Treatment in an Intensive Care Unit (ICU) is about life-saving or life-prolonging interventions that have dramatically changed the
outcome for many life-threatening conditions. But a significant minority of patients do not survive and this book sets out to review the optimal management of patients dying in ICU and their
families; an alternative subtitle might be "Application of the principles and practices of palliative care in the ICU".
The book is divided into five sections. The first deals with changing attitudes and ethics regarding death in the ICU. The second
reviews the ever-difficult decisions to limit life-support therapy and how this might be easier if more patients had advance directives. The next section is about the application of the principles
and practices of palliative care in the management of patients dying in the ICU and their families. The fourth section includes a discussion of anxieties related to legal liabilities. The final
section deals with specific patient populations, such as those with cancer or AIDS; these chapters seemed to be more about what ICU therapy can achieve for these patients than about how to deal
with those who are dying.
End-of-life care is difficult in any situation, and possibly most difficult in an ICU. For doctors, nurses and other allied health
professionals who work in an ICU, this is a very important book that describes the optimal management of dying patients and their families. The principles and practices of palliative care—multidisciplinary
holistic care, good pain and symptom control, attention to psychosocial and spiritual issues, support for both the family and the health care professional—are discussed in the context of the
ICU management of the dying patient and shown to be both appropriate and beneficial.
The editors are to be congratulated on this volume that for the first time stresses the need for good palliative care for patients
dying in an ICU and their families. Perhaps the next edition should have more contributions from palliative care professionals who, whilst they do not work in an ICU, do this work every day.
Their contributions may help further dispel the concept that deaths in ICU are ‘treatment failures’ and allow an acceptance and understanding that death, in some circumstances, has to be regarded
as a normal part of life.
Roger Woodruff
Director of Palliative Care, Austin & Repatriation Medical Centre, Melbourne, Australia
Former Chairman, IAHPC
(December 2002)
Author Information
J. Randall Curtis is Associate Professor, Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview
Medical Centre, Seattle, Washington, USA
Gordon D. Rubenfeld is Assistant Professor, Division of Pulmonary and Critical Care Medicine, University of Washington, Harborview Medical Centre, Seattle, Washington, USA
Table of Contents
Part I THE CHANGING LANDSCAPE OF DEATH IN THE ICU
1. Introducing the concept of managing death in the ICU 3
Curtis, Rubenfeld
2. The changing ethics of death in the ICU 7
Mularskie, Osborne
3. The changing nature of death in the ICU 19
Luce, Prendergast
4. Making a personal relationship with death 31
Levy
Part II THE DECISION TO LIMIT LIFE SUPPORT IN THE ICU
5. Outcome prediction in the ICU 39
Kollef
6. Transdisciplinary research to understand the role of bias and heuristics 59
Cook
7. The role of quality of life and health status in making decisions about withdrawing life-sustaining treatments in the ICU 69
Curtis and Patrick
8. Advanced care planning in the outpatient and ICU setting 75
Teno
Part III PRACTICAL SKILLS NEEDED TO MANAGE DEATH IN THE ICU
9. How to discuss dying and death in the ICU 85
Curtis, Patrick
10. Pain and symptom control in the dying ICU patient 103
Foley
11. Principles and practice of withdrawing life-sustaining treatment in the ICU 127
Rubenfeld, Crawford
12. The role of critical care nurses in providing and managing end-of-life care 149
Puntillo
13. Helping families prepare for and cope with a death in the ICU 165
Shannon
14. Helping the clinician cope with death in the ICU 183
Block
15. The interface of technology and spirituality in the ICU 193
Chambers, Curtis
16. The role of the physician in sacred end-of-life rituals in the ICU 207
Miles
Part IV SOCIETAL ISSUES
17. The roles of ethnicity, race, religion and socioeconomic status in end-of-life care in the ICU 215
Danis
18. Legal liability anxieties in the ICU 231
Kapp
19. Economics of managing death in the ICU 245
Pronovost, Angus
20. Organisational change and improving the quality of palliative care in the ICU 257
Daly
21. An international perspective on death in the ICU 273
Fisher
Part V SPECIFIC DISEASES AND SPECIAL POPULATIONS
22. AIDS 291
Rosen
23. Cancer 301
Back
24. Congestive heart failure 311
Sackner-Bernstein
25. Chronic obstructive pulmonary disease 319
Heffner
26. Decisions to limit intensive care in patients with coma 329
Wijdicks
27. Special concerns for infants and children 337
Robinson
28. Special concerns for the very old 349
Nelson, Nierman
Index 369
