title: When is an invasive palliative intervention in an acute internal medical patient worth it? A structured palliative approach.
abstract: A 67-year-old patient with coronary artery disease (CAD), diabetes, and chronic obstructive pulmonary disease (COPD) was scheduled for coronary artery bypass graft (CABG) surgery after a recent myocardial infarction despite a high perioperative risk of death. While waiting, acute renal failure developed, and the patient was admitted to the intensive care unit (ICU). After the patient and his wife were informed that CABG surgery was no longer possible, he declined further intensive care treatment and subsequently died peacefully.We show that a structured palliative approach which has been proposed for cancer patients may also be feasible in palliative situations concerning nononcologic patients.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine and Palliative Care Liaison Unit, SMZ Ost Danube Hospital, Langobardenstr. 122, 1220, Vienna, Austria. thomas.weber@wienkav.at.
authors.forename: Thomas
authors.initials: T
authors.lastname: Weber
authors.affiliation: Oncological Palliative Medicine, Cantonal Hospital Sankt Gallen, Sankt Gallen, Switzerland.
authors.forename: Florian
authors.initials: F
authors.lastname: Strasser
mesh_terms: D000208:Acute Disease; D000368:Aged; D001317:Austria; D015897:Comorbidity; D001026:Coronary Artery Bypass; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D018447:Medical Futility; D010166:Palliative Care / Q000458:organization & administration*; D016312:Treatment Refusal
keywords: Acute renal failure; Chronic obstructive pulmonary disease (COPD); Coronary artery bypass grafting; Coronary artery disease (CAD); Palliative care; Shared decision-making