by Between Life
enteral nutrition. Any method of feeding that uses the gastrointestinal tract to deliver a source of calories.
epinephrine. Another term for adrenaline, a hormone that increases blood pressure and quickens heartbeat.
extubation. Removal of an endotracheal tube.
functional status. An individual’s ability to perform daily routines necessary to meet basic needs and maintain health.
gastrostomy tube. A surgically placed tube that directly enters the stomach through the abdominal wall.
goals-of-care meeting. A meeting between physicians and a patient or his/her family to determine the next step in care, usually for complex circumstances in the ICU.
healthcare proxy. A document that legally appoints an individual to make healthcare decisions on behalf of a patient in the event that the patient is incapacitated.
hemodialysis. Process of removing waste and fluid and restoring normal electrolyte balance in patients with kidney failure.
hospice. A philosophy of care that focuses on palliation of symptoms at the end of life, with emphasis on quality of life and spiritual and physical well-being.
hypoxia. Low oxygen levels in the bloodstream or body tissues.
iatrogenic. A type of event or complication that occurs secondary to medical interventions.
inotrope. Medication that enhances the ability of the heart to pump. Examples include milrinone, dobutamine, dopamine, and epinephrine (which is also a vasopressor).
intensive care unit (ICU). The department in a hospital where the most seriously ill patients are constantly observed.
intravenous. Medications administered through the bloodstream via access in a vein.
living will. A document completed by a patient, attested to by witnesses, that outlines wishes for end-of-life care.
mechanical ventilator. A machine that provides breathing support.
myocardial infarction. Medical term for heart attack; death of a portion of the heart muscle due to inadequate blood flow.
nasogastric tube. A tube threaded through the nostrils and into the stomach to administer nutrition or remove intestinal contents.
nephrologist. A doctor who specializes in kidney function and disease.
noninvasive positive pressure ventilation (NIPPV). Mechanical ventilation delivered through a facemask or nasal mask rather than through an endotracheal tube.
palliative care. An approach to medical care that focuses on improvement in quality of life at all stages of illness.
perfusion. A supply of oxygen-rich blood.
peritoneum. A membrane lining the abdominal cavity.
pharynx. Medical term for throat.
physician-assisted suicide (PAS). The process of intentionally taking one’s life after ingestion of a physician-prescribed lethal dose of medication.
physician orders for life-sustaining treatment (POLST). Legal orders from a physician, formulated in conjunction with a patient, to withhold or administer life-sustaining measures including CPR and mechanical ventilation.
platelets. Cell fragments that circulate throughout the bloodstream and play an essential role in normal blood clotting.
pleural effusion. Fluid in the chest cavity, in the space surrounding the lungs.
pneumonia. Infection of the lungs.
pneumothorax. Accumulation of air in the space between the lung and the chest wall, leading to lung collapse.
post-traumatic stress disorder. A psychiatric disorder that arises in response to a traumatic event and is characterized by nightmares, flashbacks, anxiety, and intrusive thoughts about the event.
pulmonary edema. Fluid within the lung tissue.
pulmonary embolism. When a blood clot becomes lodged in the vessels that carry blood from the heart to the lungs.
pulseless electrical activity (PEA). Cardiac arrest in which the heart continues to beat with a normal electrical rhythm, but disease or injury prevents effective circulation of blood.
renal. Pertaining to the kidneys.
resident. A doctor who has completed medical school but has not yet finished on-the-job training in a specific medical specialty.
respiratory. Pertaining to breathing.
sepsis. A widespread response to infection that reduces blood flow to organs and threatens life.
shock. A condition characterized by inadequate blood flow to organs, resulting in poor oxygen delivery and death if untreated.
solute. One substance dissolved in another.
somnolence. Pathological sleepiness or drowsiness; in medicine it often points to impaired blood flow to the brain or disturbances in breathing.
total parenteral nutrition (TPN). Intravenous feeding, i.e., nutrition administered through the bloodstream, bypassing the gastrointestinal tract.
trachea. Medical term for windpipe.
tracheostomy. Surgical placement of a tube through the neck and into the windpipe to permit connection to a mechanical ventilator.
vasomotor tone. Constriction of blood vessels to maintain blood pressure.
vasopressors. Medications that act on blood vessels to constrict them and elevate blood pressure. Examples include norepinephrine (Levophed), vasopressin, phenylephrine (Neosynephrine), and epinephrine (also an inotrope).
vegetative state. State of unconsciousness and minimal responsiveness, usually from brain injury.
ventilation. Air exchange in breathing, specifically removal of carbon dioxide from the bloodstream.
ventricular fibrillation. An abnormal heart rhythm, leading to cardiac arrest, in which the ventricles contract erratically and fail to pump.
ventricular tachycardia. An abnormal heart rhythm in which the ventricles contract at a rate too high to allow filling with blood; in many cases, this arrhythmia causes cardiac arrest.
voluntary active euthanasia. Deliberate shortening of a patient’s life, usually by a physician, through administration of a lethal dose of medication.
Notes
Chapter 1: Framing the Issue
1 Patients often suspend orders that limit life-sustaining treatment when they undergo surgery, as reversible life-threatening events can arise perioperatively.
2 Dylan Thomas, “Do Not Go Gentle into That Good Night,” from In Country Sleep, and Other Poems (New York: New Directions, 1952), Academy of American Poets website, accessed August 16, 2018, https://www.poets.org/poetsorg/poem/do-not-go-gentle-good-night.
3 William Shakespeare, Hamlet (Hertfordshire, UK: Wordsworth Editions Ltd., 1992), 60.
4 Robert V. Wells, Facing the “King of Terrors”: Death and Society in an American Community, 1750–1990 (New York: Cambridge University Press, 2000), 195.
5 Liz Hamel, Bryan Wu, and Mollyann Brodie, “Views and Experiences with End-of-Life Medical Care in the U.S.,” The Henry J. Kaiser Family Foundation (April 2017), accessed January 4, 2018, http://files.kff.org/attachment/Report-Views-and-Experiences-with-End-of-Life-Medical-Care-in-the-US.
6 William Colby, “How We Die in America,” an excerpt of Unplugged: Reclaiming Our Right to Die in America (New York: Amacom Books, 2006), in AuthorViews.com, accessed January 4, 2018, www.authorviews.com/authors/Colby/obd.htm.
7 Centers for Disease Control and Prevention National Center for Health Statistics, “Health, United States, 2010: With Special Feature on Death and Dying,” accessed January 4, 2018, https://www.cdc.gov/nchs/data/hus/hus10.pdf. See also The Dartmouth Institute for Health Policy and Clinical Practice, “Percent of Deaths Associated with ICU Admission, 2014,” The Dartmouth Atlas of Health Care, http://www.dartmouthatlas.org/data/table.aspx?ind=14.
8 Rachelle E. Bernacki and Susan D. Block, “Communication about Serious Illness Care Goals: A Review and Synthesis of Best Practices,” JAMA Internal Medicine 174, no. 12 (2014): 1994–2003.
9 Jaya K. Rao, Lynda A. Anderson, et al., “Completion of Advance Directives Among U.S. Consumers,” American Journal of Preventative Medicine 46, no. 1 (2014): 65–70.
10 Marta Spranzi and Veronique Fournier,
“The Near-Failure of Advance Directives: Why They Should Not Be Abandoned Altogether, But Their Role Radically Reconsidered,” Medicine, Health Care, and Philosophy 19, no. 4 (2016): 563–64.
Zara Cooper, Andrew Courtwright, et al., “Pitfalls in Communication That Lead to Nonbeneficial Surgery in Elderly Patients with Serious Illness: Description of the Problem and Elements of a Solution,” Annals of Surgery 260, no. 6 (2014): 949–57.
Ibid., 949.
Natalie C. Ernecoff, Farr A. Curlin, et al., “Healthcare Professionals’ Responses to Religious or Spiritual Statements by Surrogate Decision Makers During Goals-of-Care Discussions,” JAMA Internal Medicine 175, no. 10 (2015): 1662–69.
Michael J. Balboni, Adam Sullivan, et al., “Nurse and Physician Barriers to Spiritual Care Provision at the End of Life,” Journal of Pain and Symptom Management 48, no. 3 (2014): 400–410.
Ibid.
Tracy A. Balboni, Michael Balboni, et al., “Provision of Spiritual Support to Patients with Advanced Cancer by Religious Communities and Associations with Medical Care at the End of Life,” JAMA Internal Medicine 173, no. 12 (2013): 1109–17.
Chapter 2: Wisdom Begins with the Word
1 A condensed version of the content in this chapter first appeared online in Christianity Today. Kathryn Butler, “When Prolonging Life Means Prolonging Suffering,” Christianity Today (September 8, 2016), http://www.christianitytoday.com/ct/2016/june-web-only/when-prolonging-life-means-prolonging-suffering.html. Used with permission.
2 Tracy A. Balboni, Michael Balboni, et al., “Provision of Spiritual Support to Patients with Advanced Cancer by Religious Communities and Associations with Medical Care at the End of Life,” JAMA Internal Medicine 173, no. 12 (2013): 1109–17. See also Andrea C. Phelps, Paul K. Maciejewski, et al., “Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients with Advanced Cancer,” Journal of the American Medical Association 301, no. 11 (2009): 1140–47; Paul K. Maciejewski, Andrea C. Phelps, et al., “Religious Coping and Behavioral Disengagement: Opposing Influences on Advance Care Planning and Receipt of Intensive Care Near Death,” Psycho-Oncology 21, no. 7 (2012): 714–23.
3 Ann M. Parker, Thiti Sricharoenchai, et al., “Posttraumatic Stress Disorder in Critical Illness Survivors: A Metaanalysis,” Critical Care Medicine 43, no. 5 (2015): 1121–29.
4 Eduard Kralj, Matej Podbregar, et al., “Frequency and Number of Resuscitation Related Rib and Sternum Fractures Are Higher Than Generally Considered,” Resuscitation 93 (2015): 136–41.
Chapter 3: Resuscitation for Cardiac Arrest
1 Dylan Harris and Hannah Willoughby, “Resuscitation on Television: Realistic or Ridiculous? A Quantitative Observational Analysis of the Portrayal of Cardiopulmonary Resuscitation in Television Medical Drama,” Resuscitation 80, no. 11 (2009): 1275–79. See also Jochen Hinkelbein, Oliver Spelten, et al., “An Assessment of Resuscitation Quality in the Television Drama Emergency Room: Guideline Non-Compliance and Low-Quality Cardiopulmonary Resuscitation Lead to a Favorable Outcome?,” Resuscitation 85, no. 8 (2014): 1106–10; Jaclyn Portanova, Krystle Irvine, et al., “It Isn’t Like This on TV: Revisiting CPR Survival Rates Depicted on Popular TV Shows,” Resuscitation 96 (2015): 148–50.
2 Portanova, Irvine, et al., “It Isn’t Like This on TV,” 148–50.
3 Ibid.
4 Derrick H. Adams and David P. Snedden, “How Misconceptions among Elderly Patients Regarding Survival Outcomes of Inpatient Cardiopulmonary Resuscitation Affect Do-Not-Resuscitate Orders,” The Journal of the American Osteopathic Association 106 (2006): 402–4.
5 Ibid., 402.
6 Guillermo Gutierrez, “Cellular Effects of Hypoxemia and Ischemia,” in The Lung: Scientific Foundations, 2nd ed., ed. Ronald G. Crystal et al. (Philadelphia: Lippincott-Raven, 1997), 1969. See also Thomas F. Hornbein, “Hypoxia and the Brain,” in The Lung: Scientific Foundations, 1981.
7 Thomas D. Rea, Mickey S. Eisenberg, et al., “Temporal Trends in Sudden Cardiac Arrest: A 25-Year Emergency Medical Services Perspective,” Circulation 107, no. 22 (2003): 2780–85.
8 Mads Wissenberg, Freddy K. Lippert, et al., “Association of National Initiatives to Improve Cardiac Arrest Management with Rates of Bystander Intervention and Patient Survival Out-of-Hospital Cardiac Arrest,” Journal of the American Medical Association 310, no. 13 (2013): 1377–84.
9 Peter G. Brindley, Darren M. Markland, et al., “Predictors of Survival Following In-Hospital Adult Cardiopulmonary Resuscitation,” Canadian Medical Association Journal 167, no. 4 (2002): 343–48. See also Heather L. Bloom, Irfan Shukrullah, et al., “Long-Term Survival After Successful Inhospital Cardiac Arrest Resuscitation,” American Heart Journal 153, no. 5 (2007): 831–36; Zachary D. Goldberger, Paul S. Chan, et al., “Duration of Resuscitation Efforts and Survival after In-Hospital Cardiac Arrest: An Observational Study,” The Lancet 380, no. 9852 (2012): 1473–81; Paul S. Chan, Bryan McNally, et al., “Recent Trends in Survival from Out-of-Hospital Cardiac Arrest in the United States,” Circulation 130, no. 21 (2014): 1876–78; Michael K. Y. Wong, Laurie J. Morrison, et al., “Trends in Short- and Long-Term Survival among Out-of-Hospital Cardiac Arrest Patients Alive at Hospital Arrival,” Circulation 130, no. 21 (2014): 1883–90.
10 C. R. Green, J. A. Botha, and R. Tiruvoipati, “Cognitive Function, Quality of Life and Mental Health in Survivors of Out-of-Hospital Cardiac Arrest: A Review,” Anaesthesia and Intensive Care 43, no. 5 (2015): 569.
11 Eduard Kralj, Matej Podbregar, et al., “Frequency and Number of Resuscitation Related Rib and Sternum Fractures Are Higher Than Generally Considered,” Resuscitation 93 (2015): 136–41.
12 J. J. De Vreede-Swagemakers, A. P. Gorgels, et al., “Circumstances and Causes of Out-of-Hospital Cardiac Arrest in Sudden Death Survivors,” Heart 79, no. 4 (1998): 356–61.
13 Ibid. See also Sidney Goldstein, Richard Landis, et al., “Characteristics of the Resuscitated Out-of-Hospital Cardiac Arrest Victim with Coronary Artery Disease,” Circulation 64, no. 5 (1981): 977–84; Rea et al., “Temporal Trends,” 2780–85; Jared T. Bunch, Roger White, et al., “Outcomes and In-Hospital Treatment of Out-of-Hospital Cardiac Arrest Patients Resuscitated from Ventricular Fibrillation by Early Defibrillation,” Mayo Clinic Proceedings 79, no. 5 (2004): 613–19.
14 De Vreede-Swagemakers et al., “Causes of Out-of-Hospital Cardiac Arrest,” 356–61. See also Goldstein et al., “Cardiac Arrest Victim with Coronary Artery Disease,” 977–84; Rea et al., “Temporal Trends,” 2780–85; Bunch et al., “Outcomes Ventricular Fibrillation,” 613–19.
15 Rea et al., “Temporal Trends,” 2780–85. See also M. Kuisma and A. Alaspää, “Out-of-Hospital Cardiac Arrests of Non-Cardiac Origin; Epidemiology and Outcome,” European Heart Journal 18, no. 7 (1997): 1122–28; Johan Engdahl, Angela Bång, et al., “Can We Define Patients with No and Those with Some Chance of Survival When Found in Asystole Out of Hospital?” American Journal of Cardiology 86, no. 6 (2000): 610–14; William A. Gray, Robert J. Capone, and Albert S. Most, “Unsuccessful Emergency Medical Resuscitation: Are Continued Efforts in the Emergency Department Justified?” New England Journal of Medicine 325, no. 20 (1991): 1393–98; Robert L. Levine, Marvin A. Wayne, and Charles C. Miller, “End-Tidal Carbon Dioxide and Outcome of Out-of-Hospital Cardiac Arrest,” New England Journal of Medicine 337, no. 5 (1997): 301–6.
16 De Vreede-Swagemakers et al., “Causes of Out-of-Hospital Cardiac Arrest,” 356–61; H. Leon Greene, “Sudden Arrhythmic Cardiac Death: Mechanisms—Resuscitation and Classification: The Seattle Perspective,” American Journal of Cardiology 65, no. 4 (1990): 4B–12B; Thomas H. Marwick, Colin C. Case, et al., “Prediction of Survival from Resuscitation: A Prognostic Index Derived from Multivariate Logistic Model Analysis,” Resuscitation 22, no. 2 (1991): 129–37.
Chapter 4: Introduction to Intensive Care
1 Portions of this chapter first appeared in my “Christian, Your Pain Is Never Punishment,” Desiring God website (February 2, 2017), https://www.desiringgod.org/articl
es/christian-your-pain-is-never-punishment. Used with permission.
2 Jack E. Zimmerman, Andrew A. Kramer, and William A. Knaus, “Changes in Hospital Mortality for United States Intensive Care Unit Admissions from 1988 to 2012,” Critical Care 17, no. 2 (2013): 1–9.
3 Ibid.
4 Gerald L. Weinhouse, “Delirium and Sleep Disturbances in the Intensive Care Unit: Can We Do Better?” Current Opinion in Anaesthesiology 27, no. 4 (2014): 403.
5 Alexi A. Wright, Nancy L. Keating, et al., “Place of Death: Correlations with Quality of Life of Patients with Cancer and Predictors of Bereaved Caregivers’ Mental Health,” Journal of Clinical Oncology 28, no. 29 (2010): 4457–64.
6 James C. Jackson, Pratik P. Pandharipande, et al., “Depression, Post-Traumatic Stress Disorder, and Functional Disability in Survivors of Critical Illness in the BRAIN-ICU Study: A Longitudinal Cohort Study,” The Lancet Respiratory Medicine 2, no. 5 (2014): 369–79.
7 Ann M. Parker, Thiti Sricharoenchai, et al., “Posttraumatic Stress Disorder in Critical Illness Survivors: A Metaanalysis,” Critical Care Medicine 43, no. 5 (2015): 1121–29.
8 Charles S. Milliken, Jennifer L. Auchterlonie, and Charles W. Hoge, “Longitudinal Assessment of Mental Health Problems Among Active and Reserve Component Soldiers Returning from the Iraq War,” Journal of the American Medical Association 298, no. 18 (2007): 2141–49.
9 Scott K. Fridkin, Sharon F. Welbel, and Robert A. Weinstein, “Magnitude and Prevention of Nosocomial Infections in the Intensive Care Unit,” Infectious Disease Clinics of North America 11, no. 2 (1997): 479–96.
10 Jean-Louis Vincent, Jordi Rello, et al., “International Study of the Prevalence and Outcomes of Infection in Intensive Care Units,” Journal of the American Medical Association 302, no. 21 (2009): 2323–29.
11 Greet Hermans, Bernard De Jonghe, et al., “Clinical Review: Critical Illness Polyneuropathy and Myopathy,” Critical Care 12, no. 6 (2008): 238–47.
12 Jeremy Kahn, Derek C. Angus, et al., “The Epidemiology of Chronic Critical Illness in the United States,” Critical Care Medicine 43, no. 2 (2015): 284–85.
