2,833 publications from this institution
Intensive Care Departments are designed for the care of the critically ill, and are equipped with all the material necessary for monitoring and treatment, as well as specially trained medical, nursing, and paramedical staff. With a team of more than 170 highly qualified staff, the Department of Intensive Care at Erasme Hospital, has acquired a national and international reputation in the fields of clinical and experimental research and education, as well as for its standards of clinical practice. Clinical and experimental studies have been high in quantity and quality, and have covered all the key areas in the field of intensive care medicine: severe sepsis, multiple organ failure, transport and metabolism of oxygen, systemic and regional hemodynamic alterations (pulmonary, cerebral, hepato-splanchnic,...), metabolic disorders,... not forgetting issues associated with the complexities of medical ethics. The quality of care, clinical, scientific and personal, offered by the Department of Intensive Care at Erasme Hospital has earned it the high level reputation for which it is renowned in Belgium, and indeed worldwide.
Editorial
info:eu-repo/semantics/published
An arterial catheter should be placed as soon as possible in patients with septic shock. Vasopressors are indicated to maintain mean arterial pressure of <65 mm Hg, both during and following adequate fluid resuscitation. Norepinephrine or dopamine are the vasopressors of choice in the treatment of septic shock. Norepinephrine may be combined with dobutamine when cardiac output is being measured. Epinephrine, phenylephrine, and vasopressin are not recommended as first-line agents in the treatment of septic shock. Vasopressin may be considered for salvage therapy. Low-dose dopamine is not recommended for the purpose of renal protection. Dobutamine is recommended as the agent of choice to increase cardiac output but should not be used for the purpose of increasing cardiac output above physiologic levels.
Summary The intensive care unit (ICU) is where patients are given some of the most technologically advanced life-sustaining treatments, and where diffi cult decisions are made about the usefulness of such treatments. The substantial regional variability in these ethical decisions is a result of many factors, including religious and cultural beliefs. Because most critically ill patients lack the capacity to make decisions, family and other individuals often act as the surrogate decision makers, and in many regions communication between the clinician and family is central to decision making in the ICU. Elsewhere, involvement of the family is reduced and that of the physicians is increased. End-of-life care is associated with increased burnout and distress among clinicians working in the ICU. Since many deaths in the ICU are preceded by a decision to withhold or withdraw life support, high-quality decision making and end-of-life care are essential in all regions, and can improve patient and family outcomes, and also retention of clinicians working in the ICU. To make such a decision requires adequate training, good communication between the clinician and family, and the collaboration of a well functioning interdisciplinary team.
