| Autor: |
Moritz RD; Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil., Lago PM; Hospital de Clínicas de Porto Alegre, RS, Brasil., Souza RP; Serviço de Psicologia, Hospitais VITA, Curitiba, PR, Brasil., Silva NB; Faculdade Federal de Ciências Médicas de Porto Alegre, RS, Brasil., Meneses FA; Hospital Universitário Walter Cantídeo, Universidade Federal do Ceará, Fortaleza, CE, Brasil., Othero JC; Hospital do Pronto Socorro de Porto Alegre, RS, Brasil., Machado FO; Universidade Federal de Santa Catarina, Florianópolis, SC, Brasil., Piva JP; Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brasil., Dias MD; Unidade de Terapia Intensiva Geral, Hospital 9 de Julho, São Paulo, SP, Brasil., Verdeal JC; Serviço de Terapia Intensiva, Hospital Barra D´Or., Rocha E; Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil., Viana RA; Unidade de Terapia Intensiva, Hospital do Servidor Público Estadual, São Paulo, SP, Brasil., Magalhães AM; Departamento de Psicologia, Associação de Medicina Intensiva Brasileira., Azeredo N; Departamento de Enfermagem, Associação de Medicina Intensiva Brasileira. |
| Abstrakt: |
The objective of this review was to evaluate current knowledge regarding terminal illness and palliative care in the intensive care unit, to identify the major challenges involved and propose a research agenda on these issues The Brazilian Critical Care Association organized a specific forum on terminally ill patients, to which were invited experienced and skilled professionals on critical care. These professionals were divided in three groups: communication in the intensive care unit, the decision making process when faced with a terminally ill patient and palliative actions and care in the intensive care unit. Data and bibliographic references were stored in a restricted website. During a twelve hour meeting and following a modified Delphi methodology, the groups prepared the final document. Consensual definition regarding terminality was reached. Good communication was considered the cornerstone to define the best treatment for a terminally ill patient. Accordingly some communication barriers were described that should be avoided as well as some approaches that should be pursued. Criteria for palliative care and palliative action in the intensive care unit were defined. Acceptance of death as a natural event as well as respect for the patient's autonomy and the nonmaleficence principles were stressed. A recommendation was made to withdraw the futile treatment that prolongs the dying process and to elected analgesia and measures that alleviate suffering in terminally ill patients. To deliver palliative care to terminally ill patients and their relatives some principles and guides should be followed, respecting individual necessities and beliefs. The intensive care unit staff involved with the treatment of terminally ill patients is subject to stress and tension. Availability of a continuous education program on palliative care is desirable. |
