Canadian Journal of Anesthesia

, Volume 51, Issue 3, pp 266–272

Dying in the ICU: strategies that may improve end-of-life care

Neuroanesthesia and Intensive Care

Abstract

Purpose

Since 10 to 20% of adult patients admitted to the intensive care unit (ICU) in Canada die, addressing the needs of dying critically ill patients is of paramount importance. The purpose ofthis article is to suggest some strategies to consider to improve the care of patients dying in the ICU.

Source

Data sources were randomized clinical trials, observational studies and surveys. We purposively selected key articles on end-of-life care to highlight eight initiatives that have the potential to improve care for dying critically ill patients. These initiatives were presented at the International Consensus Conference on End-of-Life Care in the ICU on April 24–25, 2003 in Brussels, Belgium.

Principal findings

We describe eight strategies that, if adopted, may positively impact on the end-of-life care of critically ill patients: 1) promote social change through professional initiatives; 2) legitimize research in end-of-life care; 3) determine what dying patients need; 4) determine what families of dying patients need; 5) initiate quality improvement locally; 6) use quality tools with care; 7) educate future clinicians; and 8) personally engage in end-of-life care. Most of these strategies have not been subjected to rigorous evaluation.

Conclusion

Adoption of some of these strategies we describe may lead to improved end-of-life care in the ICU. Future studies should include more formal evaluation of the efficacy of end-of-life interventions to help us ensure high quality, clinically relevant, culturally adapted care for all dying critically ill patients.

Mourir à l’USI: les stratégies qui peuvent améliorer les soins enfin de vie

Résumé

Objectif

Au Canada, comme 10 à 20 % des patients admis à l’unité des soins intensifs (USI) y décèdent, il devient primordial de s’occuper des besoins des grands malades en fin de vie. Le but du présent article est de proposer certaines stratégies pour améliorer les soins de ceux qui meurent à l’USI.

Source

Les données proviennent d’essais cliniques randomisés, d’études observationnelles et d’enquêtes. Nous avons volontairement choisi des articles clés sur les soins aux mourants pour mettre en lumière huit initiatives qui peuvent améliorer la condition des grands malades mourants. Ces initiatives ont été présentées à l’International Consensus Conference on End-of-Life Care in the ICU le 24 avril 2003 à Bruxelles en Belgique.

Constatations principales

Nous décrivons huit stratégies qui, si elles sont adoptées, pourraient avoir un impact positif sur les soins aux mourants: 1) promouvoir un changement social par des initiatives professionnelles; 2) légitimer la recherche sur les soins aux mourants; 3) déterminer les besoins des mourants; 4) déterminer les besoins des familles des mourants; 5) commencer par améliorer la qualité localement; 6) utiliser les outils de qualité avec précaution; 7) former les futurs cliniciens et 8) s’engager personnellement dans les soins de fin de vie. La majorité de ces stratégies n’a pas fait l’objet d’évaluation rigoureuse.

Conclusion

L’adoption de certaines stratégies décrites pourrait améliorer les soins aux mourants à l’USI. D’autres études devraient comporter une évaluation formelle de l’efficacité des interventions aux mourants afin de nous aider à assurer des soins de grande qualité, applicables en clinique et adaptés culturellement à tous les grands malades en fin de vie.

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Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  1. 1.Department of MedicineMcMaster UniversityHamilton
  2. 2.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamilton
  3. 3.Department of MedicineDalhousie UniversityHalifax
  4. 4.Department of MedicineKingston General HospitalKingstonCanada
  5. 5.Departments of Medicine and Clinical EpidemiologyMcMaster University Medical CenterHamiltonCanada

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