Of course, they also need to be given a realistic sense of what they can achieve so that they can feel motivated and encouraged rather than crushed. The same issues arise for people with strokes, dementia, brain tumors, and traumatic brain injuries. Here it appears to selleck compound be standard practice to offer ‘neuro-rehab’ �C cautiously optimistic advice about the unknown future with encouragement to push the boundaries and not to get upset if failure is experienced. Something approximating the required sensitivity, it seems to me, is achieved in the excellent ‘Patient/family info’ section of http://ICUdelirium.org[27] from Ely’s ICU Delirium and Cognitive Impairment Study Group at Vanderbilt University.There is another ethical issue here.

Care must be taken in making the kind of argument I make, lest it be inferred that research into post-ICU cognitive impairment is not something that ought to go forward. This research has real significance for the short- and long-term outcomes of those who have been gravely ill, and nothing I say here diminishes its importance. Nonetheless, it is important to ask the hard questions and to try to arrive at the best answers.AbbreviationsARDS: acute respiratory distress syndrome; ICU: intensive care unit; PTSD: post-traumatic stress disorder.Competing interestsThe author declares that they have no competing interests.AcknowledgementsI am a tourist in this field and owe a tremendous debt to generous tutelage from some of its proper inhabitants, including Jonathan Freedman, Peter St. George Hyslop, Mona Hopkins, Jim Jackson, Christina Jones, David Naylor, David Mazer, and Lucy Padina.

Special thanks go to Wes Ely and Margaret Herridge for their extremely helpful comments and encouragement. My philosophy colleagues Jim Brown, Ian Hacking, Diana Raffman, and Jennifer Nagel gave me excellent comments of a very different sort.
We reviewed the cases of all patients treated with emergency cardiopulmonary bypass for prolonged cardiac arrest or cardiogenic shock following drug intoxication at the University Hospital of Caen between 1997 and 2007. Our medical teams and nurses have a large amount of experience with emergency ECLS, specifically among critically ill patients [15,18,21,22].PatientsDuring the study period, 721 patients were admitted for drug intoxication (Figure (Figure1).1).

One hundred and ten patients had hemodynamic failure responding to conventional treatment and 17 patients had refractory shock or cardiac arrest. In our practice, patients with refractory cardiac arrest, defined as an absence of return to spontaneous circulation after continuous cardio-pulmonary resuscitation over at least 45 minutes or refractory shock, defined as shock not responding to optimal conventional Batimastat treatment, were candidates for ECLS support [23]. When the decision to implant ECLS was made by a senior intensivist, a senior cardiac surgeon and a perfusionist were immediately informed and ECLS performed.