Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Introduction
- Withholding or Withdrawing Treatment
- Presumption in Favour of Prolonging Life
- Decisions Need to Be Informed by Multidisciplinary Team Assessment
- Put Patients at the Heart of the Decision-Making Process
- When a Treatment Is Deemed to Clearly Offer no ‘Clinical Benefit’
- When the Overall Benefit of a Treatment Is Less Clear
- Clinically Assisted Nutrition and Hydration
- Disagreement
- Care of the Patient during Withdrawal of Life-Sustaining Treatment
- Introduction
- Treat Your Patient as an Individual
- Capacity
- Confidentiality
- Rapport
- Know All the Relevant Information
- Optimise the Setting
- What Does the Patient Already Know?
- What Does the Patient Want to Know?
- Warning Shot
- Speak Honestly and Directly
- Allow the Expression of Emotions
- Listen to Concerns and Answer Questions
- Agree New Goals
- Summarise
- Pitfalls to Avoid
- Tricky Cases
- Introduction
- ‘Good Death’
- Recognising the Dying Patient
- The Decision-Making Process
- Decisions and Care at the End of Life
- Recognising Symptoms
- Involving Family Members
- Religion and Spirituality
- Communication
- Definition of Death
- The Personnel
- Brainstem Reflexes
- The Apnoea Test
- Ancillary Tests
- Introduction
- Pathophysiological Changes after Brainstem Death
- Stabilisation of a Brain-Dead Donor to Optimise Organ Function
- General Management
- Introduction
- Controlled and Uncontrolled Donations
- The Process of Controlled DCD
- Ischaemia Times
- Patients from Emergency Department
- 8.1 How to Manage the Process of Withholding or Withdrawing Treatment with the Multidisciplinary Team
- 8.2 How to Discuss End-of-Life Care with Patients and Their Families/Surrogates
- 8.3 Managing Palliative Care of the Critically Ill Patient
- 8.4 Brainstem Death Testing
- 8.5 Physiological Support of the Organ Donor
- 8.6 Management of Organ Donation Following Circulatory Death
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
8.3 - Managing Palliative Care of the Critically Ill Patient
from Section 8 - End-of-Life Care
Published online by Cambridge University Press: 27 July 2023
Book contents
- Intensive Care Medicine
- Intensive Care Medicine
- Copyright page
- Dedication
- Dedication
- Epigraph
- Contents
- Contributors
- Preface
- Foreword
- Abbreviations
- Section 1 Resuscitation and Management of the Acutely Ill Patient
- Section 2 Diagnosis, Assessment, Investigation, Monitoring and Data Interpretation
- Domain 3 Disease Management: Recognition, Causes and Management
- Section 4 Therapeutic Interventions and Organ Support
- Domain 5 Practical Procedures
- Section 6 Perioperative Care
- Section 7 Comfort and Recovery
- Section 8 End-of-Life Care
- Introduction
- Withholding or Withdrawing Treatment
- Presumption in Favour of Prolonging Life
- Decisions Need to Be Informed by Multidisciplinary Team Assessment
- Put Patients at the Heart of the Decision-Making Process
- When a Treatment Is Deemed to Clearly Offer no ‘Clinical Benefit’
- When the Overall Benefit of a Treatment Is Less Clear
- Clinically Assisted Nutrition and Hydration
- Disagreement
- Care of the Patient during Withdrawal of Life-Sustaining Treatment
- Introduction
- Treat Your Patient as an Individual
- Capacity
- Confidentiality
- Rapport
- Know All the Relevant Information
- Optimise the Setting
- What Does the Patient Already Know?
- What Does the Patient Want to Know?
- Warning Shot
- Speak Honestly and Directly
- Allow the Expression of Emotions
- Listen to Concerns and Answer Questions
- Agree New Goals
- Summarise
- Pitfalls to Avoid
- Tricky Cases
- Introduction
- ‘Good Death’
- Recognising the Dying Patient
- The Decision-Making Process
- Decisions and Care at the End of Life
- Recognising Symptoms
- Involving Family Members
- Religion and Spirituality
- Communication
- Definition of Death
- The Personnel
- Brainstem Reflexes
- The Apnoea Test
- Ancillary Tests
- Introduction
- Pathophysiological Changes after Brainstem Death
- Stabilisation of a Brain-Dead Donor to Optimise Organ Function
- General Management
- Introduction
- Controlled and Uncontrolled Donations
- The Process of Controlled DCD
- Ischaemia Times
- Patients from Emergency Department
- 8.1 How to Manage the Process of Withholding or Withdrawing Treatment with the Multidisciplinary Team
- 8.2 How to Discuss End-of-Life Care with Patients and Their Families/Surrogates
- 8.3 Managing Palliative Care of the Critically Ill Patient
- 8.4 Brainstem Death Testing
- 8.5 Physiological Support of the Organ Donor
- 8.6 Management of Organ Donation Following Circulatory Death
- Section 9 Paediatric Care
- Section 10 Transport
- Section 11 Professionalism, Patient Safety, Governance and Health Systems Management
- Index
- References
Summary
Key Learning Points
1. Palliative care is an approach that aims to improve the quality of life of patients and their families.
2. The limitation of therapy is considered when the burden of life-sustaining treatment outweighs the benefits.
3. At the point of withholding and withdrawal of life-sustaining treatment, the priority of care changes from ‘cure’ to ‘comfort’.
4. A multidisciplinary and collaborative approach should be adopted for decision-making.
5. There should be access to spiritual care, including cultural and religious rituals.
- Type
- Chapter
- Information
- Intensive Care MedicineThe Essential Guide, pp. 677 - 679Publisher: Cambridge University PressPrint publication year: 2021
References
References and Further Reading
Aslakson, RA, Randall Curtis, J, Nelson, JE. The changing role of palliative care in the ICU. Crit Care Med 2014;42:2418–28.Google Scholar
Braganza, MA, Glossop, AJ, Vora, VA. Treatment withdrawal and end-of-life care in the intensive care unit. BJA Education 2017;17:396–400.CrossRefGoogle Scholar
Downar, J, Delaney, JW, Hawry luck, L, Kenny, L. Guidelines for the withdrawal of life-sustaining measures. Intensive Care Med 2016;42:1003–17.Google ScholarPubMed
General Medical Council. Treatment and care towards the end of life: the duties of a doctor registered with the General Medical Council. London: General Medical Council; 2010.Google Scholar
Truog, RD, Campbell, ML, Curtis, JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008;36:953–63.CrossRefGoogle Scholar