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Hernández-Zambrano SM, Carrillo-Algarra AJ, Manotas-Solano OE, Ibáñez-Gamboa SE, Mejia-Mendez LM, Martínez-Montoya OH, Fernández-Alcántara M, Hueso-Montoro C. Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review. ENFERMERIA INTENSIVA 2024:S2529-9840(23)00069-1. [PMID: 38910066 DOI: 10.1016/j.enfie.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/24/2023] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.
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Affiliation(s)
- S M Hernández-Zambrano
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia.
| | - A J Carrillo-Algarra
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O E Manotas-Solano
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - S E Ibáñez-Gamboa
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - L M Mejia-Mendez
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O H Martínez-Montoya
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | | | - C Hueso-Montoro
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Jaén, Spain
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Picón-Jaimes YA, Lozada-Martinez ID, Rahman S, Cantón Álvarez MB. Knowledge and attitudes of physicians in Chile toward Do-Not-Attempt-Resuscitation orders: A cross-sectional nation-wide study. SAGE Open Med 2024; 12:20503121241259285. [PMID: 38867717 PMCID: PMC11168045 DOI: 10.1177/20503121241259285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/19/2024] [Indexed: 06/14/2024] Open
Abstract
Objective Do-Not-Attempt-Resuscitation orders originated in the early 1960s with the establishment of advanced cardiopulmonary resuscitation. These orders aim to limit therapeutic efforts in cases where it may be futile. The decision not to resuscitate a patient is a process that involves a series of ethical, legal, and clinical considerations. Still, it also requires a process in which priority is given to the patients and their autonomy. The objective of this study was to describe the knowledge and attitudes of physicians working in Chile toward Do-Not-Attempt-Resuscitation orders. Methods A cross-sectional study was conducted, in which a digital questionnaire was sent to physicians from different regions of Chile. Quantitative variables were analyzed using measures of central tendency and dispersion (e.g., median and interquartile range), while qualitative variables were evaluated using frequencies and percentages. Results Four hundred and thirty-one physicians completed the survey. 85.4% were familiar with the ethical and legal guidelines for cardiopulmonary resuscitation and the rights and duties of the patient. 39.2% believed that patients should have the final decision Do-Not-Attempt-Resuscitation orders, especially if they themselves requested not to be resuscitated. 87.7% mentioned that the Do-Not-Attempt-Resuscitation orders should be reassessed if the patient's prognosis improves. In addition, it was found that the decision not to resuscitate was not always discussed with the patient or their family. Conclusions The study revealed an ethical conflict regarding Do-Not-Attempt-Resuscitation orders and their management by Chilean physicians. Therefore, it is necessary to create recommendations and provide training to guide professionals in this process, which should also involve patients and their families.
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Affiliation(s)
- Yelson Alejandro Picón-Jaimes
- Universidad Internacional de la Rioja, Logroño, Spain
- Faculty of Health Sciences, Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Ivan David Lozada-Martinez
- Epidemiology Program, Department of Graduate Studies in Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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López González UA, Bautista Rentero D, Crespo Gómez M, Cárcamo Ibarra P, Míguez Santiyán AM. Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:387-393. [PMID: 38342305 DOI: 10.1016/j.redare.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/23/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it. OBJECTIVE To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU. DESIGN Retrospective longitudinal study. AMBIT Intensive care unit of a tertiary hospital. PATIENTS People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019. INTERVENTIONS None. This is an observational study. VARIABLES OF INTEREST Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays. RESULTS Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients. CONCLUSIONS Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.
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Affiliation(s)
- U A López González
- Servicio de Medicina Preventiva, Hospital Universitario Doctor Peset, Valencia, Spain.
| | - D Bautista Rentero
- Servicio de Medicina Preventiva, Hospital Universitario Doctor Peset, Valencia, Spain
| | - M Crespo Gómez
- Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain
| | - P Cárcamo Ibarra
- Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - A M Míguez Santiyán
- Servicio de Medicina Preventiva, Hospital Universitario Doctor Peset, Valencia, Spain
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THE IMPORTANCE OF AN INTERPROFESSIONAL PALLIATIVE APPROACH FOR THE CRITICAL PATIENT. ENFERMERIA INTENSIVA 2019; 30:1-3. [PMID: 30712653 DOI: 10.1016/j.enfi.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/19/2018] [Indexed: 11/22/2022]
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Update and recommendations in decision making referred to limitation of advanced life support treatment. Med Intensiva 2019; 44:101-112. [PMID: 31472947 DOI: 10.1016/j.medin.2019.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/16/2019] [Accepted: 07/14/2019] [Indexed: 12/18/2022]
Abstract
The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Bioethics Working Group has developed recommendations on the Limitation of Advanced Life Support Treatment (LLST) decisions, with the aim of reducing variability in clinical practice and of improving end of life care in critically ill patients. The conceptual framework of LLST and futility are explained. Recommendations referred to new forms of LLST encompassing also the adequacy of other treatments and diagnostic methods are developed. In addition, planning of the possible clinical courses following the decision of LLST is commented. The importance of advanced care planning in decision-making is emphasized, and intensive care oriented towards organ donation at end of life in the critically ill patient is described. The integration of palliative care in the critical patient treatment is promoted in end of life stages in the Intensive Care Unit.
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Lomero-Martínez MM, Jiménez-Herrera MF, Bodí-Saera MA, Llaurado-Serra M, Masnou-Burrallo N, Oliver-Juan E, Sandiumenge-Camps A. Comment to «In reply to the question: Are we really playing together in the same team?». ENFERMERIA INTENSIVA 2019; 30:149-150. [PMID: 30691986 DOI: 10.1016/j.enfi.2018.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 11/18/2022]
Affiliation(s)
- M M Lomero-Martínez
- Departamento de Enfermería, Universidad Rovira i Virgili, Campus Catalunya, Tarragona, España
| | - M F Jiménez-Herrera
- Departamento de Enfermería, Universidad Rovira i Virgili, Campus Catalunya, Tarragona, España.
| | - M A Bodí-Saera
- Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, CIBERES, Tarragona, España
| | - M Llaurado-Serra
- Departamento de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
| | | | - E Oliver-Juan
- Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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Estella Á, Velasco T, Saralegui I, Velasco Bueno JM, Rubio Sanchiz O, Del Barrio M, Martín Delgado MC. Multidisciplinary palliative care at the end of life of critically ill patient. Med Intensiva 2018; 43:61-62. [PMID: 30309756 DOI: 10.1016/j.medin.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Á Estella
- Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, España.
| | - T Velasco
- Hospital Clínico San Carlos, Madrid, España
| | - I Saralegui
- Hospital de Áraba, Vitoria-Gasteiz, Araba, España
| | | | - O Rubio Sanchiz
- Althaia Xarxa Hospitalaria Universitaria de Manresa, Manresa, Barcelona, España
| | - M Del Barrio
- Clínica Universitaria de Navarra, Pamplona, Navarra, España
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Estella Á. Team clinical decision making in end-of-life care. Rev Clin Esp 2018. [DOI: 10.1016/j.rceng.2018.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Estella Á. Toma de decisiones en equipo en los cuidados al final de la vida. Rev Clin Esp 2018; 218:266-267. [DOI: 10.1016/j.rce.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 02/07/2018] [Indexed: 01/14/2023]
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Blazquez V, Rodríguez A, Sandiumenge A, Oliver E, Cancio B, Ibañez M, Miró G, Navas E, Badía M, Bosque MD, Jurado MT, López M, Llauradó M, Masnou N, Pont T, Bodí M. Factors related to limitation of life support within 48h of intensive care unit admission: A multicenter study. Med Intensiva 2018; 43:352-361. [PMID: 29747939 DOI: 10.1016/j.medin.2018.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/09/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine factors related to limitations on life support within 48h of intensive care unit (ICU) admission. STUDY DESIGN Prospective multicenter study. SETTING Eleven ICUs. PATIENTS All patients who died and/or had limitations on life support after ICU admission during a four-month period. VARIABLES Patient characteristics, hospital characteristics, characteristics of limitations on life support. Time-to-first-limitation was classified as early (<48h of admission) or late (≥48h). We performed univariate, multivariate analyses and CHAID (chi-square automatic interaction detection) analysis of variables associated with limitation of life support within 48h of ICU admission. RESULTS 3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%-84.2%). The median (p25-p75) time from admission to initial limitation was 2 (0-7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR=2.5; 95% CI: 1.5-4.4) and lung disease was the variable most strongly associated with early limitations (OR=12.29; 95% CI: 1.63-255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR=2.4; 95% CI: 1.1-5.5). CONCLUSION Limitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48h of admission.
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Affiliation(s)
- V Blazquez
- Intensive Care Unit, University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain
| | - A Rodríguez
- Intensive Care Unit, University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain
| | - A Sandiumenge
- Transplant Coordination, University Hospital Vall d'Hebron, Barcelona, Spain
| | - E Oliver
- Transplant Coordination, University Hospital Bellvitge, Barcelona, Spain
| | - B Cancio
- Intensive Care Unit, University Hospital Moises Broggi, Barcelona, Spain
| | - M Ibañez
- Intensive Care Unit, University Hospital Verge de la Cinta de Tortosa, Tortosa, Spain
| | - G Miró
- Intensive Care Unit, Consorci Sanitari del Maresme, Mataró, Spain
| | - E Navas
- Intensive Care Unit, University Hospital Mutua de Terrassa, Terrassa, Spain
| | - M Badía
- Intensive Care Unit, University Hospital Arnau de Vilanova, Lleida, Spain
| | - M D Bosque
- Intensive Care Unit, University Hospital General de Catalunya, Barcelona, Spain
| | - M T Jurado
- Intensive Care Unit, Hospital de Terrassa, Terrassa, Spain
| | - M López
- Intensive Care Unit, University Hospital de Vic, Vic, Spain
| | - M Llauradó
- International University of Catalunya, Barcelona, Spain
| | - N Masnou
- Transplant Coordination, University Hospital Dr. Trueta, Girona, Spain
| | - T Pont
- Transplant Coordination, University Hospital Vall d'Hebron, Barcelona, Spain
| | - M Bodí
- Intensive Care Unit, University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain.
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López Camps V, García García MA, Martín Delgado MC, Añón Elizalde JM, Masnou Burrallo N, Rubio Sanchiz O, Estella García A, Monzón Marín JL. National survey on the indicators of quality in Bioethics of the SEMICYUC in the departments of Intensive Care Medicine in Spain. Med Intensiva 2017; 41:523-531. [PMID: 28389026 DOI: 10.1016/j.medin.2017.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 01/11/2017] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Multiple interventions are performed in critical patients admitted to Intensive Care Units (ICUs). This study explores the presence in the daily practice of ICUs of elements related to the 6 bioethics quality indicators of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units, and the participation of their members in the hospital ethics committees. MATERIALS AND METHODS A multicenter observational study was carried out, using a survey exploring descriptive aspects of the ICUs, with 25 questions related to bioethics quality indicators, and assessing the participation of ICU members in the hospital ethics committees. The ICUs were classified by size (larger or smaller than 10 beds) and type of hospital (public/private-public concerted center, with/without teaching). RESULTS The 68 analyzed surveys revealed: daily informing of the family (97%), carried out in the information room (82%); end-of-life care protocols (44%); life support limitation form (48.43%); and physical containment protocol (40%). Compliance with the informed consent process referred to different procedures is: tracheostomy (92%), vascular procedures (76%), and extrarenal clearance (25%). The presence of ICU members in the hospital ethics committee is currently frequent (69%). CONCLUSIONS Information supplied to relatives is adequate, although there are ICUs without an information room. Compliance with the informed consent requirements of various procedures is insufficient. The participation of ICU members in the hospital ethics committees is frequent. The results obtained suggest a chance for improvement in the bioethical quality of the ICU.
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Affiliation(s)
| | | | | | | | | | - O Rubio Sanchiz
- UCI, Hospital Sant Joan de Déu, Fundación Althaia, Manresa, Barcelona, España
| | - A Estella García
- UCI, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España
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