]). CONCLUSION: An increased risk of acute injury in obese and overweight adolescents was not observed. However, the subgroup analysis suggested that multiple injuries are relatively frequent in the overweight BMI group.
2010-07
Doan Q; Koehoorn M; Kissoon N
Paediatrics & Child Health
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1093/pch/15.6.351" target="_blank" rel="noreferrer">10.1093/pch/15.6.351</a>
Clinical research ethics for critically ill patients: a pandemic proposal
Humans; Critical Illness; Research; Informed Consent; Disease Outbreaks; Ethics; Ethics Committees; Human; H1N1 Subtype; Influenza; Influenza A Virus
Pandemic H1N1 influenza is projected to be unprecedented in its scope, causing acute critical illness among thousands of young otherwise healthy adults, who will need advanced life support. Rigorous, relevant, timely, and ethical clinical and health services research is crucial to improve their care and outcomes. Studies designed and conducted during a pandemic should be held to the same high methodologic and implementation standards as during other times. However, unique challenges arise with the need to conduct investigations as efficiently as possible, focused on the optimal outcome for the individual patient, while balancing the need for maximal societal benefit. We believe that clinical critical care research during a pandemic must be approached differently from research undertaken under nonemergent circumstances. We propose recommendations to clinical investigators and research ethics committees regarding clinical and health services research on pandemic-related critical illness. We also propose strategies such as expedited and centralized research ethics committee reviews and alternate consent models.
2010
Cook D; Burns K; Finfer S; Kissoon N; Bhagwanjee S; Annane D; Sprung CL; Fowler R; Latronico N; Marshall J
Critical Care Medicine
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/CCM.0b013e3181cbaff4" target="_blank" rel="noreferrer">10.1097/CCM.0b013e3181cbaff4</a>