Palliative care in critical care units

Abstract

Palliative care plays an integral role in the management of patients within the critical care unit as many experience pain, fear, discomfort and confusion. The majority of patients admitted to critical care are for acute reversible diseases or, for acute exacerbations or complications of a chronic condition. A subset of these patients will fail to respond and palliative care becomes the main focus of therapy. Many of the problems experienced by patients requiring palliative care are seen in the critical care unit. Some of these are discussed elsewhere and should not be forgotten. Acute primary diseases or exacerbations of chronic conditions often require supportive management strategies, such as non-invasive ventilation, whilst the body recovers from the acute insult. For this to be successful, an understanding of complications and side effects is required. Electrolyte disturbances require immediate emergency management and then investigation and treatment of the underlying cause. Though the cause may be due to the chronic or terminal disease process itself, such as cancer or diabetes, other causes must also be ruled out. Complications of chronic diseases, such as diabetic ketoacidosis, can be fatal and require prompt appropriate management. The critical care unit can offer respiratory, cardiac and renal support and is also well placed to aid correction of biochemical and metabolic disturbances. However, investigation and treatment must be directed to the individual patient. There will be circumstances when aggressive management of the disease process is no longer in the patient's best interest. When this occurs comfort becomes the main goal of therapy.