A pilot study on the utility of a more informative living will.

Most written advance directives are designed to help people prescribe the care they would desire at the very end of their life. They provide little guidance for elderly patients with potentially treatable diseases who may be temporarily incapacitated and thus unable to articulate their wishes. The authors developed an alternative living will format with the intent of better documenting the care wishes of this population.

Visual hallucinations in a patient with adult onset acid maltase deficiency disorder.

A 66-year-old male presented with visual hallucinations. He had chronically elevated serum creatine kinase (CK) levels without muscle weakness. His hospital course was complicated by hypercapnic respiratory failure requiring mechanical ventilation.

Are blood gases necessary in mechanically ventilated patients who have successfully completed a spontaneous breathing trial?

Background: The utility of routinely obtaining arterial blood gas analyses (ABGs) prior to extubation in patients who have successfully completed a spontaneous breathing trial is not known.

Objective: Review our practices and determine our extubation success rate with a policy of selective ABG utilization.

Methods: Retrospective chart review.

Stress ulcer prophylaxis.

Preview Which critically ill patients are at increased risk for gastrointestinal hemorrhage from stress ulcers? Do prophylactic agents effectively reduce the morbidity and mortality associated with stress-related hemorrhage? The author, former director of a medical intensive care unit, reviews recent literature on stress ulcer prophylaxis and outlines the risks and benefits of providing preventive therapy.