Palliative care in the intensive care unit: Part II

Although intensivists have not thought of their patients as 'terminally ill,' critically ill patients can be seen to share many salient features with populations of terminally ill patients for whom the principles and practice of palliative medicine were originally developed. In this two-part series, we review the role of palliative care in the intensive care unit. Part 1 discussed aspects of death and distress among the critically ill that mandate expertise and education in palliative medicine. In Part II we review the practice of withdrawal and withholding of life support, which now precedes the majority of ICU deaths, discuss management of distress and discomfort experienced by critically ill patients, and suggest strategies for improving palliative care in the ICU. Traditionally palliative care and curative or life-prolonging treatments have been dichotomized, the former deferred or deemphasized until hope of cure was abandoned. In a newer, integrated model that provides tile conceptual framework for this review, palliative care is provided to all patients receiving intensive care, including those pursuing aggressive, life-prolonging therapies as well as those more clearly at the end of life.