End of life care in the intensive care unit

Abstract

One in five Americans die in or directly following an ICU stay. Predicting who will survive the ICU is difficult and those who do survive struggle with post-ICU physical and psychological symptoms and functional and cognitive impairments. All patients, regardless of prognosis, benefit from a multidisciplinary, patient- and family-centered approach to care aimed at assessing and treating multiple sources of suffering. Research highlights potential areas for improvement in EOL care in the ICU. Measures of quality ICU palliative care and models for integrating palliative care into the ICU are reviewed. Skillful clinician communication is necessary to facilitate shared decision-making, provide care that is concordant with patients’ values, and support patients facing serious life threatening illness and their families. Decision making and best practices for forgoing life sustaining treatment in the ICU are reviewed.