Continuous infusion of methylene blue for septic shock.

Nitric oxide has been determined to be a potential mediator of the haemodynamic changes associated with sepsis. The haemodynamic eects of nitric oxide can be partially antagonised by methylene blue, through inhibition of the enzyme, guanylate cyclase. The case report presented here demonstrates a beneficial haemodynamic eect of continuous infusion of methylene blue during sepsis. These findings could be extrapolated to other patients or prompt additional research.

Attitudes of hospitalized patients toward life support: a survey of 200 medical inpatients.

PURPOSE: Life-support decisions have profound medical, ethical, and economic implications; yet little is known about inpatients' preferences for life-sustaining treatments. We therefore conducted a prospective survey of medical inpatients to determine attitudes toward life support under differing medical outcomes, and the extent of physician communication about these issues. PATIENTS AND METHODS: The study population consisted of 200 adult patients admitted to the general medical services at UCLA Medical Center during August and September 1987. Each patient completed a standardized 13-item questionnaire. Patients rated their agreement with life-support treatment in the context of four outcome scenarios. A five-point Lickert scale for each question was used, and an overall life-support scale was created by summing the four items. Patients were also asked about previous life-support discussions with their physicians. RESULTS: Life support was desired in 90 percent of the patients if their health could be restored to its usual level, in 30 percent if they would be unable to care for themselves after discharge, in 16 percent if their chance for recovery was hopeless, and in only 6 percent if they would remain in a vegetative state. Patients who desired less aggressive care were older, female, and more likely to have terminal illnesses. Only 16 percent reported having discussed life support with their physicians; however, an additional 47 percent desired such discussions. CONCLUSION: Hospitalized medical patients base their preferences for life support upon perceived outcomes. Lack of communication creates the potential for patients to be subjected to burdensome and expensive treatments they may not desire. We encourage physicians to offer their patients discussions about prognosis and the efficacy of life support so that disproportionate treatments can be avoided.