Ethics roundtable: 'Open-ended ICU care: Can we afford it?'

David Crippen*, Dick Burrows, Nino Stocchetti, Stephan A. Mayer, Peter Andrews, Thomas P Bleck, Leslie Whetstine

*Corresponding author for this work

Research output: Contribution to journalReview article

11 Scopus citations

Abstract

The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months, he has been in status epilepticus (SE) on high doses of barbiturates, benzodiazepines, and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on continuous electroencephalography (EEG). He is trached and has a percutaneous endoscopic gastrostomy (PEG) feeding tube. He has been treated several times for pneumonia, and he is on a warming blanket and is on vasopressors to maintain his blood pressure. His vitals are stable and his lab work is within limits. The sedation is decreased under EEG guidance every 72 hours, after which he goes back into SE and heavy sedation is resumed. The latest magnetic resonance imaging (MRI) shows edema but otherwise no obvious permanent cortical damage. The family wants a realistic assessment of the likely outcome. The neurologist tells them the literature suggests the outlook is poor but not 100% fatal. As long as all of his other organs are functioning on life support, there is always a chance the seizures will stop at some time in the future, and so the neurologist recommends an open-ended intensive care unit (ICU) plan and hopes for that outcome.

Original languageEnglish (US)
Article number222
JournalCritical Care
Volume14
Issue number3
DOIs
StatePublished - Jul 21 2010

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Crippen, D., Burrows, D., Stocchetti, N., Mayer, S. A., Andrews, P., Bleck, T. P., & Whetstine, L. (2010). Ethics roundtable: 'Open-ended ICU care: Can we afford it?'. Critical Care, 14(3), [222]. https://doi.org/10.1186/cc8962