Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review,Intensive Care Medicine

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Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review
Intensive Care Medicine ( IF 27.1 ) Pub Date : 2024-08-14 , DOI: 10.1007/s00134-024-07565-7
Naveen Salins ₁ , Vijay Shree Dhyani ₂ , Mebin Mathew ₃ , Ashmitha Prasad ₃ , Arathi Prahallada Rao ₄ , Anuja Damani ₁ , Krithika Rao ₁ , Shreya Nair ₁ , Vishal Shanbhag ₅ , Shwethapriya Rao ₅ , Shivakumar Iyer ₆ , Roop Gursahani ₇ , Raj Kumar Mani ₈ , Sushma Bhatnagar ₉ , Srinagesh Simha ₃

Affiliation

Purpose

Intensive care units (ICUs) have significant palliative care needs but lack a reliable care framework. This umbrella review addresses them by synthesising palliative care practices provided at end-of-life to critically ill patients and their families before, during, and after ICU admission.

Methods

Seven databases were systematically searched for systematic reviews, and the umbrella review was conducted according to the guidelines laid out by the Joanna Briggs Institute (JBI).

Results

Out of 3122 initial records identified, 40 systematic reviews were included in the synthesis. Six key themes were generated that reflect the palliative and end-of-life care practices in the ICUs and their outcomes. Effective communication and accurate prognostications enabled families to make informed decisions, cope with uncertainty, ease distress, and shorten ICU stays. Inter-team discussions and agreement on a plan are essential before discussing care goals. Recording care preferences prevents unnecessary end-of-life treatments. Exceptional end-of-life care should include symptom management, family support, hydration and nutrition optimisation, avoidance of unhelpful treatments, and bereavement support. Evaluating end-of-life care quality is critical and can be accomplished by seeking family feedback or conducting a survey.

Conclusion

This umbrella review encapsulates current palliative care practices in ICUs, influencing patient and family outcomes and providing insights into developing an appropriate care framework for critically ill patients needing end-of-life care and their families.

中文翻译：

评估重症监护病房的姑息治疗实践，并使用适当的护理概念进行解释。伞式评论

目的

重症监护病房（ICU）有大量的姑息治疗需求，但缺乏可靠的护理框架。本综述通过综合在入住 ICU 之前、期间和之后为危重患者及其家人在临终时提供的姑息治疗实践来解决这些问题。

方法

系统检索了 7 个数据库的系统评价，总括性评价是根据 Joanna Briggs Institute （JBI）制定的指南进行的。

结果

在确定的 3122 条初始记录中，综合纳入了 40 篇系统评价。生成了六个关键主题，反映了 ICU 中的姑息治疗和临终关怀实践及其结果。有效的沟通和准确的预测使家庭能够做出明智的决定、应对不确定性、缓解痛苦并缩短 ICU 住院时间。在讨论护理目标之前，团队间讨论和就计划达成一致是必不可少的。记录护理偏好可防止不必要的临终治疗。特殊的临终关怀应包括症状管理、家庭支持、补水和营养优化、避免无益的治疗以及丧亲支持。评估临终关怀质量至关重要，可以通过寻求家庭反馈或进行调查来完成。