Carrillo ER, Carrillo CJR, Carrillo CLD

Language: Spanish
References: 37
Page: 207-216
PDF size: 193.63 Kb.

ABSTRACT

Because of the severity of illness, the intensive care unit (ICU) is a setting where death is common. Approximately 20% of all deaths in the United States occur in the ICU which translates to approximately 540,000 Americans who die in the ICU each year. This is similar to the number of Americans who die of cancer each year. ICU use at the end of life varies markedly by the nature of the diseases, such as cancer less likely to result in death in the ICU, while the more acute, potentially reversible illnesses are more likely to result in death in the ICU. Of patients who die in the hospital, approximately half are cared for in an ICU within 3 days of their death. Although optimal palliative care of outpatients may prevent many ICU admissions, the ICU will always remain an important setting for the end of life care because of the severity of illness of patients in the ICU and because many patients and families will opt for a trial of intensive care even in the setting of severe underlying chronic illness.
ICU provide sophisticated care to seriously ill patients. Unfortunately, there are many barriers to providing effective palliative care in this setting. These barriers include insufficient communication skills about end of life issues among health care providers, inability of patients to participate in discussions about their treatment, unrealistic expectations on the part of patients and families about the prognosis of patients or the effectiveness of ICU treatment, and lack of advanced directives from patients about how they wish their care to be handled at the end of life.
Palliative care programs excel at integrating vigorous pain and symptom management whether life prolonging or curative treatment is being provided or is being withheld or withdrawn. Palliative care programs also ease case management burdens on primary physician and staff and provide assistance with care coordination and time intensive patient-family communication.

REFERENCES

1. Angus DC, Barnato AE, Linde-Zwirble WT. Use of intensive care at the end of life in the United States: An epidemiologic study. Crit Care Med 2004;32:638-643.

2. SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients: The Study to Understand Prognoses and Preferences for Outcomes and Risk of Treatments (SUPPORT). JAMA 1995;274:1591-1598.

3. Wennenberg JE, Cooper MM. The Darthmouth Atlas of Health Care in the United States: A report on the Medicare Program. Chicago, American Hospital Publishing. 1990.

4. Breen CM, Abernethy AP, Abbott, KH et al. Conflict associated with decisions to limit life-sustaining treatment in intensive care units. J Gen Intern Med 2001;16(5):283-289.

5. Rubenfield GD, Curtis JR. Improving care for patients dying in the intensive care unit. Clin Chest Med 2003; 24:763-773.

6. Desbiens NA, Mueller-Rinzen N. How well do surrogates assess the pain of seriously ill patients? Crit Care Med 2000;28:1347-1352.

7. Hamill-Ruth RJ. Use of anelgesics in the intensive care unit: who says it hurts? Crit Care Med 2002;30:2597-8.

8. Puntillo KA, Morris AB, Thompson CL et al. Pain behaviors observed during six common procedures: results from Thunder Project II. Crit Care Med 2004;32(2):421-7.

9. Frenzel D, Greim CA, Sommer C et al. Is the bispectral index appropriate for monitoring the sedation level of mechanically ventilated surgical ICU patients? Intensive Care Med 2002;28(2):178-83.

10. Sprung CL, Cohen LS, Sjokvist P et al. End-of-life Practices in European Intensive Care Units. The Ethicus Study. JAMA 2003;290:790-797.

11. Clarke EB, Curtis JR, Luce MJ et al. Quality indicators for end-of-life care in the intensive care unit. Crit Care Med 2003:2252-2262.

12. Hodde NH, Engelberg RA, Treece DP et al. Factor Associated with nurse assessment of the quality of dying and death in the intensive care unit. Crit Care Med 2004;32: 1648-1653.

13. Crossno RJ. Dying in the emergency department. What emergency physicians should know about palliative medicine. Top Emerg Med 2004;26:19-28.

14. Mosenthal AC, Murphy PA. Trauma care palliative care: Time to integrate the two? J Am Coll Surg 2003;197:509-516.

15. Davidson PM, Paull G, Intronta K et al. Integrated collaborative palliative care in heart failure. The St. George Heart Failure Service Experience 1999-2002. J Cariovasc Nur 2004;19:68-75.

16. DeVita MA, Arnold RM, Barnard D. Teaching palliative care to critical care medicine trainees. Crit Care Med 2003;31:1-13.

17. Troug RD, Cist AF, Brackett SE. Recommendations for end of life on the intensive care unit: The Ethics Committee of the society of Critical Care Medicine. Crit Care Med 2001;29:

18. Mularski RA. Pain management in the intensive care unit. Crit Care Clin 2004;20:381-401.

19. Cammarano WB, Pittet JF, Weitz S et al. Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients. Crit Care Med 1998;26:676-84.

20. Jacobi J, Fraser GL, Coursin DB et al. Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult. Crit Care Med 2002;30: 119-41.

21. Kress JP, Hall JB. Delirium and sedation. Crit Care Clin 2004;20:419-433.

22. Ely E, Gautam S, Margolin R et al. The impact of delirium in the intensive care unit on hospital lenght of stay. Intensive Care Med 2001;27:1892-1900.

23. Ely E, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001;286:2703-10.

24. Campbell ML. Terminal dyspnea and respiratory distress. Crit Care Clin 2004;20:403-17.

25. Wildiers H, Menten J. Death rattle: prevalence, preventions and treatment. J Pain Symptom Manage 2002; 23:310-7.

26. Jacobs L. Managing respiratory symptoms at the end of life. Clin Geriatr Med 2003;19:225-239.

27. Barnes EA, Bruera E. Fatigue in patients with advanced cancer: a review. Int J Gynecol Cancer 2002;12:424-8.

28. McCann RM, Hall WJ, Groth-Juncker A. Confort care for terminally ill patients: the appropiate use of nutrition and hidratation. JAMA 1994;272:1263-66.

29. Ciccarelo GP. Strategies to improve End-of-life Care in the Intensive Care Unit. Dimens Crit Care Nurs 2003;22:216-222.

30. Carrillo ER, Carvajal RR, Villaseñor OP. La etapa terminal de la vida en la unidad de terapia intensiva. Rev Asoc Mex Med Crit y Ter Int 2004;18:173-191.

31. Pitorak EF. Respecting the dying patient’s rights. Home Healthcare Nurse 2003;21:833-836.

32. Treece PD, Engelberg RA, Crowley L et al. Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Crit Care Med 2004;32:1141-1148.

33. Billings J, Pantilat S. Survey of palliative care programs in the United States teaching hospitals. J Paliative Med 2001;4:309-14.

34. Pan C, Morrison R, Meier D et al. How prevalent are hospital – based palliative care programs ? Status report and future directions. J Palliative Med 2001;4:315-24.

35. Azoulay E, Sprung Ch L. Family – physician interactions in the intensive care unit. Crit Care Med 2004;32:2323-2328.

36. Weissman DE, Blust L. Education in Palliative Care. Clin Geriatr Med 2005;21:165-175.

37. Aulisio MP, Chaitin E, Arnold RM. Ethics and palliative care consultation in the intensive care unit. Crit Care Clin 2004;20:505-523.