End of Life Care in Critical Care

Callum Taylor - callum.taylor@glasgow.ac.uk

2025-04-03

Evidence Based Palliative Care

Scale of the Problem

Intro Summary

  • 1 in 6 ICU Patients Die in Hospital
  • 1 in 20 of All Deaths Are in Critical Care
    • Under 40?: 1 in 8 of All Deaths
  • Deaths in Critical Care:
    • Younger and More Deprived

The goals of these guidelines are to:
- improve quality of dying and death,
- minimize the adverse effects of the experience on families,
- support the well-being of healthcare professionals (HCPs),
- serve as a resource for hospital administrators and healthcare policymakers.

  1. Variability across countries
  2. Decision Making
  3. Palliative and End of Life Care in The ICU
  4. Communication
  5. Family Centered Care
  6. Interprofessional Decision Making
  7. Conflict Management

3 - Palliative and End of Life Care in The ICU

  • Symptom Assessment and Management
  • Integration With Palliative Care Specialists
  • Re-evaluation of Life-Sustaining Therapies
  • Withdrawal of Life Support

Symptom Assessment and Management

In patients with advanced medical illnesses and deteriorating health in spite of optimal intensive care treatment, does use of standardized tools for assessment of symptoms, compared to usual care, increase frequency of symptom assessment?

Symptom Burden

Symptom Burden

  • Pain
  • Dyspnoea
  • Agitation
  • Nausea and Vomiting
  • Constipation
  • Thirst
  • Hunger
  • Anxiety and Fear
  • Depression
  • Spiritual (Existential) Distress

Dyspnoea

Dyspnoea ~ 50%

Management - Dyspnoea

Management - Dyspnoea

  • Reassurance
  • Reducing Stimuli
  • Suctioning
  • Supplemental Oxygen
  • Non-Pharmacological

Ventilation Strategies

Drugs

Pain ~ 50-80%

Management - Pain

Pain Adjuncts

  • Paracetamol
  • NSAIDS
  • Nefopam
  • Ketamine
  • Neuropathic Pain

Non Pharmacological

  • Massage
  • Music Therapy
  • Cold Therapy
  • Relaxation Techniques

3 - Palliative and End of Life Care in The ICU

  • Symptom Assessment and Management
  • Integration With Palliative Care Specialists
  • Re-evaluation of Life-Sustaining Therapies
  • Withdrawal of Life Support

Communication

Patients With Cancer

Patients who recognized their terminal illness were more likely to prefer symptom-directed care (83%). However, some patients who were aware they were terminally ill wished to receive life-extending care7

Patients With Cancer

Patients who reported having discussed their wishes for EOL care with a physician were more likely to receive care that was consistent with their preferences*7

Resources

https://www.goodlifedeathgrief.org.uk/support-after/

https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/