End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Myburgh, John; Abillama, Fayez; Chiumello, Davide; Dobb, Geoff; Jacobe, Stephen; Kleinpell, Ruth M.; Y, Koh; Martin, Claudio M.; Michalsen, Andej; Pelosi, Paolo; Torra, L. Blanch; Vincent, Jean‐Louis; Yeager, Susan; Zimmerman, Janice L.

doi:10.1016/j.jcrc.2016.04.017

Cited by 102 publications

(71 citation statements)

References 16 publications

(5 reference statements)

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“…AD are a written document, available in many countries, that a patient may prepare to consign, in writing, their wishes regarding end-of-life care, in case they subsequently become incompetent and unable to communicate their preferences (3,4). This ensures that for patients who lose © Annals of Translational Medicine.…”

Section: What Exactly Are Acp and Ad?mentioning

confidence: 99%

“…Despite numerous international recommendations and legislation formalizing AD in many countries (3,4), uptake of AD remains poor in the general population. The main problem likely concerns the fact that many patients find it hard to envisage their own demise, and are unable to say in advance what they might want at the end-oflife.…”

Section: What Exactly Are Acp and Ad?mentioning

confidence: 99%

“…However, in a substantial proportion of cases, artificial life support will not yield an enduring benefit for the patient, and will engender physical, emotional, spiritual and financial burdens on the patients, their families and society in general (2). Although a number of consensus documents and recommendations for end-of-life situations have been published (3,4), which have undoubtedly improved our practices in this domain (5), ICU physicians still have two major goals for patient management, namely to anticipate ICU admission where prognosis would be highly unfavourable, and to limit the use of certain lifesustaining therapies in the ICU (e.g., proposing noninvasive ventilation, but not intubation). In the literature, different approaches have been proposed for meeting these objectives, in particular advance care planning (ACP), ethics consultations, and palliative care consultations (1,(6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

What are the ethical questions raised by the integration of intensive care into advance care planning?

Quenot¹,

Ecarnot²,

Meunier-Beillard³

et al. 2017

Ann. Transl. Med.

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A major goal of intensive care units (ICUs) is to offer optimal management, but for many patients admitted to the ICU, they are unlikely to yield any lasting benefit. In this context, the ICU physician remains a key intermediary, particularly when a decision regarding possible limitation or withdrawal of lifesustaining therapy becomes necessary. The possibility of admission to the ICU, and the type of care the patient would like to receive there, should be integrated into the healthcare project in agreement with the patient, regardless of the stage of disease that the patient suffers from. These dispositions should be recorded in the patient's file, and should respect the progressive nature of both the disease itself, and the discussions necessary in such complex situations. The ICU physician can serve as a valuable consultant for the treating physician, in particular to guide patient choices when formalizing their healthcare preferences in the form of advance care planning (ACP) or advance directives (AD). Ideally, the best time to address this issue is before the patient's clinical situation deteriorates towards an acute emergency, and providing complete and transparent information to inform the patient's choices.

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Section: What Exactly Are Acp and Ad?mentioning

confidence: 99%

Section: What Exactly Are Acp and Ad?mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

What are the ethical questions raised by the integration of intensive care into advance care planning?

Quenot¹,

Ecarnot²,

Meunier-Beillard³

et al. 2017

Ann. Transl. Med.

View full text Add to dashboard Cite

show abstract

“…Published guidelines mainly focus on the decision-making principles rather than practical details about how end-of-life care should be managed (19,20). Once artificial breathing support is switched off, it becomes possible to remove the endotracheal tube that connects the patient to the ventilator and secures the airway (10).…”

Section: Caregivers Have Equal Responsibility Towards Both the Dying mentioning

confidence: 99%

A few realistic questions raised by organ retrieval in the intensive care unit

Lesieur¹,

Genteuil²,

Leloup³

2017

Ann. Transl. Med.

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Organ transplantation saves the lives of many persons who would otherwise die from end-stage organ disease. The increasing demand for donated organs has led to a renewed interest in donation after circulatory determination of death (CDD). In many countries (including France), terminally ill patients who die of circulatory arrest after a planned withdrawal of life support may be considered as organ donors under certain conditions. While having equal responsibility towards the potential donor and the persons awaiting a transplant, caregivers may experience an ethical dilemma between the responsibility to deliver the best care to the dying, and the need to retrieve the organs. Once it has been established that the patient wishes to be a donor, we assume that end-of-life care and organ donation may have convergent goals when they contribute to transforming a comfortable death into a chance of life for others in need.

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“…The type of death, the place and ICU mortality rates show differences according to sociological factors including the demographic structure of the country, disease patterns, existing resources and cultural, religious, economic and legal factors [19]. In Turkey, there are great differences in the understanding and attitudes of physicians towards end-of-life care and because of the lack of non-medical regulations and laws and an undeveloped awareness of PC, patients and their families think of ICU as a place where end-of-life care is given and request advanced life support [20].…”

Section: Overwievmentioning

confidence: 99%

Palliative care and intensive care integration

Kahveci¹

2017

Med-Science

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With developments in technology and in healthcare policies in Turkey, both the quality and number of applications of care have increased in recent years in intensive care units. At the same time, rates of hospital mortality have increased due to the rise in the elderly population, changes in family structure, increased urban population and easier access to health facilities. Intensive care units are the places where deaths and functional and cognitive disorders are most frequently seen. Current models where intensive care and palliative care are integrated are seen as an important component of comprehensive care for patients with critical disease and who are receiving aggressive intensive care treatment. The goal in intensive care and palliative care integration is to promote better quality, lower cost, patient and family satisfaction. The aim of this review was to highlight the importance and necessity of palliative care applications in intensive care units. It can be concluded that an increase in palliative care training, legal regulations made related to end-of-life patient care and the implementation of palliative care in intensive care unit would provide more effective use of intensive care units.

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End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine

Cited by 102 publications

References 16 publications

What are the ethical questions raised by the integration of intensive care into advance care planning?

What are the ethical questions raised by the integration of intensive care into advance care planning?

A few realistic questions raised by organ retrieval in the intensive care unit

Palliative care and intensive care integration

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