title: End of life and palliative care in intensive care unit.
abstract: The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable.
authors.affiliation: Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Rachel Duarte
authors.initials: RD
authors.lastname: Moritz
authors.affiliation: Hospital de Clínicas de Porto Alegre, RS, Brasil.
authors.forename: Patricia Miranda do
authors.initials: PM
authors.lastname: Lago
authors.affiliation: Serviço de Psicologia, Hospitais VITA, Curitiba, PR, Brasil.
authors.forename: Raquel Pusch de
authors.initials: RP
authors.lastname: Souza
authors.affiliation: Faculdade Federal de Ciências Médicas de Porto Alegre, RS, Brasil.
authors.forename: Nilton Brandão da
authors.initials: NB
authors.lastname: Silva
authors.affiliation: Hospital Universitário Walter Cantídeo, Universidade Federal do Ceará, Fortaleza, CE, Brasil.
authors.forename: Francisco Albano de
authors.initials: FA
authors.lastname: Meneses
authors.affiliation: Hospital do Pronto Socorro de Porto Alegre, RS, Brasil.
authors.forename: Jairo Constante Bitencourt
authors.initials: JC
authors.lastname: Othero
authors.affiliation: Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil.
authors.forename: Fernando Osni
authors.initials: FO
authors.lastname: Machado
authors.affiliation: Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil.
authors.forename: Jefferson Pedro
authors.initials: JP
authors.lastname: Piva
authors.affiliation: Unidade de Terapia Intensiva Geral, Hospital 9 de Julho, São Paulo, SP, Brasil.
authors.forename: Mariza D Agostino
authors.initials: MD
authors.lastname: Dias
authors.affiliation: Serviço de Terapia Intensiva, Hospital Barra D´Or.
authors.forename: Juan Carlos Rosso
authors.initials: JC
authors.lastname: Verdeal
authors.affiliation: Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rocha
authors.affiliation: Unidade de Terapia Intensiva, Hospital do Servidor Público Estadual, São Paulo, SP, Brasil.
authors.forename: Renata Andrea Pietro Pereira
authors.initials: RA
authors.lastname: Viana
authors.affiliation: Departamento de Psicologia, Associação de Medicina Intensiva Brasileira.
authors.forename: Ana Maria Pueyo Blasco de
authors.initials: AM
authors.lastname: Magalhães
authors.affiliation: Departamento de Enfermagem, Associação de Medicina Intensiva Brasileira.
authors.forename: Nara
authors.initials: N
authors.lastname: Azeredo