European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.

IF 27.1 1区 医学 Q1 CRITICAL CARE MEDICINE Intensive Care Medicine Pub Date : 2024-11-01 Epub Date: 2024-10-03 DOI:10.1007/s00134-024-07579-1
Jozef Kesecioglu, Katerina Rusinova, Daniela Alampi, Yaseen M Arabi, Julie Benbenishty, Dominique Benoit, Carole Boulanger, Maurizio Cecconi, Christopher Cox, Marjel van Dam, Diederik van Dijk, James Downar, Nikolas Efstathiou, Ruth Endacott, Alessandro Galazzi, Fiona van Gelder, Rik T Gerritsen, Armand Girbes, Laura Hawyrluck, Margaret Herridge, Jan Hudec, Nancy Kentish-Barnes, Monika Kerckhoffs, Jos M Latour, Jan Malaska, Annachiara Marra, Stephanie Meddick-Dyson, Spyridon Mentzelopoulos, Mervyn Mer, Victoria Metaxa, Andrej Michalsen, Rajesh Mishra, Giovanni Mistraletti, Margo van Mol, Rui Moreno, Judith Nelson, Andrea Ortiz Suñer, Natalie Pattison, Tereza Prokopova, Kathleen Puntillo, Kathryn Puxty, Samah Al Qahtani, Lukas Radbruch, Emilio Rodriguez-Ruiz, Ron Sabar, Stefan J Schaller, Shahla Siddiqui, Charles L Sprung, Michele Umbrello, Marco Vergano, Massimo Zambon, Marieke Zegers, Michael Darmon, Elie Azoulay
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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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欧洲重症监护医学会重症监护病房生命终结与姑息治疗指南。
欧洲重症监护医学会(ESICM)针对成人重症患者的生命末期(EoL)和姑息关怀提出了循证建议和专家意见,以优化以患者为中心的关怀,改善亲属的预后,并支持重症监护病房(ICU)工作人员提供富有同情心和有效的生命末期和姑息关怀。一个由临床专家、方法论专家以及患者和家属代表组成的国际多学科小组对关键领域进行了研究,包括各国的差异性、决策、姑息关怀整合、沟通、以家庭为中心的关怀以及冲突管理。会上提出了 8 项循证建议(6 项证据水平较低,2 项证据水平较高)和 19 条专家意见。EoL立法以及尊重患者自主性和偏好的重要性受到了密切关注。研究还考虑到了因国家收入和医疗服务的不同而导致的老年生活护理的差异。建议采用结构化的 EoL 决策策略,以改善患者和亲属的治疗效果,提高工作人员的满意度和心理健康水平。建议尽早整合姑息治疗,并使用标准化工具对高危患者进行症状评估。提倡对重症监护室的工作人员进行沟通培训,并为家属提供印刷的沟通辅助工具,以提高疗效和满意度。加强以家属为中心的护理的方法包括结构化家属会议和文化敏感性干预。此外,还考虑了冲突管理协议和防止医护人员职业倦怠的策略。为制定这些指南所做的工作强调了许多需要进一步研究的领域。
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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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