Publications

info:eu-repo/semantics/published

Acute cardiac syndromes are common and responsible for considerable mortality and morbidity. Decision making in such patients can be difficult clinically but can also be complex and challenging from an ethical perspective. This chapter reviews some of the ethical problems, including organ donation and withholding/withdrawing, that can occur in the acutely ill adult cardiac patient, starting with a brief look at the ethical principles that should guide our decision making: beneficence, non-maleficence, autonomy, and distributive justice. The role of advance directives and considerations related to family presence during cardiopulmonary resuscitation will also be discussed. With the increasing incidence and prevalence of coronary artery disease worldwide, the number of patients with cardiac arrest and requiring acute cardiac care is going to increase, and doctors will increasingly be faced with difficult ethical decisions associated with these patients. Open discussion and debate about these issues and good communication among patients, family members, and members of the health care team are essential to ensure that all patients receive the best possible end-of-life care.

A goal-directed resuscitation therapy (GDT) through optimization of cardiac output reduces complications in noncardiac surgeries. We investigated whether the implementation of a GDT protocol in high-risk cardiac surgery with the use of LiDCO Rapid reduces postoperative complications as compared with the standard of care.

A reduction in the total power variability of RRI and a lowered LF/HF ratio of the RRI are associated with a poor quality recovery or death after neurosurgical illness. A reduction in the baroreflex was specifically associated with death in this patient group.