Editorial
Multidisciplinary palliative care at the end of life of critically ill patient
Cuidados paliativos multidisciplinares al final de la vida del paciente crítico
Á. Estellaa,
, T. Velascob, I. Saraleguic, J.M. Velasco Buenod, O. Rubio Sanchize, M. del Barriof, M.C. Martín Delgadog
Corresponding author
a Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
b Hospital Clínico San Carlos, Madrid, Spain
c Hospital de Áraba, Vitoria-Gasteiz, Araba, Spain
d Hospital Virgen de la Victoria, Málaga, Spain
e Althaia Xarxa Hospitalaria Universitaria de Manresa, Manresa, Barcelona, Spain
f Clínica Universitaria de Navarra, Pamplona, Navarra, Spain
g Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
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This agreement speaks against the topical and false view that intensive care and palliative care represent antagonistic disciplines. Critical patients are characterized by life-threatening clinical situations and continuous and unpredictable evolutive changes. The treatment objectives are therefore also dynamic and are conditioned to the patient evolutive course and response to therapy. Current intensive care practice must contemplate not only supportive treatment for the seriously ill but also the adoption of measures in the event of a negative evolutive course, poor response to therapy and a high risk of death during admission to the ICU or in the course of hospital stay.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Multidisciplinary or integral management of the critical patient therefore needs to include palliative care,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> which must form part of treatment in the ICU, with a view to guaranteeing maximum quality care in such patients, where healing intent gives way to optimum end of life care. Early identification of the palliative needs of these patients is crucial in this regard.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Humanization of healthcare projects have been developed in recent years, promoting open ICU policies, introducing more flexible visiting policies, and favoring the presence and participation of the families in the care of the critically ill patient.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> The Societies that participate in this cooperation agreement have set the ambitious goal of encouraging measures to improve end of life care in patients admitted to the ICU. This requires the adoption of interventional strategies comprising the assessment of clinical, psychological, social and contextual aspects with the purpose of reorienting the care of those patients that present an unfavorable clinical course, seeking to afford relief from suffering, improve the symptoms and ensure greater wellbeing. A further objective is to address the needs of the families of these patients and of the healthcare professionals, who may suffer from exhaustion or other syndromes such as moral stress, compassion fatigue, or inappropriate care function.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Due respect for the autonomy of critical patients, including them in the clinical decision process from the time of admission, proves particularly relevant in those situations where the patients lose their capacity to decide. This is where anticipated planning of healthcare or the contemplation of living wills (or advance directives) is important and should form part of daily practice in the ICU. Such practice is not always implemented, however, and patient will may be infringed as a result.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">1,3,4</span></a> The control of symptoms such as pain, dyspnea, fear or anxiety must be a priority concern in end of life care, facilitating patient accompaniment by loved ones and ensuring an environment as comfortable as possible for both the patients and their families.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a> Close and true communication, adapted to the clinical situation, should play a key role with the same importance as other care processes during patient admission to the ICU.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Limitation of life support measures are common in Spanish ICUs<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> and must be decided on a team basis<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> with participation of the different healthcare professionals involved. The contribution of points of view serves to reinforce such decisions. In this regard, the opinions of the professionals directly in charge of caring for the patient are particularly relevant. These decisions must be based on prudent clinical criteria supported by clinical facts such as the patient course, response to treatment and prognosis. Furthermore, however, the values of the patients and their families, and of the healthcare organization, also need to be taken into account. The principal aim is to avoid therapeutic obstinacy, futile treatments or therapies regarded as inappropriate, as well as to foresee the different outcomes and deal with them adequately both within and outside the ICU. Coordination with the palliative care teams is crucial in this sense.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Healthcare professionals in the ICU need to acquire knowledge and skills in order to comply with the essential role played by palliative care in certain critical patients.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The development of training programs for the professionals that care for critically ill patients in the end of life scenario, and the updating and divulgation of management recommendations in these situations, justify the mentioned cooperation agreement, which should serve to ensure the optimum care of such patients – offering integral management for both the critically ill and their families, and support for the professionals involved in the process.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Estella Á, Velasco T, Saralegui I, Velasco Bueno JM, Rubio Sanchiz O, del Barrio M, et al. Cuidados paliativos multidisciplinares al final de la vida del paciente crítico. Med Intensiva. 2019;43:61–62.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "pii:S0210-5691(18)30117-7 [in English, Spanish]" "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "Grupos de trabajo de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias“Do not do” recommendations of the working groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the management of critically ill patients" "etal" => true "autores" => array:6 [ 0 => "F.J. González de Molina Ortiz" 1 => "F. Gordó Vidal" 2 => "A. Estella García" 3 => "P. Morrondo Valdeolmillos" 4 => "J.F. Fernández Ortega" 5 => "J. Caballero López" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2018.04.001" "Revista" => array:3 [ "tituloSerie" => "Med Intensiva" "fecha" => "2018" "volumen" => "19" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0065" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Buscando humanizar los cuidados intensivos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Heras La Calle" 1 => "M.C. Martín" 2 => "N. Nin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5935/0103-507X.20170003" "Revista" => array:6 [ "tituloSerie" => "Rev Bras Ter Intensiva" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "9" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28444067" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0070" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Substituted judgment in real life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Dresser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/medethics-2014-102504" "Revista" => array:6 [ "tituloSerie" => "J Med Ethics" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "731" "paginaFinal" => "738" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25378551" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0075" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Instrucciones previas en cuidados intensivos: competencias de los profesionales sanitarios" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.R. Velasco-Sanz" 1 => "E. Rayón-Valpuesta" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medin.2015.04.011" "Revista" => array:6 [ "tituloSerie" => "Med Intensiva" "fecha" => "2016" "volumen" => "40" "paginaInicial" => "154" "paginaFinal" => "162" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26072095" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0080" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Palliative care in the ICU of 2050: past is prologue" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "K.S. Mathews" 1 => "J.E. Nelson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-017-4828-7" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2017" "volumen" => "43" "paginaInicial" => "1850" "paginaFinal" => "1852" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28509949" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0085" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Palliative cares and the intensivist: not confined to the intensive care unit" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Vincent" 1 => "L. Chapuis" 2 => "E. Zamparini" 3 => "C. Bornstain" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-018-5072-5" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2018" "volumen" => "44" "paginaInicial" => "667" "paginaFinal" => "668" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29374773" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0090" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Challenges in the implementation of strategies to increase communication and enhance patient and family centered care in the ICU" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.M. Furqan" 1 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 10 | 13 | 23 |
| 2024 October | 78 | 44 | 122 |
| 2024 September | 55 | 36 | 91 |
| 2024 August | 85 | 48 | 133 |
| 2024 July | 54 | 33 | 87 |
| 2024 June | 77 | 37 | 114 |
| 2024 May | 76 | 39 | 115 |
| 2024 April | 65 | 39 | 104 |
| 2024 March | 61 | 53 | 114 |
| 2024 February | 50 | 55 | 105 |
| 2024 January | 50 | 44 | 94 |
| 2023 December | 40 | 40 | 80 |
| 2023 November | 51 | 55 | 106 |
| 2023 October | 57 | 46 | 103 |
| 2023 September | 44 | 46 | 90 |
| 2023 August | 34 | 23 | 57 |
| 2023 July | 33 | 28 | 61 |
| 2023 June | 40 | 24 | 64 |
| 2023 May | 42 | 40 | 82 |
| 2023 April | 51 | 33 | 84 |
| 2023 March | 83 | 29 | 112 |
| 2023 February | 66 | 37 | 103 |
| 2023 January | 35 | 30 | 65 |
| 2022 December | 68 | 53 | 121 |
| 2022 November | 69 | 42 | 111 |
| 2022 October | 48 | 42 | 90 |
| 2022 September | 51 | 40 | 91 |
| 2022 August | 83 | 37 | 120 |
| 2022 July | 58 | 54 | 112 |
| 2022 June | 46 | 34 | 80 |
| 2022 May | 80 | 48 | 128 |
| 2022 April | 44 | 27 | 71 |
| 2022 March | 41 | 54 | 95 |
| 2022 February | 54 | 36 | 90 |
| 2022 January | 36 | 34 | 70 |
| 2021 December | 45 | 42 | 87 |
| 2021 November | 67 | 44 | 111 |
| 2021 October | 82 | 83 | 165 |
| 2021 September | 61 | 36 | 97 |
| 2021 August | 46 | 40 | 86 |
| 2021 July | 27 | 21 | 48 |
| 2021 June | 45 | 23 | 68 |
| 2021 May | 76 | 48 | 124 |
| 2021 April | 104 | 73 | 177 |
| 2021 March | 70 | 33 | 103 |
| 2021 February | 64 | 34 | 98 |
| 2021 January | 50 | 19 | 69 |
| 2020 December | 42 | 14 | 56 |
| 2020 November | 41 | 24 | 65 |
| 2020 October | 25 | 27 | 52 |
| 2020 September | 34 | 15 | 49 |
| 2020 August | 24 | 19 | 43 |
| 2020 July | 30 | 26 | 56 |
| 2020 June | 39 | 16 | 55 |
| 2020 May | 33 | 13 | 46 |
| 2020 April | 29 | 16 | 45 |
| 2020 March | 15 | 15 | 30 |
| 2020 February | 59 | 41 | 100 |
| 2020 January | 30 | 22 | 52 |
| 2019 December | 33 | 27 | 60 |
| 2019 November | 35 | 34 | 69 |
| 2019 October | 43 | 33 | 76 |
| 2019 September | 34 | 19 | 53 |
| 2019 August | 36 | 21 | 57 |
| 2019 July | 26 | 23 | 49 |
| 2019 June | 18 | 13 | 31 |
| 2019 May | 0 | 5 | 5 |
| 2019 April | 0 | 4 | 4 |
| 2019 March | 1 | 11 | 12 |
| 2019 February | 0 | 4 | 4 |
| 2019 January | 0 | 2 | 2 |
Show all
