The Role of Palliative Care in the Cardiac Intensive Care Unit

Romanò, Massimo

doi:10.3390/healthcare7010030

Cited by 18 publications

(7 citation statements)

References 73 publications

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“…Atrial fibrillation and lethal arrhythmias are common in patients with heart failure and shock. Some changes in cause of death may be attributed to changes in the philosophy of patients, families, physicians and the Israeli law, which in more recent years have allowed patients to die peacefully when overwhelming clinical circumstances are present [22] , [23] . We identified three patients who died due to advanced cancers, although the final events were asystole or pulseless electrical activity; these were classified as cancer-related mortality.…”

Section: Discussionmentioning

confidence: 99%

Causes of mortality in a department of cardiology over a 15-year period

Karkabi¹,

Khoury²,

Zafrir³

et al. 2021

IJC Heart & Vasculature

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Aims Over the last four decades, in-hospital mortality from acute coronary syndromes (ACS) has declined. We characterized the patients who died in our cardiovascular intensive care unit (CICU) over a 15-year period. Based on these data, we described the changing patient population in the CICU. Methods This retrospective study compared characteristics of patients who died in our CICU in 2005–6, 2013–4 and 2019. During these 5 years, 13,931 patients were hospitalized; 251 (1.8%) died. The mean age of the patients who died was 76 years, 144 (57%) were men. ACS was the leading cause of admission (93 patients, 37%), and 145 (58%) patients had a history of heart failure prior to hospitalization. The leading cause of death was cardiogenic shock in 104 (41%) patients, septic shock in 48 (19%) patients, and combined cardiogenic and septic shock in 31 (12%). Patients hospitalized in the later years of the study were significantly older (67.7, 69.0 and 70.5 years, 2005–6, 2013–4 and 2019, respectively, p < 0.02) but their medical characteristics did not differ significantly between the years examined. Conclusions The profile of the patients who died did not change significantly over the 15-year study period. Age of admitted patients was higher in later years of the study. The leading cause of admission was ACS and the leading causes of death were cardiogenic and septic shock. Based on our observations, additional skills should be added to the curriculum of cardiology, including the management of patients with multiorgan failure.

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Section: Discussionmentioning

confidence: 99%

Causes of mortality in a department of cardiology over a 15-year period

Karkabi¹,

Khoury²,

Zafrir³

et al. 2021

IJC Heart & Vasculature

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“…The consequences of this underestimation can create significant errors in ethics, communication, and care. 40 Routine palliative care consultation in ICUs and referral by intensivists to their palliative care colleagues are rare. In addition, the approach to end-of-life by critical and palliative care physicians may differ.…”

Section: Making Decisions About the End Of Lifementioning

confidence: 99%

Curative to palliative care transition challenges in the intensive care unit. A narrative review.

Koutsouki¹,

Kosmidis

2023

HRJ

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Abstract Introduction: The need for high quality palliative care services for critically ill patients and their families remains of high importance. Purpose: This review aims to present the benefits and barriers to implementing palliative care in Intensive Care Units and suggest ways to facilitate the shift from therapeutic to palliative care. Methods: PubMed, Scopus, and Google Scholar databases were searched online. Studies included were eligible for the provision of palliative care in the intensive care unit, published in English from 2012 through 2022. Review: Evidence shows that integrating palliative care impacts the quality of life in intensive care unit and increases rates of use of palliative care facilities. On the other hand decrease length of stay and impacts the cost and the opportunity cost of the intensive care unit. The data suggest that a large subset of intensive care units patients would benefit from palliative care, but palliative care remains underutilized in the ICU setting. Lack of training in palliative care, organizational factors, decisions about end of life, lack of defined criteria for inclusion, and life-saving culture of the intensive care unit are barriers to providing palliative care. Efforts should focus on education, support for effective communication and decision-making, early integration of a palliative approach, redesign of clinical protocols, and reallocation of resources to provide an environment conducive to quality at the end of life. Conclusion: Involving palliative care in critically ill patients has reduced intensive care unit resource use. Nurses need to define their essential management roles within the multidisciplinary critical care team and help develop systems by which these roles can be implemented.

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“…It is difficult to accurately determine the prognosis in patients, especially those elderly patients with co-morbidities and debilitated patients. In chronic, progressive and incurable non-oncologic patients, it is required to stage and evaluate the potential organ failures [31].…”

Section: Life-sustaining Treatmentmentioning

confidence: 99%

Palliative Care in the Intensive Care Unit: Not Just End-of-life Care

et al. 2022

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Initially, palliative care in the intensive care unit (ICU) was designed to improve hospice care. Today it has emerged as a core component of ICU care. ICU palliative care should follow the ethical principles of autonomy, beneficence, nonmaleficence, justice and fidelity. To integrate primary palliative care and professional palliative care into ICU care management, there are different modes: integrative, consultative, and a combined approach. All ICU patients should receive palliative care which includes symptom management and shared decision-making. Further research is needed to explore how to provide the best palliative care for ICU patients and their families.

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The Role of Palliative Care in the Cardiac Intensive Care Unit

Cited by 18 publications

References 73 publications

Causes of mortality in a department of cardiology over a 15-year period

Causes of mortality in a department of cardiology over a 15-year period

Curative to palliative care transition challenges in the intensive care unit. A narrative review.

Palliative Care in the Intensive Care Unit: Not Just End-of-life Care

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