TY - JOUR
T1 - Palliative care in the ICU
T2 - Relief of pain, dyspnea, and thirst - A report from the IPAL-ICU Advisory Board
AU - Puntillo, Kathleen
AU - Nelson, Judith Eve
AU - Weissman, David
AU - Curtis, Randall
AU - Weiss, Stefanie
AU - Frontera, Jennifer
AU - Gabriel, Michelle
AU - Hays, Ross
AU - Lustbader, Dana
AU - Mosenthal, Anne
AU - Mulkerin, Colleen
AU - Ray, Daniel
AU - Bassett, Rick
AU - Boss, Renee
AU - Brasel, Karen
AU - Campbell, Margaret
N1 - Funding Information:
Expert guidelines are available to assist in the management of pain [7] and dyspnea [8, 9], but additional empirical evidence to support clinical care is needed, and wide variation in practice is common. Meanwhile, the high prevalence, frequency, and intensity of other distressing physical symptoms, such as thirst, and psychological symptoms, have come into clearer view recently, but without development and rigorous testing of palliative interventions. The Improving Palliative Care in the ICU (IPAL-ICU) Project, sponsored by the National Institutes of Health and the Center to Advance Palliative Care, shares technical assistance, evidence, and tools to integrate palliative care and intensive care successfully from the onset of critical illness for all ICU patients, including those pursuing intensive therapies to prolong life and restore baseline health. In this review, the interdisciplinary IPAL-ICU Advisory Board brings together the combined expertise of its members in palliative care and intensive care to address challenges in assessment and management of pain, dyspnea, and thirst during critical illness. We focus on the following questions: (1) What are key elements necessary to assess these three common symptoms in the ICU? (2) What are optimal strategies for managing these symptoms during critical illness? (3) How can symptom care be systematized for improvement?
PY - 2014/2
Y1 - 2014/2
N2 - Purpose: Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. Methods: We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst. Results: Evidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able to self-report and the Critical Care Pain Observation Tool or Behavior Pain Scale for patients who cannot report symptoms verbally or non-verbally. The Respiratory Distress Observation Scale is the only known behavioral scale for assessment of dyspnea, and thirst is evaluated by patient self-report using an 0-10 NRS. Opioids remain the mainstay for pain management, and all available intravenous opioids, when titrated to similar pain intensity end points, are equally effective. Dyspnea is treated (with or without invasive or noninvasive mechanical ventilation) by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Several oral interventions are recommended to alleviate thirst. Systematized improvement efforts addressing symptom management and assessment can be implemented in ICUs. Conclusions: Relief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.
AB - Purpose: Pain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management. Methods: We conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst. Results: Evidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able to self-report and the Critical Care Pain Observation Tool or Behavior Pain Scale for patients who cannot report symptoms verbally or non-verbally. The Respiratory Distress Observation Scale is the only known behavioral scale for assessment of dyspnea, and thirst is evaluated by patient self-report using an 0-10 NRS. Opioids remain the mainstay for pain management, and all available intravenous opioids, when titrated to similar pain intensity end points, are equally effective. Dyspnea is treated (with or without invasive or noninvasive mechanical ventilation) by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Several oral interventions are recommended to alleviate thirst. Systematized improvement efforts addressing symptom management and assessment can be implemented in ICUs. Conclusions: Relief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.
KW - Dyspnea
KW - Pain
KW - Palliation
KW - Thirst
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U2 - 10.1007/s00134-013-3153-z
DO - 10.1007/s00134-013-3153-z
M3 - Review article
C2 - 24275901
AN - SCOPUS:84893848434
VL - 40
SP - 235
EP - 248
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 2
ER -