Eight things we would never do regarding end-of-life care in the ICU
As intensivists from three distinct regions of the world with different cultural backgrounds, we believe it relevant in this rapidly emerging period of healthcare to share thoughts among clinicians providing end-of-life care in the intensive care unit (ICU). Intimate encounters with patients near the end of their lives  form a foundational aspect of our vocation as intensivists. This article is our vision of eight top-tier concepts that should be embraced to usher in the best end-of-life care for all patients. We realize that not everyone will agree with these points and anticipate that our “eight things” will stimulate healthy discussion and debate. Furthermore, there might be caregivers throughout the world dealing with different cultural, legal, political, and ethical preconditions that make implementation of the approach presented within this manuscript difficult in some respects. The joint American Thoracic Society (ATS)/American Association for Critical Care...
Compliance with ethical standards
Conflicts of interest
On behalf of all authors, the corresponding author states that there is no conflicts of interest.
An approval by an ethics committee was not applicable.
- 1.Ely EW (2018) What happens when a patient says, ‘Doc, help me die’. https://www.cnn.com/2018/03/20/opinions/caregiving-what-its-like-to-be-me-wes-ely-opinion/index.html. Accessed 2 Jan 2019
- 2.Bosslet GT, Pope TM, Rubenfeld GD, Lo B, Truog RD, Rushton CH, Curtis JR, Ford DW, Osborne M, Misak C, Au DH, Azoulay E, Brody B, Fahy BG, Hall JB, Kesecioglu J, Kon AA, Lindell KO, White DB (2015) An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med 191(11):1318–1330. https://doi.org/10.1164/rccm.201505-0924ST CrossRefGoogle Scholar
- 3.Kon AA, Shepard EK, Sederstrom NO, Swoboda SM, Marshall MF, Birriel B, Rincon F (2016) Defining futile and potentially inappropriate interventions: a policy statement from the society of critical care medicine ethics committee. Crit Care Med 44(9):1769–1774. https://doi.org/10.1097/ccm.0000000000001965 CrossRefGoogle Scholar
- 4.Downar J, You JJ, Bagshaw SM, Golan E, Lamontagne F, Burns K, Sridhar SK, Seely A, Meade MO, Fox-Robichaud A, Cook D, Turgeon AF, Dodek P, Xiong W, Fowler R, Canadian Critical Care Trials Group (2015) Nonbeneficial treatment Canada: definitions, causes, and potential solutions from the perspective of healthcare practitioners. Crit Care Med 43(2):270–281. https://doi.org/10.1097/ccm.0000000000000704 CrossRefGoogle Scholar
- 6.Messika J, Martin Y, Maquigneau N, Puechberty C, Henry-Lagarrigue M, Stoclin A, Panneckouke N, Villard S, Dechanet A, Lafourcade A, Dreyfuss D, Hajage D, Ricard JD, MUS-IRA Team, MUS-IRA Investigators (2019) A musical intervention for respiratory comfort during noninvasive ventilation in the ICU. Eur Respir J. https://doi.org/10.1183/13993003.01873-2018 Google Scholar
- 7.Messika J, Hajage D, Panneckoucke N, Villard S, Martin Y, Renard E, Blivet A, Reignier J, Maquigneau N, Stoclin A, Puechberty C, Guetin S, Dechanet A, Fauquembergue A, Gaudry S, Dreyfuss D, Ricard JD (2016) Effect of a musical intervention on tolerance and efficacy of non-invasive ventilation in the ICU: study protocol for a randomized controlled trial (MUSique pour l’Insuffisance Respiratoire Aigue—Mus-IRA). Trials 17(1):450. https://doi.org/10.1186/s13063-016-1574-z CrossRefGoogle Scholar
- 8.Chlan LL, Weinert CR, Heiderscheit A, Tracy MF, Skaar DJ, Guttormson JL, Savik K (2013) Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA 309(22):2335–2344. https://doi.org/10.1001/jama.2013.5670 CrossRefGoogle Scholar
- 9.Rosa RG, Tonietto TF, da Silva DB, Gutierres FA, Ascoli AM, Madeira LC, Rutzen W, Falavigna M, Robinson CC, Salluh JI, Cavalcanti AB, Azevedo LC, Cremonese RV, Haack TR, Eugenio CS, Dornelles A, Bessel M, Teles JMM, Skrobik Y, Teixeira C, ICU Visits Study Group Investigators (2017) Effectiveness and safety of an extended ICU visitation model for delirium prevention: a before and after study. Crit Care Med 45(10):1660–1667. https://doi.org/10.1097/CCM.0000000000002588 CrossRefGoogle Scholar
- 11.Piers RD, Azoulay E, Ricou B, Dekeyser Ganz F, Decruyenaere J, Max A, Michalsen A, Maia PA, Owczuk R, Rubulotta F, Depuydt P, Meert AP, Reyners AK, Aquilina A, Bekaert M, Van den Noortgate NJ, Schrauwen WJ, Benoit DD (2011) Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians. JAMA 306(24):2694–2703. https://doi.org/10.1001/jama.2011.1888 CrossRefGoogle Scholar
- 12.Lilley EJ, Gemunden SA, Kristo G, Changoor N, Scott JW, Rickerson E, Shimizu N, Salim A, Cooper Z (2017) Utility of the “surprise” question in predicting survival among older patients with acute surgical conditions. J Palliat Med 20(4):420–423. https://doi.org/10.1089/jpm.2016.0313 CrossRefGoogle Scholar
- 13.Sprung CL, Baras M, Iapichino G, Kesecioglu J, Lippert A, Hargreaves C, Pezzi A, Pirracchio R, Edbrooke DL, Pesenti A, Bakker J, Gurman G, Cohen SL, Wiis J, Payen D, Artigas A (2012) The Eldicus prospective, observational study of triage decision making in European intensive care units: part I-European Intensive Care Admission Triage Scores. Crit Care Med 40(1):125–131. https://doi.org/10.1097/CCM.0b013e31822e5692 CrossRefGoogle Scholar
- 14.Sprung CL, Artigas A, Kesecioglu J, Pezzi A, Wiis J, Pirracchio R, Baras M, Edbrooke DL, Pesenti A, Bakker J, Hargreaves C, Gurman G, Cohen SL, Lippert A, Payen D, Corbella D, Iapichino G (2012) The Eldicus prospective, observational study of triage decision making in European intensive care units. Part II: Intensive care benefit for the elderly. Crit Care Med 40(1):132–138. https://doi.org/10.1097/ccm.0b013e318232d6b0 CrossRefGoogle Scholar
- 15.Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, Ledoux D, Lippert A, Maia P, Phelan D, Schobersberger W, Wennberg E, Woodcock T, Ethicus Study Group (2003) End-of-life practices in European intensive care units: the Ethicus Study. JAMA 290(6):790–797. https://doi.org/10.1001/jama.290.6.790 CrossRefGoogle Scholar