end of life care in ICU - lancet


裏面panel 1-4 有精準的 approach, 但使用存乎一心
interdisciplinary 的溝通很重要，ICU內部要有溝通，才能對外，這個要不斷的灌輸觀念

panel 4 -> gradual withdrawal of ventilator support, 台灣還不能用，不過遲早用得到





Caring for Adults at the End of Life in the Intensive Care Unit

A guide for delivering high-quality care

Treatment in the intensive care unit (ICU) is geared toward sustaining life, which can make delivery of high-quality care challenging when death is imminent. Data from several studies have demonstrated that end-of-life care in ICUs varies greatly among geographical regions and countries, likely because of differences in religion, culture, case mix, and prevailing attitudes of physicians. Researchers searched the literature from 1994 to 2009 to determine approaches and ethics associated with end-of-life ICU care.

An integral part of caring for the critically ill at the end of life is recognizing which patients will benefit from aggressive treatment: Fair allocation of limited ICU resources is essential. Ethical treatment of critically ill patients requires that every individual receives all healthcare services that do not unfairly compromise availability of resources needed by other patients.

End-of-life ICU care should be delivered by an interdisciplinary team that includes nurses, social workers, chaplains, and physicians. To avoid mixed messages to patients and families, end-of-life decisions should be made after input is received from all team members. Guidelines for end-of-life care emphasize the importance of shared decision making that involves patients and families. A quiet setting where physicians can listen and display compassionate empathic behavior facilitates better patient and family outcomes. Barriers to effective communication include language or cultural differences. Family satisfaction with care is higher when spiritual needs are assessed and spiritual care is provided when desired.

Although most ethicists and critical care societies do not draw distinctions between withholding and withdrawing life-sustaining treatments, this viewpoint is not universally accepted. Patients', families', and clinicians' cultural and religious beliefs often contribute to decision making about withholding or withdrawing treatments. Finally, the rationale behind all decisions at the end of life should be discussed in detail with patients, families, or both.

— Neil H. Winawer, MD, SFHM

Published in Journal Watch Hospital Medicine November 22, 2010
Citation(s):

Curtis JR and Vincent J-L. Ethics and end-of-life care for adults in the intensive care unit. Lancet 2010 Oct 16; 376:1347.

* Medline abstract (Free)

https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7MDJhM2ZiNGQtNTk1OS00MDJkLTg2NDgtYmFkMGU3NWIyZGEz&hl=zh_TW


同場加映，critical care and global burden
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7YTNlZWQ0ZGQtNTBiZS00ZTRlLTk4NmEtNzE1NzZmOTFlYThm&hl=zh_TW

advances and future perspectives in critical care
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7ZTE2MGI0YTctNGFhYS00NGUyLWI0OTgtOTI0YzY1MDg2OWZj&hl=zh_TW

a critical look at critical care
https://docs.google.com/viewer?a=v&pid=explorer&chrome=true&srcid=0B278nGJMQBk7MzM4OWRkZmMtOWI3Yy00N2E3LWEwYWEtODM4MjJiY2VmMjAy&hl=zh_TW

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TG無用論，不用吃fenofibrate了，除非> 500mg/dl

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