Comfort care for burns patients: The gold standard for assessment and delivery of care remains in a burn center

What do we know about experiencing end-of-life in burn intensive care units? A scoping review

OBJECTIVES

The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units.

METHODS

Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021.

RESULTS

A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients' comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care.

SIGNIFICANCE OF RESULTS

End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.

Interventions of Advanced Lung Cancer Patient Receiving Chemotherapy by Computed Tomography Image Information Data Analysis-Based Soothing Care Plans

The objective of this study was to investigate the intervention effect of computed tomography (CT) image information data on patients with advanced lung cancer treated with chemotherapy under palliative care program. The research subjects were 60 patients with advanced lung cancer who received palliative care in our hospital from January 1, 2019, to January 1, 2021. All patients were grouped according to the evaluation criteria of solid tumor efficacy, including 28 patients in the remission group and 32 patients in the nonremission group. Texture analysis was performed on the CT images of the two groups of patients. The gray-scale cooccurrence matrix parameters, the maximum diameter of the lesion, and the CT value of the CT images of the two groups of patients before and after palliative care were compared. The results showed that after the palliative care, the combined mean, combined energy, and inverse moment of the three gray cooccurrence matrix parameters of the two groups of patients were decreased, and the combined entropy and contrast were increased. The absolute value of the gray-scale cooccurrence matrix Δ parameter of the patients in the remission group was greater than that in the nonremission group. The Δ combined entropy, Δ contrast, and Δ correlation of the two groups of patients were significantly different, and the difference in Δ contrast was the largest. It suggested that the gray-scale cooccurrence matrix parameter can evaluate the effect of soothing care, and the contrast was the best evaluation parameter. The maximum diameter of the lesions in the remission group before and after palliative care was reduced by 1.23 cm, and the degree of reduction was significantly better. The CT value was reduced by 6.22 HU, and the degree of reduction was significantly higher than that in the nonremission group. There was a significant difference in the data between the two groups (P < 0.05). Therefore, the CT image information data had a better evaluation effect on patients with advanced lung cancer under the palliative care program and can be applied to the clinical evaluation of the palliative care effect, which had good clinical value.