title: Ethics roundtable: 'Open-ended ICU care: can we afford it?'.
abstract: The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months, he has been in status epilepticus (SE) on high doses of barbiturates, benzodiazepines, and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on continuous electroencephalography (EEG). He is trached and has a percutaneous endoscopic gastrostomy (PEG) feeding tube. He has been treated several times for pneumonia, and he is on a warming blanket and is on vasopressors to maintain his blood pressure. His vitals are stable and his lab work is within limits. The sedation is decreased under EEG guidance every 72 hours, after which he goes back into SE and heavy sedation is resumed. The latest magnetic resonance imaging (MRI) shows edema but otherwise no obvious permanent cortical damage. The family wants a realistic assessment of the likely outcome. The neurologist tells them the literature suggests the outlook is poor but not 100% fatal. As long as all of his other organs are functioning on life support, there is always a chance the seizures will stop at some time in the future, and so the neurologist recommends an open-ended intensive care unit (ICU) plan and hopes for that outcome.
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh Medical Center, 644a Saife Hall, 3550 Terrace Street, Pittsburgh, PA 15261, USA. crippen@pitt.edu
authors.forename: David
authors.initials: D
authors.lastname: Crippen
authors.forename: Dick
authors.initials: D
authors.lastname: Burrows
authors.forename: Nino
authors.initials: N
authors.lastname: Stocchetti
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.forename: Peter
authors.initials: P
authors.lastname: Andrews
authors.forename: Tom
authors.initials: T
authors.lastname: Bleck
authors.forename: Leslie
authors.initials: L
authors.lastname: Whetstine
mesh_terms: D000328:Adult; D018792:Encephalitis, Viral / Q000150:complications / Q000503:physiopathology; D017721:Hospital Costs; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D008134:Long-Term Care / Q000191:economics; D008297:Male; D011379:Prognosis; D040841:Resource Allocation / Q000941:ethics*; D013226:Status Epilepticus / Q000188:drug therapy / Q000209:etiology