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Palliative care in the ICU

David Picker, Maria Dans, Kevin Heard, Thomas Bailey, Yixin Chen, Chenyang Lu, Marin H Kollef
OBJECTIVE: To determine whether an Early Warning System could identify patients wishing to focus on palliative care measures. DESIGN: Prospective, randomized, pilot study. SETTING: Barnes-Jewish Hospital, Saint Louis, MO (January 15, 2015, to December 12, 2015). PATIENTS: A total of 206 patients; 89 intervention (43.2%) and 117 controls (56.8%). INTERVENTIONS: Palliative care in high-risk patients targeted by an Early Warning System...
October 20, 2016: Critical Care Medicine
Rachael E C Schutz, Heather L Coats, Ruth A Engelberg, J Randall Curtis, Claire J Creutzfeldt
BACKGROUND: Patients with severe acute brain injury (SABI) raise important palliative care considerations associated with sudden devastating injury and uncertain prognosis. OBJECTIVE: The goal of this study was to explore how family members, nurses, and physicians experience the palliative and supportive care needs of patients with SABI receiving care in the neuroscience intensive care unit (neuro-ICU). DESIGN: Semistructured interviews were audiotaped, transcribed, and analyzed using thematic analysis...
October 20, 2016: Journal of Palliative Medicine
Zhan Liang, Leslie A Hoffman, Mehdi Nouraie, Daniel J Kass, Michael P Donahoe, Kevin F Gibson, Melissa I Saul, Kathleen O Lindell
BACKGROUND: Palliative care has been recommended as a means to assist patients with idiopathic pulmonary fibrosis (IPF) in managing symptom burden and advanced care planning. Timing of referral is important because although most patients display a gradually progressive course, a minority experience acute deterioration, an outcome associated with high mortality. AIM: To describe characteristics of IPF patients referred to a specialty lung disease center over a 10-year period who experienced acute deterioration and subsequent intensive care unit (ICU) admission, including frequency and timing of referral to palliative care...
October 18, 2016: Journal of Palliative Medicine
Tarek Assi, Elie El Rassy, Tony Ibrahim, Tania Moussa, Aline Tohme, Fadi El Karak, Fadi Farhat, Salma Faddoul, Marwan Ghosn, Joseph Kattan
INTRODUCTION: One major health care issue encountered in elderly cancer patients is the alteration of the quality of life. The purpose of our study is to evaluate the administration of chemotherapy in the last month of life (CLML) and to evaluate the impact of the palliative care consult (PCC) in the elderly patients. METHODS: We conducted a retrospective observational study that included elderly patients diagnosed with an end-stage cancer and who were deceased between the 1st of January 2012 and the 31st of December 2015...
October 13, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Christian Michael Horvath, Martin Horvath Brutsche, Otto Dagobert Schoch, Bernarde Schillig, Florent Baty, Dieter vonOw, Jochen Julius Rüdiger
Non-invasive ventilatory support is frequently used in patients with severe respiratory failure (SRF), but is often limited to intensive care units (ICU). We hypothesized that an instantaneous short course of NIV (up to 2 h), limited to regular working hours as an additional therapy on the emergency department (ED) would be feasible and could improve patient´s dyspnoea measured by respiratory rate and Borg visual dyspnea scale. NIV was set up by an interdisciplinary respiratory care team. Outside these predefined hours NIV was performed in the ICU...
October 8, 2016: Internal and Emergency Medicine
Robert J Zalenski, Spencer S Jones, Cheryl Courage, Denise R Waselewsky, Anna S Kostaroff, David Kaufman, Afzal Beemath, John Bronfman, James W Castillo, Hicham Krayem, Anthony Marinelli, Bradley Milner, Maria Teresa Palleschi, Mona Tareen, Sheri Testani, Ayman Soubani, Julie Walch, Judy Wheeler, Sonali Wilborn, Hanna Granovsky, Robert D Welch
CONTEXT: There are few multi-center studies that examine the impact of systematic screening for palliative care and specialty consultation in the ICU. OBJECTIVE: To determine the outcomes of receiving palliative care consultation (PCC) for patients who screened positive on palliative care referral criteria. METHODS: In a prospective quality assurance intervention with a retrospective analysis, the covariate balancing propensity score method was utilized to estimate the conditional probability of receiving a PCC and to balance important covariates...
October 5, 2016: Journal of Pain and Symptom Management
Jennifer B Seaman, Amber E Barnato, Susan M Sereika, Mary Beth Happ, Judith A Erlen
OBJECTIVE: Describe patterns of palliative care service consultation among a sample of ICU patients at high risk of dying. BACKGROUND: Patients receiving mechanical ventilation (MV) face threats to comfort, social connectedness and dignity due to pain, heavy sedation and physical restraint. Palliative care consultation services may mitigate poor outcomes. METHODS: From a dataset of 1440 ICU patients with ≥2 days of MV and ≥12 h of sustained wakefulness, we identified those at high risk of dying and/or who died and assessed patterns of sub-specialty palliative care consultation...
October 4, 2016: Heart & Lung: the Journal of Critical Care
Nicholas G Wysham, Michael J Hochman, Steven P Wolf, Christopher E Cox, Arif H Kamal
CONTEXT: Quality metrics for intensive care unit (ICU)-based palliative care have been proposed but it is unknown how consultative palliative care can contribute to performance on these measures. OBJECTIVES: Assess adherence to proposed quality metrics of intensive care unit (ICU)-based palliative care by palliative care specialists. METHODS: Surrogates for 9/14 patient-level quality metrics were assessed in all patients who received an initial palliative care specialist consult while in an ICU from 10/26/2012 to 1/16/2015 in the Global Palliative Care Quality Alliance, a nationwide palliative care quality registry...
September 30, 2016: Journal of Pain and Symptom Management
Kathleen O'Connell, Ronald Maier
PURPOSE OF REVIEW: The benefits of palliative care for critically ill patients are well recognized, yet acceptance into surgical culture is lagging. With the increasing proportion of geriatric trauma patients, integration of palliative medicine within daily intensive care services to facilitate goal-concordant care is imperative. RECENT FINDINGS: Misconceptions of palliative medicine as it applies to trauma patients linger among trauma surgeons and many continue to practice without routine consultation of a palliative care service...
September 21, 2016: Current Opinion in Critical Care
Eluned Mun, Clementina Ceria-Ulep, Lillian Umbarger, Craig Nakatsuka
CONTEXT: Is a decrease in length of stay (LOS) in the intensive care unit (ICU) and hospital possible with the implementation of a structured, palliative care, quality-improvement program in the ICU? OBJECTIVE: Incorporate palliative care into the routine ICU workflow to increase the numbers of palliative care consultations, improve end-of-life care in the ICU, and demonstrate an impact on ICU and/or hospital LOS. DESIGN: A program was developed that followed recommendations from the Center to Advance Palliative Care's Improving Palliative Care in the ICU project...
August 31, 2016: Permanente Journal
M Begoña Girbau Campo, Pablo Monedero Rodríguez, Carlos Centeno Cortés
Recent scientific literature has shown a growing interest to integrate palliative medicine principles into the daily workflow in the intensive care unit (ICU). This article reviews this trend with the goal that its application might provide more understanding in the resolution of some current ethical issues. Patients with an advanced disease process and at the end of life who are admitted in the intensive care unit are in such a profound level of suffering and vulnerability that only an holistic and comprehensive approach can provide adequate relief to them...
May 2016: Cuadernos de Bioética: Revista Oficial de la Asociación Española de Bioética y Ética Médica
Daniela J Lamas, Robert L Owens, R Nicholas Nace, Anthony F Massaro, Nathan J Pertsch, Jonathon Gass, Rachelle E Bernacki, Susan D Block
OBJECTIVE: Chronically critically ill patients have recurrent infections, organ dysfunction, and at least half die within 1 year. They are frequently cared for in long-term acute care hospitals, yet little is known about their experience in this setting. Our objective was to explore the understanding and expectations and goals of these patients and surrogates. DESIGN: We conducted semi-structured interviews with chronically critically ill long-term acute care hospital patients or surrogates...
September 14, 2016: Critical Care Medicine
Nicholas G Wysham, May Hua, Catherine L Hough, Stephanie Gundel, Sharron L Docherty, Derek M Jones, Owen Reagan, Haley Goucher, Jessica Mcfarlin, Christopher E Cox
OBJECTIVE: Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment. DESIGN: Mixed-methods study. SETTING: Medical and surgical ICUs at three large academic hospitals. PARTICIPANTS: Three hundred three nurses, intensivists, and advanced practice providers...
September 9, 2016: Critical Care Medicine
Joao Gabriel Rosa Ramos, Mario Diego Teles Correa, Ricardo Tavares de Carvalho, Daryl Jones, Daniel Neves Forte
PURPOSE: To evaluate clinical characteristics of patients with palliative care (PC) and urgent intensive care unit (ICU) referrals in the same hospital admission. METHODS: All urgent ICU referrals at an academic, tertiary hospital, and the co-occurrence and timing of PC assessment were retrieved from a prospectively collected database. RESULTS: From May 2014 to May 2015, 2476 patients were analyzed and 179 (7%) had co-occurrence of PC assessment and urgent ICU referral in the same hospital admission...
August 21, 2016: Journal of Critical Care
Kwadwo Kyeremanteng, Louis-Philippe Gagnon, Kednapa Thavorn, Daren Heyland, Gianni D'Egidio
INTRODUCTION: The intensive care unit (ICU) consumes 20% of hospital expenditures and 1% of gross domestic product. Many strategies have been attempted to reduce ICU costs. A systematic review was conducted to evaluate the effect of palliative care (PC) consultations in the ICU on length of stay (LOS) and costs. METHODS: A literature search was performed using PubMed, MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs), prospective, and retrospective cohort studies looking at PC consultations in adult ICUs published between January 2000 and February 2016 were selected...
August 31, 2016: Journal of Intensive Care Medicine
Ayano Kiyota, Christina L Bell, Kamal Masaki, Daniel J Fischberg
To inform earlier identification of intensive care unit (ICU) patients needing palliative care, we examined factors associated with in-hospital death among ICU patients (N=260) receiving palliative care consultations at a 542-bed tertiary care hospital (2005-2009). High pre-consultation length of stay (LOS, ≥7 days) (adjusted odds ratio (aOR)=5.0, 95% confidence interval (95% CI)=2.5-9.9, P<.01) and consultations for assistance with plan of care (aOR=11.6, 95% CI=5.6-23.9, P<.01) were independently associated with in-hospital death...
August 2016: Hawai'i Journal of Medicine & Public Health: a Journal of Asia Pacific Medicine & Public Health
Pam Ramsay, Guro Huby, Judith Merriweather, Lisa Salisbury, Janice Rattray, David Griffith, Timothy Walsh
OBJECTIVES: To explore and compare patient/carer experiences of rehabilitation in the intervention and usual care arms of the RECOVER trial (ISRCTN09412438); a randomised controlled trial of a complex intervention of post-intensive care unit (ICU) acute hospital-based rehabilitation following critical illness. DESIGN: Mixed methods process evaluation including comparison of patients' and carers' experience of usual care versus the complex intervention. We integrated and compared quantitative data from a patient experience questionnaire (PEQ) with qualitative data from focus groups with patients and carers...
2016: BMJ Open
Belmira D C P C C Martins, Reinaldo A Oliveira, Antonio J M Cataneo
OBJECTIVE: The purpose of our systematic review was to determine whether the introduction of palliative care (PC) teams reduces length of stay and/or mortality for terminally ill patients (TIPs) in an intensive care unit (ICU). METHOD: We hoped to examine studies that compared TIPs in an ICU who received end-of-life care following implementation of a PC team (intervention group) to those who received care where PC teams had not yet been introduced (control group)...
July 27, 2016: Palliative & Supportive Care
Andrés Esteban De La Torre
There is a clear trend in the past years, dies in the environment of the patient's home. The seemingly paradoxical fact that the intensive care units are produced at the same time use them more and more, in an attempt by patients and relatives run down facilities that offer the most advanced technologies. In many cases the UCI can be considered as a therapeutic trial, which occasionally fails. At this moment occurs a fundamental step, from care to restore health to palliative care, whose main objective is to ensure the comfort of the patient...
2014: Anales de la Real Academia Nacional de Medicina
Shannon S Carson, Christopher E Cox, Sylvan Wallenstein, Laura C Hanson, Marion Danis, James A Tulsky, Emily Chai, Judith E Nelson
IMPORTANCE: Family caregivers of patients with chronic critical illness experience significant psychological distress. OBJECTIVE: To determine whether family informational and emotional support meetings led by palliative care clinicians improve family anxiety and depression. DESIGN, SETTING, AND PARTICIPANTS: A multicenter randomized clinical trial conducted from October 2010 through November 2014 in 4 medical intensive care units (ICUs). Adult patients (aged ≥21 years) requiring 7 days of mechanical ventilation were randomized and their family surrogate decision makers were enrolled in the study...
July 5, 2016: JAMA: the Journal of the American Medical Association
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