There is some dissent among physicians regarding whether to treat patients at the end of their lives in an intensive care unit setting, according to an article recently published in JAMA.
Two healthcare professionals — Derek C. Angus, MD, chair of the department of critical care medicine at UPMC in Pittsburgh, and Robert Truog, MD, senior associate in critical care medicine at Children's Hospital Boston — examined some of the arguments for and against ICU care at the end of life to help determine the appropriate and optimal delivery of patient-centered care for patients at high risk of death or severe disability.
Arguments against ICU care at the end-of-life include the following:
1. ICU care is typically associated with the aggressive use of invasive technology to rescue patients from death, as opposed to end-of-life care, which many consider free of pain.
2. Receiving care in the ICU contributes to the statistic that more than one quarter of Medicare dollars are spent on patients during the last year of life.
3. ICU use is higher in America than in most other countries, despite a lack of proof that ICU care boosts life expectancy.
Arguments for ICU care at the end of life include the following:
1. It is not always possible to discern with complete certainty whether a patient's condition will precede death or recovery, so ICU care is often in line with the patient's wishes.
2. Some care — including complex pain treatment regimens, palliative noninvasive ventilation or postoperative care — may be delivered more safely and expertly in an ICU than elsewhere.
3. Patients and families frequently form strong bonds with ICU staff and may feel more comfortable with them when making the decision to switch to comfort-only measures.
"As physicians become used to easy access to ICUs, it becomes difficult to consider caring for critically ill patients anywhere other than the ICU, even for patients at the end of their lives," wrote the authors.
More articles on ICU care:
Predictive preventive model reduces C. diff cases in ICU: 3 study findings
Study shows ICU visitation hugely affects family satisfaction: 3 things to know
Study investigates a new method of quickly identifying harmful bacteria in busy ICUs