ICUComfortCareprinciples,guidelines,andgoals-Chest.docVIP

ICU Comfort Care guidelines I. General Principles 1) All patients would like to be comfortable regardless of the goals of care. Comfort care specifically refers to care which has as its primary goal the promotion of comfort, not cure or life prolongation. It is aimed at improving quality of life and it addresses the psychological, social, and spiritual needs of patients and their families. 3) Comfort care in the ICU includes provision of treatments that promote comfort and the withholding or withdrawal of treatments that are primarily intended to cure or prolong life. 4) Comfort care provided in the ICU differs from palliative care provided outside of the ICU in that ICU comfort care is typically delivered over a much shorter time frame, often measured in minutes, hours, or in some cases a few days. 4) Death occurs as a complication of the underlying disease. The goal of comfort care is to relieve suffering in a dying patient, not to hasten death. Actions solely intended to hasten death (for example, high doses of potassium or paralytic drugs) are morally unacceptable and illegal. 5) Withdrawal of life sustaining treatment is a medical procedure that requires the same degree of physician participation and attention to quality as other procedures. 6) Withdrawing treatments is morally and legally equivalent to withholding them, although it may feel different for clinicians. 7) Any treatment can be withdrawn including artificial nutrition, fluids, antibiotics, blood products, ventilator support, and vasopressors. 8) Assessing pain and discomfort in intubated critically ill patients or patients with altered mental status can be difficult. When opioids or sedation are increased the justification for the increase should be documented in the medical record with particular attention to objective criteria such as tachypnea, tachycardia, diaphoresis, grimacing, accessory muscle use, or moaning, nasal flaring, and restlessness. 9) Concerns