Continuation of Treatment in Chronic Critical Illness
Posted Jul 07 2009 9:40pm
Sharon Camhi and colleagues at the VA Pittsburgh Health Care System had an article in the March Critical Care Medicine,titled “Deciding in the Dark: Advance Directives and Continuation of Treatment in Chronic Critical Illness.”
First, “chronic critical illness” is a great term that I am not sure I’ve heard before. Camhi et al. explain: “Chronic critical illness is a devastating syndrome for which treatment offers limited clinical benefit but imposes heavy burdens on patients, families, clinicians, and the health care system. We studied the availability of advance directives and appropriate surrogates to guide decisions about life-sustaining treatment for the chronically critically ill and the extent and timing of treatment limitation.”
Camhi et al found” “most chronically critically ill patients fail to designate a surrogate decision-maker or express preferences regarding life-sustaining treatments. Despite burdensome symptoms and poor outcomes, limitation of such treatments was rare and occurred late, when patients were near death.”
“More and more patients survive acute critical illness only to remain dependent on life-sustaining therapies on a chronic basis. . . .[F]ew of these patients achieve functional recovery . . . .Treatment is prolonged, expensive, and burdensome . . . .”Camhi et al agree that might be appropriate to continue but argue that “continuation of treatment in the chronic phase of critical illness should never be driven by default . . . .”
Sharon Camhi and colleagues at the VA Pittsburgh Health Care System had an article in the March Critical Care Medicine,titled “Deciding in the Dark: Advance Directives and Continuation of Treatment in Chronic Critical Illness.”
First, “chronic critical illness” is a great term that I am not sure I’ve heard before. Camhi et al. explain: “Chronic critical illness is a devastating syndrome for which treatment offers limited clinical benefit but imposes heavy burdens on patients, families, clinicians, and the health care system. We studied the availability of advance directives and appropriate surrogates to guide decisions about life-sustaining treatment for the chronically critically ill and the extent and timing of treatment limitation.”
Camhi et al found” “most chronically critically ill patients fail to designate a surrogate decision-maker or express preferences regarding life-sustaining treatments. Despite burdensome symptoms and poor outcomes, limitation of such treatments was rare and occurred late, when patients were near death.”
“More and more patients survive acute critical illness only to remain dependent on life-sustaining therapies on a chronic basis. . . .[F]ew of these patients achieve functional recovery . . . .Treatment is prolonged, expensive, and burdensome . . . .”Camhi et al agree that might be appropriate to continue but argue that “continuation of treatment in the chronic phase of critical illness should never be driven by default . . . .”