Palliative care interventions in intensive care unit patients.
Critical care
End-of-life care
Palliative care
Journal
Intensive care medicine
ISSN: 1432-1238
Titre abrégé: Intensive Care Med
Pays: United States
ID NLM: 7704851
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
02
08
2021
accepted:
21
09
2021
pubmed:
16
10
2021
medline:
15
12
2021
entrez:
15
10
2021
Statut:
ppublish
Résumé
The integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear. We conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries. Fifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies. Beneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.
Identifiants
pubmed: 34652465
doi: 10.1007/s00134-021-06544-6
pii: 10.1007/s00134-021-06544-6
doi:
Types de publication
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1415-1425Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.
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