Palliative care in intensive care units: an integrative review

Molina Filho, Enio Teixeira; Olivero, Aline Augusto; Gurgel, Sanderland José Tavares; Gil, Nelly Moraes; Sanches, Rafaely de Cassia Nogueira; Sanches, Mário Antônio; Souza, Waldir

doi:10.1590/1983-803420233418EN

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Research • Rev. Bioét. 31 • 2023 • https://doi.org/10.1590/1983-803420233418EN copy

Palliative care in intensive care units: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Our integrative review sought to identify therapeutic decisions for palliative care in intensive care units. Bibliographic search conducted on the Virtual Health Library using the descriptors “palliative care,” “intensive care units” and “delivery of health care” returned 1,579 studies, of which seven were included in the final sample. Textual analysis was performed using the Iramuteq software. From the main results and words—”patient,” “end of life,” “family,” “intensive care unit,” “hospital”—we produced a co-occurrences tree, resulting in two categories and four subcategories. Currently, the spread of chronic noncommunicable diseases and increased life expectancy call for the large-scale use of this type of care, improving quality of life, care and academia.

Palliative care; Intensive care units; Delivery of health care

Author and year	Title and country	Study type and no. of participants	Objective	Outcome
Alliprandini and collaborators; 2019 ¹⁴14. Alliprandini M, Ferrandin A, Fernandes A, Belim M, Jorge M, Colombo B et al. End-of-life management in intensive care units: a multicentre observational prospective cohort study. Anaesthesiol Intensive Ther [Internet]. 2019 [acesso 24 mar 2022];51(5):348-56. DOI: 10.5114/ait.2019.91189 https://doi.org/10.5114/ait.2019.91189... (A1)	“End-of-life management in intensive care units: a multicenter observational prospective cohort study”; Paraná, Brazil	Observational cohort n=201	To evaluate which patients hospitalized in five ICUs in the city of Cascavel/PR are eligible for the performance and administration of PC.	Among the patients who died during the period, proper PC criteria was performed in only 15%, with terminal extubation being one of the rarely performed procedures.
Irmak and collaborators; 2020 ¹⁵15. Irmak I, Adigüzel N, Yildiz E, Kargin F, Yazicioğlu Moçin Ö, Çiftaslan Gökşenoğlu N e t al . The comparison of the survival rates of intensive and palliative care units. Tuberk Toraks [Internet]. 2020 [acesso 24 mar 2022];68(3):245-51. DOI: 10.5578/tt.69753 https://doi.org/10.5578/tt.69753... (A2)	“The comparison of the survival rates of intensive and palliative care units”; Ankara, Turkey	Observational study n=112	To compare survival rates in the intensive care unit and the palliative care unit.	Long-term survival rates proved similar between the intensive care unit and the PC unit.
Hua and collaborators; 2020 ¹⁶16. Hua M, Lu Y, Ma X, Morrison RS, Li G, Wunsch H. Association between the implementation of hospital-based palliative care and use of intensive care during terminal hospitalizations. JAMA Netw Open [Internet]. 2020 [acesso 24 mar 2022];3(1):e1918675. DOI: 10.1001/jamanetworkopen.2019.18675 https://doi.org/10.1001/jamanetworkopen.... (A3)	“Association between the implementation of hospital-based palliative care and use of intensive care during terminal hospitalization”; New York, United States	Observational cohort n=73,370	To determine whether the implementation of hospital-based palliative care was associated with decreased ICU use during terminal hospitalizations.	A 10% reduction in the use of intensive care during terminal hospitalizations was identified in hospitals with PC programs in place.
Clara and collaborators; 2020 ¹⁷17. Santa Clara MG, Silva VR, Alves R, Coelho MCR. The Palliative Care Screening Tool as an instrument for recommending palliative care for older adults. Rev Bras Geriatr Gerontol [Internet]. 2019 [acesso 24 mar 2022];22(5):e190143. DOI: 10.1590/1981-22562019022.190143 https://doi.org/10.1590/1981-22562019022... (A4)	“The palliative care screening tool as an instrument for recommending palliative care for older adults”; Espírito Santo, Brazil	Cross-sectional study n=594	To evaluate the use of the Palliative Care Screening Tool and its agreement with the Palliative Performance Scale, as well as describe the causes of hospitalization in older adults receiving palliative care and in the ICU.	The Palliative Care Screening Tool proved to be of great importance in referring patients to PC due to its high sensitivity.
Reeve and collaborators; 2021 ¹⁸18. Reeve BK, Dennis BB, Dechert W, Longo B, Heels-Ansdell D, Scholes A et al. Community implementation of the 3 Wishes Project: an observational study of a compassionate end-of-life care initiative for critically ill patients. CMAJ Open [Internet]. 2021 [acesso 24 mar 2022];9(3):57-64. DOI: 10.9778/cmajo.20200273 https://doi.org/10.9778/cmajo.20200273... (A5)	“Community implementation of the 3 Wishes Project: an observational study of a compassionate end-of-life care initiative for critically ill patients”; Ontario, Canada	Observational and descriptive n=101	To evaluate the adaptability of the 3 Wishes Project to an intensive care unit and describe the patients treated with this palliative approach, as well as local implementation strategies.	99.2% of terminal wishes were met at an average cost of US$5.39 per patient, and for 89.8% there was no cost. The program comforted patients and relatives.
Takaoka and collaborators; 2021 ¹⁹19. Takaoka A, Tam B, Vanstone M, Clarke FJ, Hoad N, Swinton M et al. Scale-up and sustainability of a personalized end-of-life care intervention: a longitudinal mixed-methods study. BMC Health Serv Res [Internet]. 2021 [acesso 24 mar 2022];21(1):218. DOI: 10.1186/s12913-021-06241-6 https://doi.org/10.1186/s12913-021-06241... (A6)	“Scale-up and sustainability of a personalized end-of-life care intervention: a longitudinal mixed-methods study”; Ontario, Canada	Longitudinal n=369	To describe how the 3 Wishes Project, a personalized end-of-life intervention, was scaled up and maintained in an intensive care unit.	The 3 Wishes Project began as a study and was integrated into clinical practice as an accessible and sustainable care approach.
Lacerda and collaborators; 2021 ²⁰20. Lacerda FH, Checoli PG, Silva CMD, Brandão CE, Besen BAMP. Mechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit. Rev Bras Ter Intensiva [Internet]. 2020 [acesso 24 mar 2022];32(4):528-34. DOI: 10.5935/0103-507X.20200090 https://doi.org/10.5935/0103-507X.202000... (A7)	“Mechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit”; São Paulo, Brazil	Retrospective cohort n=282	To describe characteristics and outcomes of patients undergoing withdrawal from mechanical ventilation and compare them to patients with mechanical ventilation and limitations of life support therapy (limited or withdrawn), but without removal of mechanical ventilation.	The authors observed that there is no association between withdrawal of mechanical ventilation and increased hospital mortality.

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[1] Correspondence: Rafaely de Cassia Nogueira Sanches – Av. Colombo, 5790, bloco 1, sala 8 CEP 87020-900. Maringá/PR, Brasil.