Many intensive care doctors believe the battle has been won once a patient leaves the intensive care unit, however Gordon Rubenfeld from the University of Washington in Seattle suggests that it is important to focus intensive care treatment on improving the long-term health of those who survive. Rubenfeld shows that doctors may face a conflict in deciding on treatments that are best at saving lives and those that give the best quality of life to those patients who survive. He stresses that more research is needed to make these decisions with confidence.
An example of research into how well or badly patients fare after they have left the intensive care unit is the study by Dale Rublee and colleagues. It examines the long-term effects of treating patients with sepsis with the drug antithrombin III. Antithrombin III affects the blood's clotting mechanism and is a potential treatment for sepsis, a critical condition characterised by a combination of problems with the clotting mechanism and an inflammation throughout the body, which can lead to multiple organ failure and death.
The results of this study suggest that treatment with antithrombin III neither improves nor diminishes patients' chances of survival but it does leave patients with an improved quality of life 90 days after treatment. By focusing on the long-term effects of treatment Rublee and colleagues may have identified a treatment that will help improve the quality of patients' lives if they survive critical illness.
Quality of life was measured by looking at a range of factors such as the patients' mobility, their level of physical activity and their ability to communicate effectively. The study showed that improvements in social and psychological functioning were most marked in patients treated with antithrombin III.
Reducing the long-term impairment in health associated with critical illness represents a new challenge in medicine and it is hoped that clinical research will begin to focus on these issues.
The research article by Dale Rublee and colleagues is freely available in Critical Care, a journal published by BioMed Central, simply visit: http://ccforum.
The accompanying commentary by Gordon Rubenfeld can be found in the same issue of Critical Care, for access to this article visit: http://ccforum.
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