Ethical Decisions and Dilemmas in the ACS Patients Requiring ICU: Understanding When to Start and When to Stop

  • Maria Cristina SorellaEmail author
  • B. Sakakushev
  • F. Coccolini
  • M. Sartelli
  • L. Ansaloni
  • A. Tarasconi
  • S. Di Saverio
  • R. M. Melotti
  • F. Catena
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)


The goal of intensive treatment is the complete recovery of health conditions, in a way to allow patient’s social rehabilitation. Since this goal is impossible for some patients, the new goal must be the maintenance of their dignity and quality of live, leaving out excessive therapies and ICU admission (SIAARTI Società Italiana di Anestesia Analgesia Rianimazione e Terapia Intensiva, Minerva Anestesiol 69:3, 2003).

In case of Acute Care Surgery, the surgeon must balance the need to alleviate pain and suffering and the avoidance of overtreatment, including treatment-related morbidity, acting in the best interest of the patient. In case of symptomatic patient, the surgeon must consider whether the patient could benefit from a palliative surgery.

It is important for the surgeon to prognosticate the outcome before surgical decision making, incorporating the knowledge about underlying disease, the possible surgery outcome and the patient’s preferences (Moore and Todd, Common problems in acute care surgery, Springer, 2017).

The surgeon and the anaesthesiologist, both responsible for the same patient, must share decisions, discussing and planning together the best strategy, with the patient and his family too.

The decision should involve also the necessity of ICU recovery after surgery.

To choose appropriately is an everyday challenge in Acute Care Surgery and Intensive Care.

The reduction of inappropriate surgery and consequent inappropriate admission on ICU is a clinical and ethical goal to pursue, on patient’s and global interest.


Acute care surgery ICU Ethics Appropriateness 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Maria Cristina Sorella
    • 1
    Email author
  • B. Sakakushev
    • 2
  • F. Coccolini
    • 3
  • M. Sartelli
    • 4
  • L. Ansaloni
    • 3
  • A. Tarasconi
    • 5
  • S. Di Saverio
    • 6
  • R. M. Melotti
    • 1
  • F. Catena
    • 5
  1. 1.Department of Medical and Surgical Sciences, Alma Mater StudiorumUniversity of Bologna, Policlinico S.Orsola-MalpighiBolognaItaly
  2. 2.Medical University of PlovdivPlovdivBulgaria
  3. 3.Bufalini HospitalCesenaItaly
  4. 4.Macerata HospitalMacerataItaly
  5. 5.Emergency Surgery DepartmentParma University HospitalParmaItaly
  6. 6.Cambridge University HospitalsCambridgeUK

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