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.

欧洲重症监护医学会 （ESICM） 制定了关于危重症成人临终 （EoL） 和姑息治疗的循证建议和专家意见，以优化以患者为中心的护理，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 EoL 和姑息治疗。一个由临床专家、方法学家以及患者和家属代表组成的国际多学科小组研究了关键领域，包括国家之间的差异、决策、姑息治疗整合、沟通、以家庭为中心的护理和冲突管理。提出了 8 项循证建议 （6 项低水平证据和 2 项高水平证据） 和 19 项专家意见。EoL 立法以及尊重患者自主权和偏好的重要性受到密切关注。考虑了 EoL 护理因国家收入和医疗保健提供而异。建议采用结构化的 EoL 决策策略，以改善患者和亲属的预后，以及员工满意度和心理健康。对于死亡风险高的患者，建议早期整合姑息治疗和使用标准化工具进行症状评估。提倡对 ICU 工作人员进行沟通培训，并为家庭提供印刷的沟通辅助工具，以改善结果和满意度。加强以家庭为中心的护理方法包括结构化的家庭会议和文化敏感干预。还考虑了防止医疗保健专业人员倦怠的冲突管理方案和策略。为制定这些指南所做的工作突出了许多需要进一步研究的领域。