End of Life Care in the ICU
Tonelli MR. Pulling the plug on living wills. Chest 1996;110:816-22. Discusses the difficulties and limitations of formulating and applying advanced directives.
PMID: 8797430
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Truog RD, Campbell ML, Curtis JR, et al. Recommendations for end-of-life care in the intensive care unit: a consensus statement by the American College of Critical Care Medicine. Crit Care Med 2008; 36:953-63. Provides an overview of ethical issues as well as a compassionate approach to practical aspects of end-of-life care.
PMID: 18431285
Lanken PN, Terry PB, DeLisser HM, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008;177:912-27. Overlap with above ACCM statement but offers additional worthwhile discussion of hospice eligibility and on timing and settings for palliative care.
PMID: 18390964
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Azoulay E, Pochard F, Kentish-Barnes N, et al. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med 2005; 171:987-94. This French study is noteworthy for evaluating risk factors for stress-related symptoms in a large cohort of family members of ICU patients. Interviews of 284 primary decision makers 90 days after the patients’ ICU discharge or death found that 33% were deemed to be at moderate to high risk of PTSD. Risk of PTSD was associated with perception of incomplete information in the ICU, ICU death of the relative, ICU death of the relative after end-of-life decisions, and sharing in end-of-life decisions.
PMID: 15665319
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Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007; 356:469-78. This French study of family members of 126 patients that died in an ICU found the use of a brochure on bereavement combined with a proactive communication strategy lowered symptoms of anxiety, depression, and PTSD.
PMID: 17267907
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Curtis JR, Burt RA. Point: the ethics of unilateral "do not resuscitate" orders: the role of "informed assent". Chest 2007;132:748-51; discussion 755-6. This point/counterpoint suggests an approach to end of life discussions that attempts to lessen the burden of decision making on family members when potential treatments are deemed very unlikely to benefit the patient. The counterpoint by Manthous within the same volume and multiple comments published thereafter raise concerns about the application of informed assent.
PMID: 17873188
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White DB, Evans LR, Bautista CA, et al. Are physicians’ recommendations to limit life support beneficial or burdensome? Bringing empirical data to the debate. Am J Respir Crit Care Med. 2009;180:320-5. This study calls into question current professional society guidelines’ recommendation for physicians to routinely provide a recommendation regarding limitation of life support. 169 surrogate decision makers of current ICU patients participated in a standardized video conference regarding end of life cares for a hypothetical patient. 42% percent of participants preferred not to receive a physician’s recommendation. Study limitations include possible selection bias, single-center study, and use of a hypothetical encounter, which does not take into account the effect of serial physician-family encounters that typically precede end of life discussions
PMID: 19498057
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