End of Life Care in the ICU

The Oxford Specialist Handbooks series provides readers with clear, concise information on all that is needed to successfully train in the medical sub-specialties. Each book gives an overview of clearly defined procedures, skills, guidelines, and technologies and provides practical tips and case studies to supplement hands-on experience. Where appropriate, each book complements the revised curriculum as developed by the Specialist Advisory Committees. As palliative medicine does not have the resources to care for all patients with malignant and non-malignant chronic disease, government guidelines have pushed for its inclusion on the curriculum of most medical and surgical specialties. All specialties are being encouraged to become actively engaged in managing end of life care for their own patients. End of life care in the ICU presents its own unique challenges, and this book highlights real clinical issues which need to be addressed if quality palliative care within ICUs is to be consistently delivered. It details strategies and evidence-based advice on the nature of effective palliative care in the ICU setting, dealing with issues such as diagnosing the dying, communicating with patients and families, the support of families and carers, multidisciplinary working, use and non-use of medical ventilation, TPN and fluids, dialysis, inotropic support, autonomy, dignity, effective symptom control, practical ethics and the process of decision making, management of dying, and bereavement care. This book is ideal for doctors, nurses, and allied health professionals working in the ICU and palliative care. Concise chapters make it quick and easy to read up on a particular topic Contains contributions from numerous experts from 3 continents to provide a comprehensive, yet concise and practical guide to the major issues that face patients, their families and the clinicians who work in modern day ICUs around the world Edited by Graeme Rocker , Professor of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada, Élie Azoulay , Professor of Medicine, Paris 7 University; Director assistant of the Medical ICU of the Saint-Louis Hospital, Director of the Famirea® study group, France, Kathleen Puntillo , Professor of Nursing, Department of Physiological Nursing, University of California, San Francisco, USA, and Judith Nelson , Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, USA CONTENTS 1: Introduction 2: Improving ICU care 3: Symptom control 4: Caring for families in the ICU 5: Cultural issues, spirituality and hope 6: Teamwork, relationships and moral distress 7: Legal issues and conflict resolution 8: Cardiopulmonary resuscitation 9: Withholding and withdrawal of life support 10: Lessons learned 11: Personal stories and reflections 12: Special situations 13: Organ donation 14: Research issues 15: Web-based resources Contributors: Fekri Abroug, Intensive Care Unit, CHU F.Bourguiba, Tunisia Shoshana Arai, Department of Physiological Nursing, University of California, San Francisco, USA Élie Azoulay, Professor of Medicine, Specialty Pulmonary Medicine and Critical care and Director Assistant of the Medical-ICU of the Saint-Louis Teaching Hospital, Paris, France D Benoit, Department of Intensive Care, University Hospital Ghent Belgium, Belgium Martha Billings, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center School of Medicine, University of Washington, Seattle, USA Kerry Bowman, University of Toronto and Mount Sinai Hospital, USA Peter G Brindley, Associate Professor, Critical Care Medicine, University of Alberta Hospital, Canada P Calzavacca, Institute of Anaesthesia and Intensive Care Medicine, Policlinico di Catania University Hospital, Italy Alain Cariou, Réanimation Médicale, Cochin, Paris, France Jean Carlet, French National Authority for Health (HAS), Saint Denis, France L Chapman Deborah Cook, McMaster University, Ontario, Canada Jean-Claude Chevrolet, Intensive Care Service, University Hospital, Geneva, Switzerland Simon L Cohen, Consultant Physician, Intensive Care Unit, University College Hospital, London Christophe Coupé, Service de Neurologie et Centre de Référence pour la Sclérose Latérale Amyotrophique "Ile de France", Groupe Hospitalier Pitié-Salpêtrière, Paris, France J Randall Curtis, Professor of Medicine, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, USA Freda DeKeyser Ganz, Head, Masters Program, Hadassah-Hebrew University School of Nursing, Jerusalem M DeVita, Institute of Anaesthesia and Intensive Care Medicine, Policlinico di Catania University Hospital, Italy Peter Dodek, Center for Health Evaluation and Outcome Sciences and Program in Critical Care Medicine, St. Paul's Hospital and University of British Columbia, Vancouver, Canada Jocelyn Downie, Faculties of Law and Medicine, Dalhousie University, Halifax, Canada Didier Dreyfuss, Service de Réanimation Médico-Chirurgicale, Hôpital Louis Mourier, Colombes and Assistance Publique - Hôpitaux de Paris, Université Paris-Diderot, France Thomas Fassier, The French Famirea study group, AP-HP, Hôpital Saint-Louis, Medical ICU, and University Paris-7 Paris-Diderot, UFR de Médecine, Paris, France Niall D Ferguson, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada Malcolm Fisher, Clinical Professor, University of Sydney Intensive Care Unit, Royal North Shore Hospital of Sydney and Department of Anaesthesia, University of Sydney, Australia Christopher Frank, Associate Professor, Department of Medicine, Queen's University, Providence Care, St. Mary's of the Lake Hospital site, Kingston, Canada Maité Garrouste-Orgeas, Medical ICU, Saint Joseph Hospital, Paris, France Jesus Gonzalez Bermejo, Service de pneumologie et réanimation, Groupe Hospitalier Pitié-Salpêtrière, and Service de Neurologie et Centre de Référence pour la Sclérose Latérale Amyotrophique "Ile de France", Groupe Hospitalier Pitié-Salpêtrière, Paris, France Vicki Guy, Registered Nurse, CDHA QEII Health Sciences Center, Halifax, Canada J Harper John E Heffner, Adjunct Professor of Medicine and Garnjobst Chair of Medical Education, Providence Portland Medical Center, Oregon Health and Science University, Oregon, USA Catherine Hough, Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, School of Medicine, University of Washington, Seattle, USA Daren Heyland, Professor, Department of Medicine, Queen's University; Clinical Evaluation Research Unit, Kingston General Hospital, Canada Amélie Hurbault, Service de pneumologie et réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France Philippe Jolliet, Intensive Care Service, University Hospital, Geneva, Switzerland Denah Joseph, Chaplain, Palliative Care Service, UCSF Medical Center, San Francisco, USA Nancy Kentish-Barnes, FAMIREA Study Group, Service de Réanimation Médicale, Hôpital Saint Louis, Paris, France Denice Klavano, Certified Tissue Bank Specialist, Regional Tissue Bank, Capital District Health Authority, Halifax, Canada David Kuhl, Director, Centre for Practitioner Renewal, Providence Health Care/University of British Columbia; and Associate Professor, Department of Family Practice, Faculty of Medicine, University of British Columbia, Canada Alexandre Lautrette, Medical ICU, Clermont Ferrand University, France Virginie Lemiale, Service de Réanimation Médicale, Hôpital Cochin - Saint Vincent de Paul - La Roche Guyon, Paris, France Stephen Liben, The Montreal Children's Hospital, Montreal, Canada Harold MacAloney, former Registered Nurse, Nova Scotia, Canada Heather MacDonald, Clinical Nurse Specialist in Critical Care, New Halifax Infirmary, Halifax, Canada Jane MacIver, Divisions of Cardiology and Transplantation, Toronto General Hospital, Canada Adeline Max, Medical ICU, Cochin hospital, AP-HP & University Paris Descartes, Paris, France Jennifer McAdam, Department of Physiological Nursing, University of California, San Francisco, USA Alison McCallum, Family Physician, Halifax, Canada Vincent Meininger, Service de Neurologie et Centre de Référence pour la Sclérose Latérale Amyotrophique "Ile de France", Groupe Hospitalier Pitié-Salpêtrière, Paris, France Paolo Merlani, Intensive Care Unit, University Hospital and the University of Geneva, Geneva, Switzerland Jean-Paul Mira, Medical ICU, Cochin hospital, AP-HP & University Paris Descartes, Paris, France Anne C Mosenthal, Chief, Surgical Critical Care, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA John Myburgh, Professor of Critical Care Medicine, University of New South Wales, Sydney, Department of Intensive Care Medicine, St George Hospital, Sydney and The George Institute for International Health, Sydney, Australia Judith E Nelson, Professor of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, USA Lamia Ouanes Besbes Frédéric Pène, Medical ICU, Cochin hospital, AP-HP & University Paris Descartes, Paris, France R Piers, Department of Geriatrics. University Hospital Ghent Belgium. Special Research Fund Ugent, Belgium Thomas J. Prendergast, Associate Professor of Medicine and Anesthesiology; Program Director, Pulmonary and Critical Care Medicine, Dartmouth Hitchcock Medical Center, Lebanon, USA Kathleen Puntillo. FAAN Professor of Nursing, Department of Physiological Nursing, University of California, San Francisco, USA Bara Ricou, Intensive Care Unit, University Hospital and the University of Geneva, Geneva, Switzerland Walter Robinson, Isaac Walton Killam Hospital and Dalhousie University, Halifax, Canada Graeme Rocker, Professor, Department of Medicine (Division of Respirology) and Cross Appointed in the Divisions of Palliative Medicine, Critical Care and the Departments of Surgery and Anaesthesia, Dalhousie University Interim Head, Division of Respirology, Capital District Health Authority, Halifax, Canada Heather J Ross, Divisions of Cardiology and Transplantation, Toronto General Hospital, Canada F Rubulotta, Institute of Anaesthesia and Intensive Care Medicine, Policlinico di Catania University Hospital, Italy Damon C Scales, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada W Schrauwen, Department of Oncology, Department of Palliative care, University Hospital Ghent Belgium, Belgium Cathy Schuster Sam D Shemie, Division of Pediatric Critical Care and Medical Director, Extracorporeal Life Support Program, Montreal Children's Hospital, McGill University Health Centre, Canada Michele R. Shields, Director, Spiritual Care Services, UCSF Medical Center, San Francisco, USA Thomas Similowski, Service de pneumologie et réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France Christy Simpson, Department of Bioethics, Dalhousie University, Halifax, Canada Gurmeet Singh, Clinical Assistant Professor, Critical Care Medicine and Clinical Assistant Professor, Division of Cardiac Surgery, Department of Surgery University of Alberta, Edmonton, Canada Tasnim Sinuff, Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada Bertrand Souweine Yoanna Skrobik, Critical Care Medicine, Université de Montréal and McGill University; and Intensive Care Unit, Maisonneuve-Rosemont Hospital, Montreal, Canada Vicki Spuhler, Nurse Manager RICU, Intermountain Medical Center, Murray, Utah, USA Jeannette Suurdt, Research Associate, Clinical Evaluation Research Unit, Kingston General Hospital, Canada Sandy Swoboda, Johns Hopkins University Schools of Medicine and Nursing. Baltimore, Maryland, USA N Van Den Noortgate, Department of Geriatrics, Department of Palliative care. University Hospital Ghent Belgium Jeffrey Watts Stephen Workman, The Queen Elizabeth Health Sciences Center, Halifax, Canada Duncan Young, Clinical Director, Adult Intensive Care Unit, John Radcliffe Hospital, Oxford, UK