Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
Kasturba Medical College, Manipal, Karnataka, 576104, India.
Intensive Care Med. 2024 Sep;50(9):1438-1458. doi: 10.1007/s00134-024-07565-7. Epub 2024 Aug 14.
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.
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).
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.
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.
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 ICU 入住前、入住期间和入住后的终末期危重病患者及其家属的姑息治疗实践，解决了这些问题。
系统检索了 7 个数据库中的系统评价，并根据 Joanna Briggs 研究所（JBI）制定的指南进行了伞式综述。
在最初确定的 3122 条记录中，有 40 篇系统评价被纳入综述。总结出 6 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后使家属能够做出明智的决策，应对不确定性，减轻痛苦，并缩短 ICU 住院时间。在讨论护理目标之前，团队之间的讨论和达成一致的计划至关重要。记录护理偏好可防止不必要的临终治疗。卓越的临终关怀应包括症状管理、家庭支持、水合和营养优化、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，可以通过寻求家属反馈或进行调查来完成。
本综述总结了目前 ICU 中的姑息治疗实践，影响了患者和家属的结局，并为制定需要临终关怀的危重病患者及其家属的适当护理框架提供了思路。
