Integration of palliative care in chronic critical illness management.
Palliative care is an essential component of comprehensive care for all patients with chronic critical illness, including those receiving restorative or life-sustaining therapies. Core elements include alleviation of symptom distress, communication about care goals, alignment of treatment  with the patient's values and preferences, transitional planning, and family support. Here we address strategies for assessment and management of symptoms, including pain, dyspnea, and depression, and for assisting patients to communicate while endotracheally intubated. We also discuss approaches  to optimize communication among clinicians, patients, and families about care goals. Challenges for supporting families and planning for transitions between care settings are identified, while the value of interdisciplinary input is emphasized. We review "consultative" and "integrative"  models for integrating palliative care and restorative critical care. Finally, we highlight key ethical issues that arise in the care of chronically critically ill patients and their families.
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. judith.nelson@mssm.edu
Judith E
JE
Nelson
Aluko A
AA
Hope
D002908:Chronic Disease; D003142:Communication; D003422:Critical Care / Q000941:ethics / Q000458:organization & administration*; D016638:Critical Illness / Q000628:therapy*; D004992:Ethics, Medical; D006801:Humans; D007362:Intensive Care Units; D010166:Palliative Care / Q000941:ethics / Q000458:organization & administration*; D010817:Physician-Patient Relations; D012121:Respiration, Artificial / Q000941:ethics