BMJ  2005;330:1272 (28 May), doi:10.1136/bmj.330.7502.1272

Letter

Illness trajectories are also valuable in critical care

The first 150 words of the full text of this article appear below.

Editor—I was uplifted by the simple wisdom of Murray et al and suggest that the concept of illness trajectories has value in critical as well as palliative care.1 Intensivists are often referred patients with similar trajectories to those presented,1 where a catastrophe so dominates the presentation that an immediate attempted rescue is undertaken before the opportunity is taken to appraise both the less evident underlying trajectory and the acute event. An example is the frail elderly patient with dementia and multiple comorbidities swho presents with a "potentially curable" fungating mandibular tumour.

Even previously well patients develop faster "trajectories of dying" after admission to intensive care units. I have noted a trend to attempt escalated rescue of increasingly daunting complications in dying patients. An example is the patient with severe pancreatitis who develops infected necrosum, then intraabdominal abscesses, and finally drain associated erosion of retroperitoneal vessels.

Since predicting survival of a . . . [Full text of this article]

Stephen J Streat, intensivist1

1 Department of Critical Care Medicine, Auckland City Hospital, Auckland 1003, New Zealand StephenS@adhb.govt.nz


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Relevant Article

Illness trajectories and palliative care
Scott A Murray, Marilyn Kendall, Kirsty Boyd, and Aziz Sheikh
BMJ 2005 330: 1007-1011. [Extract] [Full Text] [PDF]

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