scholarly journals 8 ‘palliative critical care’: evolution of a hospital palliative care service in the intensive care unit setting

2018 ◽  
Author(s):  
HK Crispin ◽  
K Haynes ◽  
A Cran ◽  
E Murphy ◽  
R Chambers ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Care Service ◽  
Palliative Care Service ◽  
Intensive Care Unit Setting

CUIDADO PALIATIVO NA UNIDADE DE TERAPIA INTENSIVA

2019 ◽  
Vol 1 (2) ◽  
pp. 68-94
Author(s):  
Raquel JESUS Melânia de Jesus Tassini ◽  
Joseph Fabiano Guimarães Santos ◽  
Maria Emídia de Melo Coelho
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
End Of Life Care ◽  
Critical Care Unit ◽  
Care Service ◽  
Palliative Care Service ◽  
Life Care ◽  
Comfort Care ◽  
Terapia Intensiva

No cotidiano da prática da medicina de urgência e emergência, mais especificamente na terapia intensiva, surgem diversas situações onde o paciente encontra-se na condição de um processo de morte inexorável, e muitas vezes já com o suporte avançado de vida instalado. Diante desta realidade, cada vez mais presente, necessitamos de intervenções que amenizem os sofrimentos consequentes à mesma, em que a capacidade humana de compaixão e misericórdia possam prevalecer. Neste estudo fez-se revisão sistemática, na busca de estudos observacionais e intervencionistas, além de estudos de revisão sistemática e meta-análise, obtidos através de pesquisa eletrônica realizada no banco de dados do Pubmed e Medline. O período pesquisado foi entre 2006 a 2018. Os termos pesquisados foram: “intensive care unit”, “critical care unit”, “palliative care”, “improving palliative care”, “palliative care service”, “palliative care consult”, “end-of-life care”, “comfort care” e “supportive care”. Fez-se descrição didática dos diversos aspectos encontrados na revisão, onde avaliou-se a importância e necessidade da integração dos cuidados paliativos com a terapia intensiva, por se tratar de uma opção com elevada eficiência e eficácia para dar suporte na assistência aos pacientes, principalmente àqueles com doença terminal e seus familiares. Conclui-se ser imprescindível a educação sobre a filosofia, princípios e prática dos cuidados paliativos na equipe multiprofissional, assim como nos especialistas envolvidos no cuidado do paciente.

scholarly journals An Evaluation of the Palliative Care Provided on a Medical Intensive Care Unit

2015 ◽  
Author(s):  
Peter Musso
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Care Service ◽  
Hospital Setting ◽  
Palliative Care Service ◽  
Practice Change ◽  
Care Needs ◽  
Medical Intensive Care

<p>More patients die in intensive care units (ICUs) than in any other hospital setting. For survivors, ICU treatment is often accompanied by a significant burden of symptoms for both the patient and for the family and may result in long-term cognitive and physical impairments and an unacceptable quality of life. Over the last decade, the idea that palliative care should be provided along with intensive care regardless of prognosis has evolved from a novel formulation to a clinical practice guideline. The purpose of this research was to determine whether the patients on a Medical Intensive Care Unit (MICU) were being offered appropriate palliative care. A retrospective chart review of 250 charts was performed at a 653-bed acute care, teaching facility located in southern New England with a sample of 50 patients. The Care and Communication Bundle was used to measure if primary palliative care needs were met; the Palliative Care Service Consult Tool developed by the palliative care team at the study institution was used to measure if tertiary palliative care need s were met. Results indicated approximately 85% compliance with primary palliative care overall, compliance with the individual items ranged from 40% - 100%. Tertiary palliative care compliance was 7% overall, with only two out of 29 patients actually receiving a consult. Recommendations for practice change include integrating the tool into the electronic medical record as part of the admission assessment. Interdisciplinary staff education on the process and use of the measures is indicated. State and national policies related to palliative care would facilitate the implementation of palliative care programs aimed at providing care for all people in need of these services and ensure equitable access to end-of-life care. Advanced practice nurses have a key role in advocating for policy changes within their institutions, as well as, at the state and national levels that could help patients meet their goals of care, especially at the end of their lives.</p>

scholarly journals Telemedicine coverage for post-operative ICU patients

2016 ◽  
Vol 23 (2) ◽  
pp. 360-364 ◽  
Author(s):  
Tara Ann Collins ◽  
Matthew P Robertson ◽  
Corinna P Sicoutris ◽  
Michael A Pisa ◽  
Daniel N Holena ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Care Service ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Surge Capacity ◽  
Icu Patients ◽  
Critical Care Service ◽  
Surgical Critical Care

Introduction There is an increased demand for intensive care unit (ICU) beds. We sought to determine if we could create a safe surge capacity model to increase ICU capacity by treating ICU patients in the post-anaesthesia care unit (PACU) utilizing a collaborative model between an ICU service and a telemedicine service during peak ICU bed demand. Methods We evaluated patients managed by the surgical critical care service in the surgical intensive care unit (SICU) compared to patients managed in the virtual intensive care unit (VICU) located within the PACU. A retrospective review of all patients seen by the surgical critical care service from January 1st 2008 to July 31st 2011 was conducted at an urban, academic, tertiary centre and level 1 trauma centre. Results Compared to the SICU group ( n = 6652), patients in the VICU group ( n = 1037) were slightly older (median age 60 (IQR 47–69) versus 58 (IQR 44–70) years, p = 0.002) and had lower acute physiology and chronic health evaluation (APACHE) II scores (median 10 (IQR 7–14) versus 15 (IQR 11–21), p < 0.001). The average amount of time patients spent in the VICU was 13.7 + /–9.6 hours. In the VICU group, 750 (72%) of patients were able to be transferred directly to the floor; 287 (28%) required subsequent admission to the surgical intensive care unit. All patients in the VICU group were alive upon transfer out of the PACU while mortality in the surgical intensive unit cohort was 5.5%. Discussion A collaborative care model between a surgical critical care service and a telemedicine ICU service may safely provide surge capacity during peak periods of ICU bed demand. The specific patient populations for which this approach is most appropriate merits further investigation.

scholarly journals Rapid Ultrasound Methods in Anesthesiology and Critical Care Medicine

2015 ◽  
Vol 25 (2) ◽  
pp. 94-102
Author(s):  
Andrius Macas ◽  
Asta Mačiulienė ◽  
Sandra Ramanavičiūtė ◽  
Alina Vilkė ◽  
Kęstutis Petniūnas ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Critical Care ◽  
Intensive Care ◽  
Trauma Patient ◽  
Standard Of Care ◽  
Intensive Care Unit Setting ◽  
Critically Ill Patient ◽  
Essential Information ◽  
Ultrasound Applications

The variety of focus assessed ultrasound applications and protocols in emergency department and intensive care unit setting is growing. Focus assessed protocols can provide essential information about critically ill patient. It is now the standard of care to perform focused assessment using sonography for trauma - FAST early in the evaluation of trauma patient. Other focus assessed protocols can prove to be useful as well as FAST.

scholarly journals Trends in Pediatric Palliative Care Research (TPPCR) 2021; Issue #3: Commentary on Guttmann et al and Dryden-Palmer et al.

2021 ◽  
Author(s):  
Christina Vadeboncoeur ◽  
TPPCR
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Critical Care ◽  
Intensive Care ◽  
Symptom Management ◽  
Neonatal Intensive Care ◽  
Moral Distress ◽  
Pediatric Palliative Care ◽  
Pediatric Critical Care ◽  
Intensive Care Unit Staff

This TPPCR commentary discusses the 2021 paper by Guttmann et al and Dryden-Palmer et al., “Goals of Care Discussions and Moral Distress among Neonatal Intensive Care Unit Staff” published in the Journal of Pain and Symptom Management and the 2021 paper by Dryden-Palmer et al., “Moral Distress of Clinicians in Canadian Pediatric and Neonatal ICUs” published in Pediatric Critical Care Medicine.

scholarly journals Sleep Deprivation in the Intensive Care Patient

2020 ◽  
Vol 40 (2) ◽  
pp. e16-e24
Author(s):  
Jessica Grimm
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Sleep Deprivation ◽  
Current Literature ◽  
Sleep Problems ◽  
Care Patient ◽  
Intensive Care Unit Setting ◽  
Care Plans ◽  
Clinical Tools

Topic Sleep deprivation in the intensive care unit setting. Clinical Relevance The Society of Critical Care Medicine has identified sleep deprivation as a significant contributor to the development of delirium in adult patients in the intensive care unit. Thus, preventing and managing sleep deprivation is important in reducing the incidence of delirium in this patient population. A multifaceted and multidisciplinary approach to promoting sleep in the intensive care unit setting that includes sleep hygiene routines, nursing care plans, and appropriate medication regimens may improve patient outcomes, including reducing delirium. Purpose of Article To review the current literature on sleep deprivation in the intensive care unit setting and present care guidelines in a concise format. This information may be helpful in the development of clinical tools and may guide future quality improvement projects aimed at reducing delirium through sleep promotion in critical care patients. Content Covered A review of current literature and national organization recommendations revealed consistent themes in addressing the problem of sleep deprivation in the intensive care unit. Modifiable and nonmodifiable risk factors included frequent care interactions, light, noise, medication effects, and preexisting sleep problems.

Requests for futile or inappropriate interventions near the end of life

2021 ◽  
pp. 1132-1138
Author(s):  
Alexander A. Kon
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Decision Maker ◽  
Palliative Medicine ◽  
Intensive Care Unit Setting ◽  
Surrogate Decision Maker ◽  
Ethical Considerations ◽  
Healthcare Settings ◽  
Surrogate Decision

Patients and families may, at times, request interventions that clinicians believe to be either futile or potentially inappropriate. Futile interventions are those that simply cannot accomplish the intended physiological goal. Requests for futile interventions are uncommon, and when a patient or surrogate decision maker requests an intervention that is futile, the clinician should decline the request and carefully explain the rationale for the refusal. More commonly, a patient or surrogate decision maker may request an intervention that the clinician believes to be potentially inappropriate. Potentially inappropriate interventions are those that have at least some chance of accomplishing the effect sought by the patient, but clinicians believe that competing ethical considerations justify not providing them. Conflicts can often be avoided through excellent communication; however, when conflicts arise and a mutually agreeable solution cannot be reached, such requests should be managed by a fair dispute resolution process. Five leading international, multidisciplinary, critical care organizations have published guidance for handling such disputes in the intensive care unit setting. Although the multi-organization futility statement was developed for use in intensive care units, the definitions and process can be employed in a multitude of healthcare settings and should form the basis of handling such requests in palliative medicine.

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