European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.
Journal: Intensive care medicine
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Affiliated Institutions:
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. j.kesecioglu@umcutrecht.nl.
Department of Palliative Medicine, st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.
Sapienza University of Rome, A.O.U. Sant'Andrea, Rome, Italy.
Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
Faculty of Medicine, School of Nursing, Hebrew University, Jerusalem, Israel.
Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
Royal Devon University NHS Foundation Trust, Exeter, UK.
Biomedical Sciences Department, Humanitas University, Milan, Italy.
Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC, USA.
Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Medicine, University of Ottawa, Ottawa, Canada.
School of Nursing and Midwifery, University of Birmingham, Birmingham, UK.
National Institute for Health and Care Research, London, UK.
Department of Medicine, University of Udine, Udine, Italy.
Gelderse Vallei Hospital, Ede, The Netherlands.
Centrum Voor Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
Department of Critical Care, AmsterdamUMC Location VUmc, Amsterdam, The Netherlands.
Interdepartmental Division Critical Care Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.
Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Toronto, Canada.
Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
Famiréa Research Group, APHP Nord, Saint Louis Hospital, Intensive Care Unit, Paris, France.
School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.
Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia.
Department of Neuroscience, Reproductive Science and Dentistry, University of Naples, Naples, Italy.
Wolfson Palliative Care Research Centre, Hull York, Medical School, University of Hull, Hull, UK.
First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece.
Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa.
Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Konstanz Hospital, Constance, Germany.
Ahmedabad Shaibya Comprehensive Care Clinic, Ahmedabad, India.
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
Department of Intensive Care Adults, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Hospital de São José, Unidade Local de Saúde São José, Lisbon, Portugal.
Memorial Hospital, Weill Cornell Medical College, New York, NY, USA.
Hospital Arnau de Vilanova-Lliria, Valencia, Spain.
University of Hertfordshire, East and North Hertfordshire NHS Trust, Hatfield, UK.
School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
Intensive Care, Glasgow Royal Infirmary, Glasgow, UK.
Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
Department of Intensive Care Medicine, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain.
Sabar Health, Netanya, Israel.
Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Department of Anesthesiology, Critical Care Medicine and Pain, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
S.C. Anesthesia and Intensive Care, Legnano Hospital, ASST Ovest Milanese, Milan, Italy.
Department of Anesthesia, Intensive Care and Emergency, San Giovanni Bosco Hospital, Turin, Italy.
Anesthesia and Intensive Care Ospedale "Uboldo", Cernusco sul Naviglio, Milan, Italy.
Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris, France.
Abstract summary
The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.
Authors & Co-authors:
Kesecioglu Jozef J
Rusinova Katerina K
Alampi Daniela D
Arabi Yaseen M YM
Benbenishty Julie J
Benoit Dominique D
Boulanger Carole C
Cecconi Maurizio M
Cox Christopher C
van Dam Marjel M
van Dijk Diederik D
Downar James J
Efstathiou Nikolas N
Endacott Ruth R
Galazzi Alessandro A
van Gelder Fiona F
Gerritsen Rik T RT
Girbes Armand A
Hawyrluck Laura L
Herridge Margaret M
Hudec Jan J
Kentish-Barnes Nancy N
Kerckhoffs Monika M
Latour Jos M JM
Malaska Jan J
Marra Annachiara A
Meddick-Dyson Stephanie S
Mentzelopoulos Spyridon S
Mer Mervyn M
Metaxa Victoria V
Michalsen Andrej A
Mishra Rajesh R
Mistraletti Giovanni G
van Mol Margo M
Moreno Rui R
Nelson Judith J
Suñer Andrea Ortiz AO
Pattison Natalie N
Prokopova Tereza T
Puntillo Kathleen K
Puxty Kathryn K
Qahtani Samah Al SA
Radbruch Lukas L
Rodriguez-Ruiz Emilio E
Sabar Ron R
Schaller Stefan J SJ
Siddiqui Shahla S
Sprung Charles L CL
Umbrello Michele M
Vergano Marco M
Zambon Massimo M
Zegers Marieke M
Darmon Michael M
Azoulay Elie E
Study Outcome
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