End Of Life Care In The Icu

This book highlights real clinical issues which need to be addressed if quality palliative care within ICUs is to be consistently delivered. It is presented in an easily accessible, bullet pointed style, and is illustrated with case histories from real-life patients, and drug tables.

A clear and concise statement of facts and causes that have led step by step to the present deplorable condition of public affairs and the corruption of the body politic"--Preface.

This book analyzes the main topics of Palliative Care in Cardiac Intensive Care Units (CICU), from the changing epidemiology of patients admitted to the ICU, to the main clinical and ethical issues. The changing epidemiology of patients has led to new and emerging patient needs at the end of life. Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden, high mortality rate, and increased length of stay. The main new challenges involve shared decision-making, symptom control (pain, dyspnea, etc.), and ethical issues (withholding/withdrawing life sustaining treatments, deactivation of implanted cardiac devices, palliative sedation), all of which necessitate formal education on end-of-life care. Written by opinion leaders in their respective fields, who share their experience with improving the cultural and clinical competence of medical/nursing teams, this volume is chiefly intended for cardiologists, anesthesiologists, palliative care doctors and nursing staff.

Intensive care units (ICUs) provide comprehensive, advanced care to patients with serious or life-threatening conditions and consequently, a significant amount of end-of-life care (EOLC). Indeed, approximately 20% of deaths in the U.S. are associated with an ICU stay, and nearly half of U.S. patients who die in hospitals experience an ICU stay during the last 3 days of life. Despite the commonality of the ICU experience, ICU patients typically suffer from a range of distressing symptoms such as pain, fatigue, anxiety, and dyspnea, causing families significant distress on their behalf. Thus, there is a growing imperative for better provision of palliative care (PC) in the ICU, which may prevent and relieve suffering for patients with life threatening illnesses. Effective palliative care is accomplished through aggressive symptom management, communication about the patient and family’s physical, psychosocial and spiritual concerns, and aligning treatments with each patient’s goals, values, and preferences. PC is also patient-centered and uses a multidisciplinary, team-based approach that can be provided in conjunction with other life-sustaining treatments, or as a primary treatment approach. Failure to align treatment goals with individual and family preferences can create distress for patients, families, and providers. If implemented appropriately, palliative care may significantly reduce the health care costs associated with intensive hospital care, and help patients avoid the common, non-person centered treatment that is wasteful, distressing, and potentially harmful. Due to the success of many PC programs, administrators, providers, and accrediting bodies are beginning to understand that palliative care in the ICU is vital to optimal patient outcomes.

For patients and their loved ones, no care decisions are more profound than those made near the end of life. Unfortunately, the experience of dying in the United States is often characterized by fragmented care, inadequate treatment of distressing symptoms, frequent transitions among care settings, and enormous care responsibilities for families. According to this report, the current health care system of rendering more intensive services than are necessary and desired by patients, and the lack of coordination among programs increases risks to patients and creates avoidable burdens on them and their families. Dying in America is a study of the current state of health care for persons of all ages who are nearing the end of life. Death is not a strictly medical event. Ideally, health care for those nearing the end of life harmonizes with social, psychological, and spiritual support. All people with advanced illnesses who may be approaching the end of life are entitled to access to high-quality, compassionate, evidence-based care, consistent with their wishes. Dying in America evaluates strategies to integrate care into a person- and family-centered, team-based framework, and makes recommendations to create a system that coordinates care and supports and respects the choices of patients and their families. The findings and recommendations of this report will address the needs of patients and their families and assist policy makers, clinicians and their educational and credentialing bodies, leaders of health care delivery and financing organizations, researchers, public and private funders, religious and community leaders, advocates of better care, journalists, and the public to provide the best care possible for people nearing the end of life.

This book provides learners with a unique opportunity by virtue of the format outlined above. Each case presentation has a case vignette, which leads up to an important clinical question, and is followed by additional discussion which resolves the question posed. This is a new way to present knowledge in a medical book and should help critical care practitioners, fellows, residents, allied health professionals and students expand their critical care knowledge in an efficient and effective manner. This approach should also benefit those preparing for board examinations.

For readers of Being Mortal and Modern Death, an ICU and Palliative Care specialist offers a framework for a better way to exit life that will change our medical culture at the deepest level In medical school, no one teaches you how to let a patient die. Jessica Zitter became a doctor because she wanted to be a hero. She elected to specialize in critical care—to become an ICU physician—and imagined herself swooping in to rescue patients from the brink of death. But then during her first code she found herself cracking the ribs of a patient so old and frail it was unimaginable he would ever come back to life. She began to question her choice. Extreme Measures charts Zitter’s journey from wanting to be one kind of hero to becoming another—a doctor who prioritizes the patient’s values and preferences in an environment where the default choice is the extreme use of technology. In our current medical culture, the old and the ill are put on what she terms the End-of-Life Conveyor belt. They are intubated, catheterized, and even shelved away in care facilities to suffer their final days alone, confused, and often in pain. In her work Zitter has learned what patients fear more than death itself: the prospect of dying badly. She builds bridges between patients and caregivers, formulates plans to allay patients’ pain and anxiety, and enlists the support of loved ones so that life can end well, even beautifully. Filled with rich patient stories that make a compelling medical narrative, Extreme Measures enlarges the national conversation as it thoughtfully and compassionately examines an experience that defines being human.