Palliative care in the intensive care unit

Abstract

The intensive care unit (ICU) is a setting in which critically ill patients receive high-intensity treatments such as mechanical ventilation to sustain life. These patients are at high risk of dying such that ICU clinicians manage dying patients and their families on a daily basis. ICU care is associated with a high level of symptoms and palliation of suffering is important throughout the course of treatment. Treatment is inherently intrusive and some patients with advanced disease may not wish to undergo ICU care, particularly if their deterioration indicates progression of their disease rather than a reversible complication. Failed ICU care may impose additional suffering and detract from the end of life experience. It is important to recognize when treatment is merely prolonging the dying phase. The focus then switches to making the dying process comfortable and dignified. Intrusive treatments are withdrawn and opioids and benzodiazepines are used to relieve distress. Because of the severity of the illness, the dying phase is often short, over a few hours.