Palliative Care In Cardiac Intensive Care Units

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.

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.

The ESC Textbook of Intensive and Acute Cardiovascular Care is the official textbook of the Acute Cardiovascular Care Association (ACVC) of the ESC. Cardiovascular diseases (CVDs) are a major cause of premature death worldwide and a cause of loss of disability-adjusted life years. For most types of CVD early diagnosis and intervention are independent drivers of patient outcome. Clinicians must be properly trained and centres appropriately equipped in order to deal with these critically ill cardiac patients. This new updated edition of the textbook continues to comprehensively approach all the different issues relating to intensive and acute cardiovascular care and addresses all those involved in intensive and acute cardiac care, not only cardiologists but also critical care specialists, emergency physicians and healthcare professionals. The chapters cover the various acute cardiovascular diseases that need high quality intensive treatment as well as organisational issues, cooperation among professionals, and interaction with other specialities in medicine. SECTION 1 focusses on the definition, structure, organisation and function of ICCU's, ethical issues and quality of care. SECTION 2 addresses the pre-hospital and immediate in-hospital (ED) emergency cardiac care. SECTIONS 3-5 discuss patient monitoring, diagnosis and specific procedures. Acute coronary syndromes (ACS), acute decompensated heart failure (ADHF), and serious arrhythmias form SECTIONS 6-8. The main other cardiovascular acute conditions are grouped in SECTION 9. Finally SECTION 10 is dedicated to the many concomitant acute non-cardiovascular conditions that contribute to the patients' case mix in ICCU. This edition includes new chapters such as low cardiac output states and cardiogenic shock, and pacemaker and ICDs: troubleshooting and chapters have been extensively revised. Purchasers of the print edition will also receive an access code to access the online version of the textbook which includes additional figures, tables, and videos to better to better illustrate diagnostic and therapeutic techniques and procedures in IACC. The third edition of the ESC Textbook of Intensive and Acute Cardiovascular Care will establish a common basis of knowledge and a uniform and improved quality of care across the field.

In collaboration with Consulting Editor, Dr. Cynthia Bautista, Dr. Judy Davidson has put together a comprehensive issue on family and patient experience in the ICU. Expert authors have contributed clinical review articles on the following topics: Humanizing Intensive Care: From Theory to Practice; FiCare; Patient's Own Pets in the ICU; Sleep in the ICU; Implementation of a Patient and Family-Centered ICU Peer Support Program at a Veterans Affairs Hospital; Understanding the Experiences of Patients and Families in the ICU: More than Engagement; Implementing a Patient and Family Communication Bundle in the ICU; Integrating Primary Palliative Care into the ICU: The Critical Care Nurse Communicator Program; Bereavement Care in the Adult ICU: Directions for Practice; A review on the Use of Diaries; Supporting Families of Patients with Rare or Unusual Critical Illnesses; and Meeting the Special Needs of Families of CTICU patients. Readers will come away with the information they need to improve family and patients experiences in the ICU.

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.

Part of the Mount Sinai Expert Guide series, this outstanding book provides rapid-access, clinical information on all aspects of Critical Care with a focus on clinical diagnosis and effective patient management. With strong focus on the very best in multidisciplinary patient care, it is the ideal point of care consultation tool for the busy physician.

This text is one of the first comprehensive resources on understanding and working with families in the intensive care unit. The text provides a conceptual overview of the Family ICU Syndrome, a constellation of physical morbidity, psychopathology, cognitive deficits, and conflict. Outlining its mechanisms, the book presents a guide to combating the syndrome with an interdisciplinary team. The text represents the full array of the interdisciplinary team by also spotlighting administrative considerations for health care management and approaches to training different members of the health care team. Family voices are featured prominently in the text as well. The book also addresses the complete trajectory of needs of care, including survivorship and end-of-life care. Written by experts in the field, Families in the Intensive Care Unit: A Guide to Understanding, Engaging and Supporting at the Bedside is a state-of-the-art reference for all clinicians who work with families in the ICU.