Vol 16, No 3 (2022)
Review paper
Published online: 2022-06-24
Aspects of palliative medicine in intensive care units: A narrative review
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Palliat Med Pract 2022;16(3):150-155.
Abstract
Background: The perspective of palliative care has changed dynamically over the years, and palliative
medicine, which was originally concerned with patients with advanced oncology diseases, has become
an interdisciplinary area. Many societies have published guidelines for the use of palliative medicine in
intensive care units.
Methods: This article presents indications and methods for implementing the principles of palliative
medicine in intensive care units. Particular attention is devoted to the consultations of palliative medicine
for current medical trends — COVID-19 infection, oncological diseases, fragility syndrome, and
end-stage circulatory failure.
Conclusions: Elements of palliative medicine are necessary for everyday practices in the intensive care
unit. The most important task in cooperation is to present classifications that can help in the objective
identification of patients requiring palliative care. It seems that creating a checklist of the qualifications
for a palliative medicine consultation can be the next step towards making decisions about this form
of therapy.
Keywords: futile therapyintensive care unitpalliative carepalliative medicine
References
- Cobert J, Cook AC, Lin JA, et al. Trends in Palliative Care Consultations in Critically Ill Patient Populations, 2013-2019. J Pain Symptom Manage. 2022; 63(2): e176–e181.
- Vivas L, Carpenter T. Meaningful futility: requests for resuscitation against medical recommendation. J Med Ethics. 2021; 47(10): 654–656.
- Vallabhajosyula S, Ingram C. In high-risk ICU patients, early palliative care consultation increased transition to DNR/DNI status. Ann Intern Med. 2020; 172(6): JC30.
- Wilkinson DJ. C, Savulescu J. Knowing when to stop: futility in the intensive care unit. Curr Opin Anaesthesiol. 2011; 2: 160–165.
- Kübler A, Siewiera J, Durek G, et al. Wytyczne postępowania wobec braku skuteczności podtrzymywania funkcji narządów (terapii daremnej) u pacjentów pozbawionych możliwości świadomego składania oświadczeń woli na oddziałach intensywnej terapii. Anestezjologia Intensywna Terapia. 2014; 46(4): 215–220.
- Flannery L, Ramjan LM, Peters K. End-of-life decisions in the Intensive Care Unit (ICU) - Exploring the experiences of ICU nurses and doctors - A critical literature review. Aust Crit Care. 2016; 29(2): 97–103.
- Mercadante S, Gregoretti C, Cortegiani A. Palliative care in intensive care units: why, where, what, who, when, how. BMC Anesthesiol. 2018; 18(1): 106.
- Bar B, Creutzfeldt CJ, Rubin MA. Palliative Care in the Neuro-ICU: Perceptions, Practice Patterns, and Preferences of Neurointensivists. Neurocrit Care. 2020; 32(1): 302–305.
- Creutzfeldt CJ, Engelberg RA, Healey L, et al. Palliative Care Needs in the Neuro-ICU. Crit Care Med. 2015; 43(8): 1677–1684.
- Coelho CB, Yankaskas JR. New concepts in palliative care in the intensive care unit. Rev Bras Ter Intensiva. 2017; 29(2): 222–230.
- Crooms RC, Gelfman LP. Palliative Care and End-of-Life Considerations for the Frail Patient. Anesth Analg. 2020; 130(6): 1504–1515.
- Kayser JB, Kaplan LJ. Conflict Management in the ICU. Crit Care Med. 2020; 48(9): 1349–1357.
- Aghabarary M, Dehghan Nayeri N. Medical futility and its challenges: a review study. J Med Ethics Hist Med. 2016; 9: 11.
- Metaxa V, Anagnostou D, Vlachos S, et al. Palliative care interventions in intensive care unit patients. Intensive Care Med. 2021; 47(12): 1415–1425.
- Basoulis D, Liatis S, Skouloudi M, et al. Survival predictors after intubation in medical wards: A prospective study in 151 patients. PLoS One. 2020; 15(6): e0234181.
- Taylor DR, Lightbody CJ. Futility and appropriateness: challenging words, important concepts. Postgrad Med J. 2018; 94(1110): 238–243.
- Cicero-Oneto CE, Valdez-Martinez E, Bedolla M. Decision-making on therapeutic futility in Mexican adolescents with cancer: a qualitative study. BMC Med Ethics. 2017; 18(1): 74.
- Nelson JE, Bassett R, Boss RD, et al. Improve Palliative Care in the Intensive Care Unit Project. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med. 2010; 38(9): 1765–1772.
- Aslakson RA, Curtis JR, Nelson JE. The changing role of palliative care in the ICU. Crit Care Med. 2014; 42(11): 2418–2428.
- Aslakson R, Cheng J, Vollenweider D, et al. Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med. 2014; 17(2): 219–235.
- Hua MS, Li G, Blinderman CD, et al. Estimates of the need for palliative care consultation across united states intensive care units using a trigger-based model. Am J Respir Crit Care Med. 2014; 189(4): 428–436.
- Sihra L, Harris M, O'Reardon C. Using the improving palliative care in the intensive care unit (IPAL-ICU) project to promote palliative care consultation. J Pain Symptom Manage. 2011; 42(5): 672–675.
- Jeitziner MM, Camenisch SA, Jenni-Moser B, et al. End-of-life care during the COVID-19 pandemic-What makes the difference? Nurs Crit Care. 2021; 26(3): 212–214.
- Poi C, Koh M, Neo H, et al. Palliative Care in a COVID-19 Intensive Care Unit (ICU): Challenges and Recommendations for Palliative Care Teams in a Pandemic ICU. Annals of the Academy of Medicine, Singapore. 2020; 49(7): 517–522.
- Downar J, Seccareccia D. Associated Medical Services Inc. Educational Fellows in Care at the End of Life. Palliating a pandemic: "all patients must be cared for". J Pain Symptom Manage. 2010; 39(2): 291–295.
- Lopez S, Finuf KD, Marziliano A, et al. Palliative Care Consultation in Hospitalized Patients With COVID-19: A Retrospective Study of Characteristics, Outcomes, and Unmet Needs. J Pain Symptom Manage. 2021; 62(2): 267–276.
- Poi C, Koh M, Neo H, et al. Palliative Care in a COVID-19 Intensive Care Unit (ICU): Challenges and Recommendations for Palliative Care Teams in a Pandemic ICU. Annals of the Academy of Medicine, Singapore. 2020; 49(7): 517–522.
- Schoenherr LA, Cook A, Peck S, et al. Proactive Identification of Palliative Care Needs Among Patients With COVID-19 in the ICU. J Pain Symptom Manage. 2020; 60(3): e17–e21.
- Fadul N, Elsayem AF, Bruera E. Integration of palliative care into COVID-19 pandemic planning. BMJ Support Palliat Care. 2021; 11(1): 40–44.
- Schoenherr L, Cook A, Peck S, et al. Proactive Identification of Palliative Care Needs Among Patients With COVID-19 in the ICU. Journal of Pain and Symptom Management. 2020; 60(3): e17–e21.
- So CW, Lui CT, Tsui KL, et al. Questionnaire survey on medical futility and termination of resuscitation in cardiac arrest patients among emergency physicians in Hong Kong. Hong Kong Med J. 2019; 25(3): 183–191.
- Sobański PZ, Brzezińska Rajszys G, Grodzicki T, et al. Palliative care for people living with cardiac disease. Kardiol Pol. 2020; 78(4): 364–373.
- Sobanski PZ, Krajnik M, Goodlin SJ. Palliative Care for People Living With Heart Disease-Does Sex Make a Difference? Front Cardiovasc Med. 2021; 8: 629752.
- Romano' M. The Role of Palliative Care in the Cardiac Intensive Care Unit. Healthcare (Basel). 2019; 7(1).
- Romanò M, Carriere C, Correale M, et al. [Futility in Cardiology]. G Ital Cardiol (Rome). 2016; 17(1): 6–10.
- Romano AM, Gade KE, Nielsen G, et al. Early Palliative Care Reduces End-of-Life Intensive Care Unit (ICU) Use but Not ICU Course in Patients with Advanced Cancer. Oncologist. 2017; 22(3): 318–323.
- Azoulay E, Schellongowski P, Darmon M, et al. The Intensive Care Medicine research agenda on critically ill oncology and hematology patients. Intensive Care Med. 2017; 43(9): 1366–1382.
- Seylanova N, Crichton S, Zhang J, et al. Acute kidney injury in critically ill cancer patients is associated with mortality: A retrospective analysis. PLoS One. 2020; 15(5): e0232370.
- Jeong BH, Na SJ, Lee DS, et al. Readmission and hospital mortality after ICU discharge of critically ill cancer patients. PLoS One. 2019; 14(1): e0211240.
- Vincent F, Ayed S, Bouguerba A, et al. Prognosis of Cancer Patients in the ICU: Much Work Remains. Respir Care. 2017; 62(9): 1230–1232.
- Morrison RS. Models of palliative care delivery in the United States. Curr Opin Support Palliat Care. 2013; 7(2): 201–206.
- Groeneveld EI, Cassel JB, Bausewein C, et al. Funding models in palliative care: Lessons from international experience. Palliat Med. 2017; 31(4): 296–305.
- Hui D, Heung Y, Bruera E. Timely Palliative Care: Personalizing the Process of Referral. Cancers (Basel). 2022; 14(4).
- Finn L, Malhotra S. The Development of Pathways in Palliative Medicine: Definition, Models, Cost and Quality Impact. Healthcare (Basel). 2019; 7(1).
- Góraj E. Palliative care strategies in the United Kingdom and New Zealand. Palliative Medicine. 2021; 13(4): 201–206.
- Dzierżanowski T. Definitions of palliative care – narrative review and new proposal. Palliative Medicine. 2021; 13(4): 187–200.
