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Kesecioglu J, Rusinova K, Alampi D, Arabi YM, Benbenishty J, Benoit D, Boulanger C, Cecconi M, Cox C, van Dam M, van Dijk D, Downar J, Efstathiou N, Endacott R, Galazzi A, van Gelder F, Gerritsen RT, Girbes A, Hawyrluck L, Herridge M, Hudec J, Kentish-Barnes N, Kerckhoffs M, Latour JM, Malaska J, Marra A, Meddick-Dyson S, Mentzelopoulos S, Mer M, Metaxa V, Michalsen A, Mishra R, Mistraletti G, van Mol M, Moreno R, Nelson J, Suñer AO, Pattison N, Prokopova T, Puntillo K, Puxty K, Qahtani SA, Radbruch L, Rodriguez-Ruiz E, Sabar R, Schaller SJ, Siddiqui S, Sprung CL, Umbrello M, Vergano M, Zambon M, Zegers M, Darmon M, Azoulay E. European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit. Intensive Care Med 2024; 50:1740-1766. [PMID: 39361081 PMCID: PMC11541285 DOI: 10.1007/s00134-024-07579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 07/28/2024] [Indexed: 11/07/2024]
Abstract
The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.
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Affiliation(s)
- Jozef Kesecioglu
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Katerina Rusinova
- Department of Palliative Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia
| | - Daniela Alampi
- Sapienza University of Rome, A.O.U. Sant'Andrea, Rome, Italy
| | - Yaseen M Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Julie Benbenishty
- Faculty of Medicine, School of Nursing, Hebrew University, Jerusalem, Israel
| | - Dominique Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium
| | | | - Maurizio Cecconi
- Biomedical Sciences Department, Humanitas University, Milan, Italy
- Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Christopher Cox
- Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC, USA
| | - Marjel van Dam
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Diederik van Dijk
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - James Downar
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Bruyere Research Institute, Ottawa, Canada
| | - Nikolas Efstathiou
- School of Nursing and Midwifery, University of Birmingham, Birmingham, UK
| | - Ruth Endacott
- National Institute for Health and Care Research, London, UK
| | | | | | - Rik T Gerritsen
- Centrum Voor Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Armand Girbes
- Department of Critical Care, AmsterdamUMC Location VUmc, Amsterdam, The Netherlands
| | - Laura Hawyrluck
- Interdepartmental Division Critical Care Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada
| | - Margaret Herridge
- Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Toronto, Canada
- Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Jan Hudec
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Nancy Kentish-Barnes
- Famiréa Research Group, APHP Nord, Saint Louis Hospital, Intensive Care Unit, Paris, France
| | - Monika Kerckhoffs
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Curtin School of Nursing, Curtin University, Perth, Australia
- Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jan Malaska
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Second Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czechia
| | - Annachiara Marra
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples, Naples, Italy
| | - Stephanie Meddick-Dyson
- Wolfson Palliative Care Research Centre, Hull York, Medical School, University of Hull, Hull, UK
| | - Spyridon Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece
| | - Mervyn Mer
- Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Victoria Metaxa
- Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Andrej Michalsen
- Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Konstanz Hospital, Constance, Germany
| | - Rajesh Mishra
- Ahmedabad Shaibya Comprehensive Care Clinic, Ahmedabad, India
| | - Giovanni Mistraletti
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
- S.C. Anesthesia and Intensive Care, Legnano Hospital, ASST Ovest Milanese, Milan, Italy
| | - Margo van Mol
- Department of Intensive Care Adults, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Rui Moreno
- Hospital de São José, Unidade Local de Saúde São José, Lisbon, Portugal
- Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Centro Clínico Académico de Lisboa, Lisbon, Portugal
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Judith Nelson
- Memorial Hospital, Weill Cornell Medical College, New York, NY, USA
| | - Andrea Ortiz Suñer
- Hospital Arnau de Vilanova-Lliria, Valencia, Spain
- Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain
| | - Natalie Pattison
- University of Hertfordshire, East and North Hertfordshire NHS Trust, Hatfield, UK
- Imperial Healthcare NHS Trust, Imperial College, London, UK
| | - Tereza Prokopova
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia
- Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Kathleen Puntillo
- School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Kathryn Puxty
- Intensive Care, Glasgow Royal Infirmary, Glasgow, UK
- University of Glasgow, Glasgow, UK
| | - Samah Al Qahtani
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | - Emilio Rodriguez-Ruiz
- Department of Intensive Care Medicine, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain
- Simulation, Life Support and Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Stefan J Schaller
- Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Shahla Siddiqui
- Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care Medicine and Pain, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Michele Umbrello
- S.C. Anesthesia and Intensive Care, Legnano Hospital, ASST Ovest Milanese, Milan, Italy
| | - Marco Vergano
- Department of Anesthesia, Intensive Care and Emergency, San Giovanni Bosco Hospital, Turin, Italy
| | - Massimo Zambon
- Anesthesia and Intensive Care Ospedale "Uboldo", Cernusco sul Naviglio, Milan, Italy
| | - Marieke Zegers
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michael Darmon
- Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris, France
- Université Paris Cité, Paris, France
| | - Elie Azoulay
- Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris, France
- Université Paris Cité, Paris, France
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