Palliative care in the intensive care unit

    Authors

    Keywords

    palliative care, heart failure, terminal illness, intensive care unit

    DOI

    https://doi.org/10.15836/ccar2018.504

    Full Text

    Palliative care implies a comprehensive approach to providing the necessary care to patients who are confronted with severe and incurable diseases with fatal outcome. Although it is often associated with patients with oncological diseases, palliative care also includes the whole spectrum of patients with non-oncological diseases, as well as patients with heart failure (HF). The prevalence of HF in developed countries is 1-2%, while this percentage increases to 10% among the population older than 70. ( 1 ) Heart failure, with its chronic, progressive development and frequent exacerbations and hospitalizations leads to a series of unpleasant symptoms, such as difficulties or disability in carrying out daily activities, loss of independence, impaired social functioning and reduced quality of life. Symptoms and needs of patients in the terminal stage of HF do not significantly differ from those of patients in terminal stages of oncological diseases. The research conducted by Setoguchi, Glynn, Stedman et al. compared carcinoma patients to patients with chronic HF, and they found that HF patients more often tend to be hospitalized 30 days prior to their death than carcinoma patients (60% vs. 39% emergency aid, 64% vs. 45% acute medical units, 19% vs. 7% intensive care unit), and their mortality rate is also higher in acute units (39% vs. 21%). ( 2 ) The palliative approach in the intensive care unit is the only approach which can adequately meet all patients’ needs in the advanced stage of HF, at the stage when all treatment options have already been exhausted. Choosing the right moment to start the palliative care depends on the patient’s needs, and not on the prognosis of the disease. Palliative care should not be understood as “giving up”, but rather as a form of supportive approach, which does not exclude curative medical care and which can also be included in the earlier stage of the disease. Palliative approach in the intensive care unit implies minimizing invasive procedures and it focuses on treating physical, psychosocial and mental symptoms, as well as improving the quality of life, in which a multidisciplinary team is involved. The fundamental goal is to prevent and alleviate suffering. By providing support and encouraging sincere communication between the patient, his family and members of the healthcare team, it is possible to provide the conditions in which questions can be asked, various options can be considered (e.g. quitting excessive diagnostic and therapeutic procedures) and realistic goals can be set, which take into account the patient’s value system and respect his and his family’s wishes. Affirmation of life, accepting the death as a normal process, respecting the patient’s autonomy, holistic approach and helping with decision-making are some of the principles of palliative patient care in the intensive care unit. Palliative care may seem as a paradox in the intensive care unit that primarily advocates life and maintenance of vital functions; however, enabling a death with dignity in such an environment is undoubtedly the best indicator of humanity, which also reflects the most valuable qualities of all healthcare professionals involved in such patient care.

    Cardiologia Croatica
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    Palliative care in the intensive care unit

    Extended Abstract
    Issue11-12
    Published
    Pages504
    PDF via DOIhttps://doi.org/10.15836/ccar2018.504
    palliative care
    heart failure
    terminal illness
    intensive care unit

    Authors

    Ana Marinić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vjera PisačićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Valentina JezlORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Danijela GrgurevićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Palliative care implies a comprehensive approach to providing the necessary care to patients who are confronted with severe and incurable diseases with fatal outcome. Although it is often associated with patients with oncological diseases, palliative care also includes the whole spectrum of patients with non-oncological diseases, as well as patients with heart failure (HF). The prevalence of HF in developed countries is 1-2%, while this percentage increases to 10% among the population older than 70. ( 1 ) Heart failure, with its chronic, progressive development and frequent exacerbations and hospitalizations leads to a series of unpleasant symptoms, such as difficulties or disability in carrying out daily activities, loss of independence, impaired social functioning and reduced quality of life. Symptoms and needs of patients in the terminal stage of HF do not significantly differ from those of patients in terminal stages of oncological diseases. The research conducted by Setoguchi, Glynn, Stedman et al. compared carcinoma patients to patients with chronic HF, and they found that HF patients more often tend to be hospitalized 30 days prior to their death than carcinoma patients (60% vs. 39% emergency aid, 64% vs. 45% acute medical units, 19% vs. 7% intensive care unit), and their mortality rate is also higher in acute units (39% vs. 21%). ( 2 ) The palliative approach in the intensive care unit is the only approach which can adequately meet all patients’ needs in the advanced stage of HF, at the stage when all treatment options have already been exhausted. Choosing the right moment to start the palliative care depends on the patient’s needs, and not on the prognosis of the disease. Palliative care should not be understood as “giving up”, but rather as a form of supportive approach, which does not exclude curative medical care and which can also be included in the earlier stage of the disease. Palliative approach in the intensive care unit implies minimizing invasive procedures and it focuses on treating physical, psychosocial and mental symptoms, as well as improving the quality of life, in which a multidisciplinary team is involved. The fundamental goal is to prevent and alleviate suffering. By providing support and encouraging sincere communication between the patient, his family and members of the healthcare team, it is possible to provide the conditions in which questions can be asked, various options can be considered (e.g. quitting excessive diagnostic and therapeutic procedures) and realistic goals can be set, which take into account the patient’s value system and respect his and his family’s wishes. Affirmation of life, accepting the death as a normal process, respecting the patient’s autonomy, holistic approach and helping with decision-making are some of the principles of palliative patient care in the intensive care unit. Palliative care may seem as a paradox in the intensive care unit that primarily advocates life and maintenance of vital functions; however, enabling a death with dignity in such an environment is undoubtedly the best indicator of humanity, which also reflects the most valuable qualities of all healthcare professionals involved in such patient care.