Heart failure affects a high percentage of the population, especially older patients. Cardiac resynchronization therapy is indicated in some patients with advanced heart failure. However, 20–40% of patients with implanted resynchronization device have no clinical response. In this chapter, we review factors related with the absence of a clinical response, recent technological advances that can reduce the failure rate, and an algorithm for management of patients without a clinical response.
Intensive care unit is a special medial environment for many reasons (the severity of the patients, the important technological advances). In recent years, the medicine has changed to a more focused practice on the patient, leaving behind the paternalistic medical approach, with a transparent new relationship with the patient and his family. The ethical principles-autonomy, beneficence, non-maleficence and justice-and the possibility of conflicts between them make decision-making very complex. The admission of these patients in our unit is justified based on a triangle-acute, severe, and recoverable disease-trying to optimize their treatment. Unfavorable later evolution is possible; a palliative management can often be considered, changing the patient’s approach from the cure of his illness to the relief of his symptoms. Decisions about patient’s future must be jointly made by the health care team, the patient and his family. We must look for documents about previous instructions and/or opinion of a substitute decision-maker. We must humanize our units, thinking about the best care for the sick person and his family, and improve the support to the family after his death. Therefore, the development of practice guidelines on palliative care should be promoted by the hospitals.
Part of the book: Reflections on Bioethics
Current medicine, highly technified, and capable of amazing achievements, is not possible without the support of antibiotics. The problem of antibiotic resistance is almost as old as the antibiotics themselves. But at present, it is a serious threat to public health. We have to fight against antibiotic resistance in the hospital and in the out-of-hospital environment. The Resistance Zero program, promoted by the Spanish Society of Intensive Medicine, has achieved through a multidisciplinary approach with collaboration between doctors, nurses, cleaning staff and microbiologists, to control the colonization and infection by multiresistant germs in the environment of the Intensive Care Unit.
Part of the book: Current Topics in Intensive Care Medicine