The current state of medical technology and critical care support is such that people who never had a chance of survival a generation ago routinely leave the hospital and return to productive lives. The unfortunate side effect of this remarkable advance is that not all patients fare so well. The patient rapidly delivered to tertiary care for resuscitation only to be found to have a lethal central nervous system disease is a common occurrence on trauma and critical care services. The concept of the nonsalvageable patient and the role of futile care has become a regular part of conversations among medical staff at all levels—physician, nursing, resident, medical student, and allied health professional. Recognition of this patient is not always simple. We will argue these issues among ourselves. Who is nonsalvageable? What care is futile? How do we broach this with the families of these patients?
KeywordsIntensive Care Unit Brain Death Diabetes Insipidus Disseminate Intravascular Coagulation Organ Procurement
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- 2.Knaus WA. Prognosis with mechanical ventilation: the influence of disease, severity of disease, age, and chronic health status on survival from an acute illness. Am Rev Repir Dis 1989; 140:S8–S13.Google Scholar
- 9.Brennan TA. Physicians and futile care: using ethics committees to slow the momentum. Law Medicine Health Care 1992; 20(4):336–339.Google Scholar
- 11.Miles SH. Medical futility. Law Medicine Health Care 1992; 20(4):310–315.Google Scholar
- 13.Stroud R. The withdrawal of life support in adult intensive care: an evaluative review of the literature. Nursing Crit Care 2002; 7(4):176–184.Google Scholar
- 14.Blake DC. Bioethics and the law: the case of Helga Wanglie: a clash at the bedside–medically futile treatment v. patient autonomy. Whittier Law Rev 1993; 14:119–128.Google Scholar
- 15.Joint Commission on Accreditation of Healthcare Organizations. Comprehensive Accreditation Manual for Hospitals, 2004; Ethics, Rights and Responsibilities Standards. Washington, DC: JCAHO, 2004.Google Scholar
- 18.Brody H, Campbell ML, Faber-Langendoen K. Withdrawing intensive life-sustaining treatment—recommendations for compassionate clinical management. N Engl J Med 1997; 336(9):652–657.Google Scholar
- 25.A definition of irreversible coma: report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968; 205:337–340.Google Scholar
- 26.Uniform Determination of Death Act, 12 Uniform Laws Annotated (U.L.A.) 589 (West 1993 and West Supp. 1997).Google Scholar
- 27.The Quality Standards Subcommittees of the American Academy of Neurology. Practice parameters for determining brain death in adults. Neurology 1995; 45:1012–1014.Google Scholar
- 30.American Academy of Pediatrics Task Force on Brain Death in Children. Report of special task force: guidelines for the determination of brain death in children. Pediatrics 1987; 80:298–300.Google Scholar
- 32.Novitzky D, Hicomb WN, Cooper DKC, et al. Electrocardiographic, hemodynamic and endocrine changes occurring during experimental brain death in the Chacma baboon. J Heart Transplant 1984; 4:63–69.Google Scholar
- 44.Hirsch L, Matzner MP, Huber WO, et al. Effect of desmopressin substitution during organ procurement on early renal allograft function. Nephrol Dial Transplant 1996; 11:173–176.Google Scholar