Neuropalliative care: new perspectives of intensive care

Sady, Erica Regina Ribeiro; Silva, Lígia Maria Coscrato Junqueira; Veiga, Viviane Cordeiro; Rojas, Salomón Soriano Ordinola

doi:10.5935/0103-507X.20210016

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Revista Brasileira de Terapia Intensiva

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REVIEW ARTICLE • Rev. bras. ter. intensiva 33 (1) • Jan-Mar 2021 • https://doi.org/10.5935/0103-507X.20210016 copy

Neuropalliative care: new perspectives of intensive care

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Neurological diseases are estimated to affect 1 billion people worldwide and are the cause of one in 10 deaths. In Brazil, they are responsible for approximately 14% of clinical admissions to intensive care units, 9% of elective neurosurgeries and 14% of emergency neurosurgeries. Many of these conditions are incurable, result in reduced life expectancy and quality of life and increased dependence, and are associated with symptoms that are likely to cause suffering, which justifies the integration of palliative care into usual care. In addition, factors unique to acute neurological injuries, such as their catastrophic clinical presentation, complex and uncertain prognosis, associated communication difficulties and issues related to quality of life, require a specific approach, which has recently been termed "neuropalliative care". Although the topic is relevant and current, it is still little discussed, and much of what is known about palliative care in this context is extrapolated from approaches used under other conditions. Therefore, the objective of this study was to conduct a narrative literature review to identify the challenges of applying the palliative care approach in the care of neurocritically ill patients, with a focus on three groups: neurocritically ill patients, families and intensive care teams. This review identified that in intensive care, the main demands for palliative care are for prognostic definitions and care planning. Training in primary palliative care and improving communication were also needs identified by intensivists and families, respectively. In contrast with what has been found under other conditions, the management of symptoms was not indicated as a complex issue, although it is still relevant.

Keywords:
Palliative care; Nervous system diseases/surgery; Intensive care units

Authors	Thematic axes
Authors	Patients	Family	ICU staff
Brizzi et al.⁽²2 Brizzi K, Creutzfeldt CJ. Neuropalliative care: a practical guide for the neurologist. Semin Neurol. 2018;38(5):569-75.⁾	x
Tran et al.⁽⁸8 Tran LN, Back AL, Creutzfeldt CJ. Palliative care consultations in the neuro-ICU: a qualitative study. Neurocrit Care. 2016;25(2):266-72.⁾	x	x	x
Geurts et al.⁽⁹9 Geurts M, Macleod MR, van Thiel GJ, van Gijn J, Kappelle LJ, van der Worp HB. End-of-life decisions in patients with severe acute brain injury. Lancet Neurol. 2014;13(5):515-24.⁾	x	x	x
Frontera et al.⁽¹⁰10 Frontera JA, Curtis JR, Nelson JE, Campbell M, Gabriel M, Mosenthal AC, Mulkerin C, Puntillo KA, Ray DE, Bassett R, Boss RD, Lustbader DR, Brasel KJ, Weiss SP, Weissman DE; Improving Palliative Care in the ICU Project Advisory Board. Integrating Palliative Care into the Care of Neurocritically Ill Patients: A Report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care. Crit Care Med. 2015;43(9):1964-77.⁾	x
Bar et al.⁽¹¹11 Bar B, Creutzfeldt CJ, Rubin MA. Palliative care in the neuro-ICU: perceptions, practice patterns, and preferences of neurointensivists. Neurocrit Care. 2020;32(1):302-5.⁾	x		x
Creutzfeldt et al.⁽¹²12 Creutzfeldt CJ, Wunsch H, Curtis JR, Hua M. Prevalence and outcomes of patients meeting palliative care consultation triggers in neurological intensive care units. Neurocrit Care. 2015;23(1):14-21.⁾	x
Cai et al.⁽¹³13 Cai X, Robinson J, Muehlschlegel S, White DB, Holloway RG, Sheth KN, et al. Patient preferences and surrogate decision making in neuroscience intensive care units. Neurocrit Care. 2015;23(1):131-41.⁾	x	x
Owens et al.⁽¹⁴14 Owens D, Flom J. Integrating palliative and neurological critical care. AACN Clin Issues. 2005;16(4):542-50.⁾	x
Tabibian et al.⁽¹⁵15 Tabibian BE, Salehani AA, Kuhn EN, Davis MC, Shank CD, Fisher III WS. Transitioning the treatment paradigm: how early palliative care service involvement affects the end-of-life course for critically ill patients in the neuro-intensive care unit. J Palliat Med. 2019;22(5):489-92.⁾	x
Souter et al.⁽¹⁶16 Souter MJ, Blissitt PA, Blosser S, Bonomo J, Greer D, Jichici D, et al. Recommendations for the Critical Care Management of Devastating Brain Injury: Prognostication, Psychosocial, and Ethical Management: A Position Statement for Healthcare Professionals from the Neurocritical Care Society. Neurocrit Care. 2015;23(1):4-13.⁾	x	x	x
Kross et al.⁽¹⁷17 Kross EK, Engelberg RA, Downey L, Cuschieri J, Hallman MR, Longstreth WT Jr, et al. Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians. Chest. 2014;145(2):313-21.⁾	x		x
Rubin et al.⁽¹⁸18 Rubin M, Bonomo J, Hemphill JC 3rd. Intersection of prognosis and palliation in neurocritical care. Curr Opin Crit Care. 2017;23(2):134-9.⁾	x	x
Creutzfeldt et al.⁽¹⁹19 Creutzfeldt CJ, Engelberg RA, Healey L, Cheever CS, Becker KJ, Holloway RG, et al. Palliative care needs in the neuro-ICU. Crit Care Med. 2015;43(8):1677-84.⁾	x
Adil et al.⁽²⁰20 Adil MM, Larriviere D. Family discussions on life-sustaining interventions in neurocritical care. Handb Clin Neurol. 2017;140:397-408.⁾	x	x	x
Creutzfeldt et al.⁽²¹21 Creutzfeldt CJ, Holloway RG, Curtis JR. Palliative care: a core competency for stroke neurologists. Stroke. 2015;46(9):2714-9.⁾	x		x
Knies et al.⁽²²22 Knies A, Hwang D. Palliative care practice in neurocritical care. Semin Neurol. 2016;36(6):631-41.⁾	x
Schaller et al.⁽²³23 Schaller C, Kessler M. On the difficulty of neurosurgical end of life decisions. J Med Ethics. 2006;32(2):65-9.⁾	x		x
Torbey et al.⁽²⁴24 Torbey MT, Brophy GM, Varelas PN, Bösel J, Manno E, Bader MK, et al. Guidelines for Family-Centered Care in Neuro-ICU Populations: Caveats for Routine Palliative Care. Crit Care Med. 2017;45(6):e620-1.⁾	x
Smith et al.⁽²⁵25 Smith M. Treatment withdrawal and acute brain injury: an integral part of care. Anaesthesia. 2012;67(9):941-5.⁾	x
Davidson et al.⁽²⁶26 Davidson JE, Curtis JR. The authors reply. Crit Care Med. 2017;45(6):e621-2.⁾	x
World Health Organization⁽²⁷27 World Health Organization (WHO). Palliative Care [update 5 August 2020]. [cited 2020 Feb 11]. Available from: https://www.who.int/news-room/fact-sheets/detail/palliative-care https://www.who.int/news-room/fact-sheet... ⁾	x
Creutzfeldt et al.⁽²⁸28 Creutzfeldt CJ, Hanna MG, Cheever CS, Lele AV, Spiekerman C, Engelberg RA, et al. Palliative care needs assessment in the neuro-ICU: effect on family. Neurocrit Care. 2017;27(2):163-72.⁾		x
Khan et al.⁽²⁹29 Khan MW, Muehlschlegel S. Shared decision making in neurocritical care. Neurosurg Clin N Am. 2018;29(2):315-21.⁾		x
Schutz et al.⁽³⁰30 Schutz RE, Coats HL, Engelberg RA, Curtis JR, Creutzfeldt CJ. Is there hope? Is she there? How families and clinicians experience severe acute brain injury. J Palliat Med. 2017;20(2):170-6.⁾		x
Muehlschlegel et al.⁽³¹31 Muehlschlegel S, Shutter L, Col N, Goldberg R. Decision aids and shared decision-making in neurocritical care: an unmet need in our neuroICUs. Neurocrit Care. 2015;23(1):127-30.⁾		x
Trevick et al.⁽³²32 Trevick SA, Lord AS. Post-traumatic stress disorder and complicated grief are common in caregivers of neuro-ICU patients. Neurocrit Care. 2017;26(3):436-43.⁾		x
Steigleder et al.⁽³³33 Steigleder T, Kollmar R, Ostgathe C. Palliative care for stroke patients and their families: barriers for implementation. Front Neurol. 2019;10:164.⁾		x
Miranda et al.⁽³⁴34 Miranda SP, Schaefer KG, Vates GE, Gormley WB, Buss MK. Palliative care and communication training in neurosurgery residency: results of a trainee survey. J Surg Educ. 2019;76(6):1691-702.⁾			x
Christakis et al.⁽³⁵35 Christakis NA, Lamont EB. Extent and determinants of error in doctors' prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469-72.⁾			x
Nelson et al.⁽³⁶36 Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, Curtis JR, Lustbader DR, Mulkerin C, Puntillo KA, Ray DE, Weissman DE; Improve Palliative Care in the Intensive Care Unit Project. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med. 2010;38(9):1765-72.⁾			x
Bluck et al.⁽³⁷37 Bluck S, Mroz EL, Baron-Lee J. Providers' Perspectives on palliative care in a neuromedicine-intensive care unit: end-of-life expertise and barriers to referral. J Palliat Med. 2019;22(4):364-9.⁾

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[1] Corresponding author: Erica Regina Ribeiro Sady, BP - A Beneficência Portuguesa de São Paulo, Rua Maestro Cardim, 769 - Bela Vista, Zip code: 01323-001 - São Paulo (SP), Brazil. E-mail: erica.sady@yahoo.com.br