Decision making in ICU, an essential burden

Authors

  • SRLF Commission d'Éthique SRLF
  • Cyril Goulenok Service de Médecine Intensive Réanimation, Hopital Privé Jacques Cartier, Massy
  • Zoé Cohen-Solal Médecine Intensive Réanimation, Groupe de recherche Famiréa, APHP Saint Louis, 1 avenue Claude Vellefaux, 75010 Paris, France
  • Raphaëlle David Brigade des Sapeurs-Pompiers de Paris, SSA 2ème Groupement 1, Place Jules Renard, 75017 Paris, France
  • Laure De Saint Blanquat Service de réanimation pédiatrique et USC médicochirurgicale, Hôpital Necker, 149 Rue de Sèvres, 75015 Paris, France
  • Maxime Elbaz Centre du Sommeil et de la Vigilance, Centre de Référence Hypersomnies Rares, CHU Hôtel Dieu, 1, Place du Parvis de Notre-Dame, 75181 PARIS CEDEX 04, France
  • Bénédicte Gaillard Le Roux Réanimation Pédiatrique, CHU de Nantes, boulevard Jean Monnet, 44000 Nantes, France
  • Sylvain Lavoué Service des Maladies Infectieuses et Réanimation Médicale, Hôpital Pontchaillou, CHU Rennes, 2 rue Henri Le Guilloux, 35000 Rennes, France
  • Virginie Lemiale Médecine Intensive Réanimation, APHP Saint Louis, 1 avenue Claude Vellefaux 75010 Paris, France
  • Emmanuelle Mercier Médecine Intensive Réanimation, CHRU Tours, Boulevard Tonnellé, 37044 Tours cedex, France
  • Chaouki Mezher Réanimation & Unité de Soins Continus, Hôpital Nord Franche-Comté, 100 Route de Moval, 90400 Trèvenans, France.
  • Benoit Misset Département des soins intensifs Centre Hospitalier Universitaire de Liège, Domaine du Sart Tilman, 4000, Liège, Belgique.
  • Gwendolyn Penven Hôpital Maison Blanche, CHU de Reims, 45 rue Cognacq Jay 51100 Reims
  • Anne-Laure Poujol Service de réanimation chirurgicale polyvalente, Groupe hospitalier Pitié Salpêtrière, Paris, France; École de Psychologues Praticiens, Institut Catholique de Paris, EA 7403, Paris, France; Université de Lorraine, APEMAC, F-54000 Nancy, France.
  • Régis Quéré Coordination des prélèvements d’organes et de tissus, HU Necker-Enfants malades, 149 rue de Sèvres, 75743 Paris cedex 15, France.
  • Jean-Philippe Rigaud Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Avenue Pasteur, 76200 Dieppe, France.
  • Mathieu Série Service de Réanimation Polyvalente, Centre Hospitalier Territorial Gaston-Bourret, 110 Boulevard Joseph Wamytan, Dumbéa Sur Mer 98835, Nouvelle-Calédonie
  • Olivier Lesieur Réanimation, CH Saint Louis, 17019 La Rochelle, France

DOI:

https://doi.org/10.37051/mir-00101

Keywords:

Decision making, ICU, Ethics, Clinical nurse specialist

Abstract

The decision-making process is of paramount importance for the critical care physician and is an integral part of his everyday life. Stress, frustration, and sometimes anger, occur when, during a pandemic, the flow of patients increases, and does not match any more the capacities of the intensive care unit (ICU), and selection of patients become unavoidable. There is a lack of knowledge on the decision-making process in this setting. Etymological analyses may help understanding the underlying mechanisms. Deciding is different from choosing and is not limited to a mathematical algorithm. Anxiety and uncertainties are part of the decision process. Recent researches in neurosciences and on cognitive biases have emphasized the profound complexity of the decision-making process in a critical care setting, including during the Covid-19 pandemic. Discussing and sharing the decision, a well-developed practice in critical care medicine, may help alleviating the committed physician’s burden. Daily decision is part of care and the advent of new technologies may alter the critical care physician’s responsibilities. It is therefore urgent to disentangle the decision-making process in the ICU before integrating these new technologies. Our goal, as caregivers, is to position ourselves as technosophes and not as technophiles or technophobes.

Image

Published

2022-04-22

How to Cite

Commission d’Éthique, S., Goulenok, C., Cohen-Solal, Z., David, R., De Saint Blanquat, L., Elbaz, M., Gaillard Le Roux, B., Lavoué, S., Lemiale, V., Mercier, E., Mezher, C., Misset, B., Penven, G., Poujol, A.-L., Quéré, R., Rigaud, J.-P., Série, M., & Lesieur, O. (2022). Decision making in ICU, an essential burden. Médecine Intensive Réanimation. https://doi.org/10.37051/mir-00101

Issue

Section

Original article

Most read articles by the same author(s)