Transitioning the Treatment Paradigm: How Early Palliative Care Service Involvement Affects the End-of-Life Course for Critically Ill Patients in the Neuro-Intensive Care Unit

2019 ◽  
Vol 22 (5) ◽  
pp. 489-492 ◽  
Author(s):  
Borna E. Tabibian ◽  
Arsalaan A. Salehani ◽  
Elizabeth N. Kuhn ◽  
Matthew C. Davis ◽  
Christopher D. Shank ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Life Course ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Service ◽  
Palliative Care Service ◽  
Early Palliative Care ◽  
Treatment Paradigm

Feasibility and Acceptability of a Palliative Approach Screening Tool in the Intensive Care Unit

2020 ◽  
Vol 29 (3) ◽  
pp. 214-220
Author(s):  
Jane Venis ◽  
Peter Dodek
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Focus Group ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Screening Tool ◽  
Unmet Needs ◽  
Pilot Testing ◽  
Palliative Approach

Background Identifying critically ill patients who have unmet needs for palliative care is the first step in integrating the palliative approach for patients and their families into intensive care units. Objective To explore how palliative care is addressed in an intensive care unit and to develop and test a screening tool for unmet needs that may be met through the palliative approach. Methods A mixed-methods study was conducted in the intensive care unit of a tertiary care hospital to explore the palliative approach. Focus groups and a survey were used to identify items for the screening tool. After pilot testing of the tool, interviews were conducted to refine the content. Results The first focus group (14 participants) revealed participants’ frustration with unclear communication and a desire for better collaboration among health care team members regarding patients with serious life-limiting illnesses and their families. The survey (response rate: 20%; 30 of 150) showed clinicians’ preference for items that identify specific needs rather than diagnoses. The second focus group (8 participants) yielded strategies to operationalize the tool for all patients in the intensive care unit. After 2 separate pilot testing cycles, bedside nurses noted that use of the screening tool prompted earlier discussions and broader assessments of what is meaningful to patients and their families. Conclusion Development of a screening tool for unmet palliative care needs among intensive care unit patients is feasible and acceptable and may help to systematically integrate the palliative approach into routine care for critically ill patients.

scholarly journals Differences in Characteristics, Hospital Care, and Outcomes between Acute Critically Ill Emergency Department Patients Receiving Palliative Care and Usual Care

2021 ◽  
Vol 18 (23) ◽  
pp. 12546
Author(s):  
Julia Chia-Yu Chang ◽  
Che Yang ◽  
Li-Ling Lai ◽  
Hsien-Hao Huang ◽  
Shih-Hung Tsai ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Palliative Care ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Usual Care ◽  
Critically Ill ◽  
Resource Utilization ◽  
Critically Ill Patients ◽  
Hospital Care

Background: The early integration of palliative care in the emergency department (ED-PC) provides several benefits, including improved quality of life with optimal comfort measures, and symptom control. Whether palliative care could affect the intensive care unit admissions, hospital care and resource utilization requires further investigation. Aim: To determine the differences in inpatient characteristics, hospital care, survival, and resource utilization between patients receiving palliative care (ED-PC) and usual care (UC). Design: Retrospective observational study. Setting/participants: We enrolled consecutive, acute, critically ill patients admitted to the emergency intensive care unit at Taipei Veterans General Hospital from 1 February 2018 to 31 January 2020. Results: A total of 1273 patients were evaluated for unmet palliative care needs; 685 patients received ED-PC and 588 received UC. The palliative care patients were more severely frail (AOR 2.217 (1.295–3.797), p = 0.004), had functional deterioration with three ADLs (AOR 1.348 (1.040–1.748), p = 0.024), biopsychosocial discomfort (AOR 1.696 (1.315–2.187), p < 0.001), higher Taiwan Triage and Acuity Scale 1 (p = 0.024), higher in-hospital mortality (AOR 1.983 (1.540–2.555), p < 0.001), were four times more likely to sign an DNR (AOR 4.536 (2.522–8.158), p < 0.001), and were twice as likely to sign an DNR at admission (AOR 2.1331.619–2.811), p < 0.001). Palliative care patients received less epinephrine (AOR 0.424 (0.265–0.678), p < 0.001), more frequent withdrawal of an endotracheal tube (AOR 8.780 (1.122–68.720), p = 0.038), and more narcotics (AOR1.675 (1.132–2.477), p = 0.010). Palliative care patients exhibited lower 7-day, 30-day, and 90-day survival rates (p < 0.001). There was no significant difference in the hospital length of stay (LOS) (21.2 ± 26.6 vs. 21.7 ± 20.6, p = 0.709) nor total hospital expenses (293,169 ± 350,043 vs. 294,161 ± 315,275, p = 0.958). Conclusion: Acute critically ill patients receiving palliative care were more frail, more critical, and had higher in-hospital mortality. Palliative care patients received less epinephrine, more endotracheal extubation, and more narcotics. There was no difference in the hospital LOS or hospital costs between the palliative and usual care groups. The synthesis of ED-PC is new but achievable with potential benefits to align care with patient goals.

scholarly journals An Evaluation of the Palliative Care Provided on a Medical Intensive Care Unit

2015 ◽  
Author(s):  
Peter Musso
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Medical Intensive Care Unit ◽  
Care Service ◽  
Hospital Setting ◽  
Palliative Care Service ◽  
Practice Change ◽  
Care Needs ◽  
Medical Intensive Care

<p>More patients die in intensive care units (ICUs) than in any other hospital setting. For survivors, ICU treatment is often accompanied by a significant burden of symptoms for both the patient and for the family and may result in long-term cognitive and physical impairments and an unacceptable quality of life. Over the last decade, the idea that palliative care should be provided along with intensive care regardless of prognosis has evolved from a novel formulation to a clinical practice guideline. The purpose of this research was to determine whether the patients on a Medical Intensive Care Unit (MICU) were being offered appropriate palliative care. A retrospective chart review of 250 charts was performed at a 653-bed acute care, teaching facility located in southern New England with a sample of 50 patients. The Care and Communication Bundle was used to measure if primary palliative care needs were met; the Palliative Care Service Consult Tool developed by the palliative care team at the study institution was used to measure if tertiary palliative care need s were met. Results indicated approximately 85% compliance with primary palliative care overall, compliance with the individual items ranged from 40% - 100%. Tertiary palliative care compliance was 7% overall, with only two out of 29 patients actually receiving a consult. Recommendations for practice change include integrating the tool into the electronic medical record as part of the admission assessment. Interdisciplinary staff education on the process and use of the measures is indicated. State and national policies related to palliative care would facilitate the implementation of palliative care programs aimed at providing care for all people in need of these services and ensure equitable access to end-of-life care. Advanced practice nurses have a key role in advocating for policy changes within their institutions, as well as, at the state and national levels that could help patients meet their goals of care, especially at the end of their lives.</p>

scholarly journals Treatment of a Critically Ill COVID-19 Patient with the Seraph 100 Microbind Affinity Filter

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e134-e138
Author(s):  
Anke Pape ◽  
Jan T. Kielstein ◽  
Tillman Krüger ◽  
Thomas Fühner ◽  
Reinhard Brunkhorst
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Randomized Trials ◽  
Clinical Course ◽  
Pharmacological Therapy ◽  
The European Union ◽  
Positive Effects ◽  
Special Patient

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has a serious impact on health and economics worldwide. Even though the majority of patients present with moderate and mild symptoms, yet a considerable portion of patients need to be treated in the intensive care unit. Aside from dexamethasone, there is no established pharmacological therapy. Moreover, some of the currently tested drugs are contraindicated for special patient populations like remdesivir for patients with severely impaired renal function. On this background, several extracorporeal treatments are currently explored concerning their potential to improve the clinical course and outcome of critically ill patients with COVID-19. Here, we report the use of the Seraph 100 Microbind Affinity filter, which is licensed in the European Union for the removal of pathogens. Authorization for emergency use in patients with COVID-19 admitted to the intensive care unit with confirmed or imminent respiratory failure was granted by the U.S. Food and Drug Administration on April 17, 2020.A 53-year-old Caucasian male with a severe COVID-19 infection was treated with a Seraph Microbind Affinity filter hemoperfusion after clinical deterioration and commencement of mechanical ventilation. The 70-minute treatment at a blood flow of 200 mL/minute was well tolerated, and the patient was hemodynamically stable. The hemoperfusion reduced D-dimers dramatically.This case report suggests that the use of Seraph 100 Microbind Affinity filter hemoperfusion might have positive effects on the clinical course of critically ill patients with COVID-19. However, future prospective collection of data ideally in randomized trials will have to confirm whether the use of Seraph 100 Microbind Affinity filter hemoperfusion is an option of the treatment for COVID-19.

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