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Palliative care in the ICU

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https://www.readbyqxmd.com/read/27872409/complexity-analysis-of-decision-making-in-the-critically-ill
#1
Barbara J Daly, Sara L Douglas, Elizabeth O'Toole, James Rowbottom, Alan Hoffer, Amy R Lipson, Christopher Burant
RATIONALE: Despite multiple trials of interventions to improve end-of-life care of the critically ill, there is a persistent lack of understanding of factors associated with barriers to decision-making at the end of life. OBJECTIVE: To apply the principles of complexity science in examining the extent to which transitions to end-of-life care can be predicted by physician, family, or patient characteristics; outcome expectations; and the evaluation of treatment effectiveness...
November 20, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27861180/improving-hospital-survival-and-reducing-brain-dysfunction-at-seven-california-community-hospitals-implementing-pad-guidelines-via-the-abcdef-bundle-in-6-064-patients
#2
Mary Ann Barnes-Daly, Gary Phillips, E Wesley Ely
OBJECTIVES: To track compliance by an interprofessional team with the Awakening and Breathing Coordination, Choice of drugs, Delirium monitoring and management, Early mobility, and Family engagement (ABCDEF) bundle in implementing the Pain, Agitation, and Delirium guidelines. The aim was to study the association between ABCDEF bundle compliance and outcomes including hospital survival and delirium-free and coma-free days in community hospitals. DESIGN: A prospective cohort quality improvement initiative involving ICU patients...
November 17, 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27850037/397-a-survey-of-pediatric-critical-care-fellows-on-palliative-care-principles-applied-in-the-icu-setting
#3
Jaime Jump, Mindy Dickerman
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27843637/critically-ill-patients-with-cancer-chances-and-limitations-of-intensive-care-medicine-a-narrative-review
#4
REVIEW
Peter Schellongowski, Wolfgang R Sperr, Philipp Wohlfarth, Paul Knoebl, Werner Rabitsch, Herbert H Watzke, Thomas Staudinger
This narrative review deals with the challenge of defining adequate therapy goals and intensive care unit (ICU) admission criteria for critically ill patients with cancer. Several specific complications of critically ill patients with cancer require close collaborations of intensive care and cancer specialists. Intensivists require a basic understanding of the pathophysiology, diagnosis and therapy of common cancer-specific problems. Cancer specialists must be knowledgeable in preventing, detecting and treating imminent or manifest organ failures...
2016: ESMO Open
https://www.readbyqxmd.com/read/27813724/patterns-of-cost-for-patients-dying-in-the-intensive-care-unit-and-implications-for-cost-savings-of-palliative-care-interventions
#5
Nita Khandelwal, David Benkeser, Norma B Coe, Ruth A Engelberg, Joan M Teno, J Randall Curtis
BACKGROUND: Terminal intensive care unit (ICU) stays represent an important target to increase value of care. OBJECTIVE: To characterize patterns of daily costs of ICU care at the end of life and, based on these patterns, examine the role for palliative care interventions in enhancing value. DESIGN: Secondary analysis of an intervention study to improve quality of care for critically ill patients. SETTING/PATIENTS: 572 patients who died in the ICU between 2003 and 2005 at a Level-1 trauma center...
November 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/27789776/chemotherapy-near-the-end-of-life-for-chinese-patients-with-solid-malignancies
#6
Jin Sheng, Ya-Xiong Zhang, Xiao-Bo He, Wen-Feng Fang, Yun-Peng Yang, Gui-Nan Lin, Xuan Wu, Ning Li, Jing Zhang, Lin-Zhu Zhai, Yuan-Yuan Zhao, Yan Huang, Ning-Ning Zhou, Hong-Yun Zhao, Li Zhang
INTRODUCTION: There are increasing concerns about the negative impacts of chemotherapy near the end of life (EOL). There is discrepancy among different countries about its use, and little is known about the real-world situation in China. PATIENTS AND METHODS: This retrospective study was conducted at six representative hospitals across China. Adult decedents with a record of advanced solid cancer and palliative chemotherapy were consecutively screened from 2010 through 2014...
October 27, 2016: Oncologist
https://www.readbyqxmd.com/read/27768613/a-randomized-trial-of-palliative-care-discussions-linked-to-an-automated-early-warning-system-alert
#7
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
https://www.readbyqxmd.com/read/27763820/is-there-hope-is-she-there-how-families-and-clinicians-experience-severe-acute-brain-injury
#8
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
https://www.readbyqxmd.com/read/27754815/referral-to-palliative-care-infrequent-in-patients-with-idiopathic-pulmonary-fibrosis-admitted-to-an-intensive-care-unit
#9
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
https://www.readbyqxmd.com/read/27738795/the-role-of-palliative-care-in-the-last-month-of-life-in-elderly-cancer-patients
#10
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
https://www.readbyqxmd.com/read/27722910/niv-by-an-interdisciplinary-respiratory-care-team-in-severe-respiratory-failure-in-the-emergency-department-limited-to-day-time-hours
#11
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
https://www.readbyqxmd.com/read/27720791/impact-of-palliative-care-screening-and-consultation-in-the-icu-a-multi-hospital-quality-improvement-project
#12
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
https://www.readbyqxmd.com/read/27717509/patterns-of-palliative-care-service-consultation-in-a-sample-of-critically-ill-icu-patients-at-high-risk-of-dying
#13
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
https://www.readbyqxmd.com/read/27697569/performance-of-consultative-palliative-care-model-in-achieving-quality-metrics-in-the-icu
#14
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
https://www.readbyqxmd.com/read/27661439/palliative-care-in-the-trauma-icu
#15
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...
December 2016: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/27644048/trend-of-decreased-length-of-stay-in-the-intensive-care-unit-icu-and-in-the-hospital-with-palliative-care-integration-into-the-icu
#16
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...
2016: Permanente Journal
https://www.readbyqxmd.com/read/27637192/-integration-of-the-principles-of-palliative-care-in-intensive-care-medicine
#17
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
https://www.readbyqxmd.com/read/27632675/opening-the-door-the-experience-of-chronic-critical-illness-in-a-long-term-acute-care-hospital
#18
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
https://www.readbyqxmd.com/read/27618270/improving-icu-based-palliative-care-delivery-a-multicenter-multidisciplinary-survey-of-critical-care-clinician-attitudes-and-beliefs
#19
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
https://www.readbyqxmd.com/read/27610588/clinical-significance-of-palliative-care-assessment-in-patients-referred-for-urgent-intensive-care-unit-admission-a-cohort-study
#20
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
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