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Palliative Care in Critical Care Units

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Essentials of Palliative Care

Abstract

Palliative care plays an integral role in the management of patients within the critical care unit as many experience pain, fear, discomfort and confusion. The majority of patients admitted to critical care are for acute reversible diseases or, for acute exacerbations or complications of a chronic condition. A subset of these patients will fail to respond and palliative care becomes the main focus of therapy.

Many of the problems experienced by patients requiring palliative care are seen in the critical care unit. Some of these are discussed elsewhere and should not be forgotten. Acute primary diseases or exacerbations of chronic conditions often require supportive management strategies, such as non-invasive ventilation, whilst the body recovers from the acute insult. For this to be successful, an understanding of complications and side effects is required. Electrolyte disturbances require immediate emergency management and then investigation and treatment of the underlying cause. Though the cause may be due to the chronic or terminal disease process itself, such as cancer or diabetes, other causes must also be ruled out. Complications of chronic diseases, such as diabetic ketoacidosis, can be fatal and require prompt appropriate management.

The critical care unit can offer respiratory, cardiac and renal support and is also well placed to aid correction of biochemical and metabolic disturbances. However, investigation and treatment must be directed to the individual patient. There will be circumstances when aggressive management of the disease process is no longer in the patient’s best interest. When this occurs comfort becomes the main goal of therapy.

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Author information

Authors and Affiliations

  1. Department of Anesthetics, Epsom and St Helier University Hospitals NHS Trust, Carshalton, Surrey, UK

    Rita Agarwala B.M., B.Sc., Ben Singer M.B.B.S., F.R.C.A. & Sreekumar Kunnumpurath M.B.B.S., M.D.

Authors
  1. Rita Agarwala B.M., B.Sc.
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  2. Ben Singer M.B.B.S., F.R.C.A.
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  3. Sreekumar Kunnumpurath M.B.B.S., M.D.
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Corresponding author

Correspondence to Ben Singer M.B.B.S., F.R.C.A. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    In hyperkalaemia which one of the following ECG changes does not occur?

    1. (a)

      Tall tented T waves

    2. (b)

      Loss of p wave

    3. (c)

      Appearance of u wave

    4. (d)

      Widened QRS complexes

    5. (e)

      Normal ECG

  2. 2.

    Which one of the following is a cause for hypokalaemia?

    1. (a)

      Spironolactone

    2. (b)

      Addisons disease

    3. (c)

      Conns syndrome

    4. (d)

      Rhabdomyolysis

    5. (e)

      Metabolic acidosis

  3. 3.

    Which one of the following statements is false?

    1. (a)

      Continuous positive pressure ventilation opens up underventilated alveoli

    2. (b)

      Continuous positive pressure ventilation delivers two levels of pressure to the patient

    3. (c)

      Non-invasive ventilation can be used as a comfort measure

    4. (d)

      Non-invasive ventilation should not be used in those at high risk of vomiting

    5. (e)

      Non-invasive ventilation can cause hypotension

  4. 4.

    Which one of the following statements about diabetic ketoacidosis is false?

    1. (a)

      The breakdown of proteins results in the excessive production of ketones

    2. (b)

      Diabetic ketoacidosis causes severe dehydration and requires prompt fluid resuscitation

    3. (c)

      Treatment of diabetic ketoacidosis may cause hypokalaemia

    4. (d)

      Treatment of diabetic ketoacidosis may cause a hyperchloraemic acidosis

    5. (e)

      Resolution of acidosis and ketonaemia usually occurs within 24 h

  5. 5.

    Which one is not a cause of hyponatraemia?

    1. (a)

      Pain

    2. (b)

      Hyperthyroidism

    3. (c)

      Vomiting

    4. (d)

      Renal tubular acidosis

    5. (e)

      Nephrotic syndrome

  6. 6.

    Which one of the following statements about calcium is false?

    1. (a)

      The majority of the bodies calcium is stored in bone

    2. (b)

      Vitamin D aids calcium absorption from the gut

    3. (c)

      It is the amount of bound calcium that causes symptoms of hyper- or hypocalcaemia

    4. (d)

      Normally, parathyroid hormone increases the renal absorption of calcium

    5. (e)

      The extracellular calcium concentration plays an important role in the functioning of nerves and muscles

  7. 7.

    Which one of the following causes hypocalcaemia

    1. (a)

      Primary hyperparathyroidism

    2. (b)

      Sarcoidosis

    3. (c)

      Thiazide diuretic drugs

    4. (d)

      Pseudohypoparathyroidism

    5. (e)

      Lithium therapy

  8. 8.

    Which one of the following regarding treatment of hyponatraemia is false?

    1. (a)

      If hyponatraemia is corrected too quickly it may result in osmotic demyelination

    2. (b)

      Hypovolaemic hyponatraemia should be treated with water restriction

    3. (c)

      Hypertonic Saline should be considered if hyponatraemia presents with seizures

    4. (d)

      Vasopressin receptor antagonists have recently been developed for the treatment of hyponatraemia

    5. (e)

      Demeclocycline may cause nephrotoxicity

  9. 9.

    Which one of the following is a cause of hyperkalaemia

    1. (a)

      Hypomagnesaemia

    2. (b)

      Alkalosis

    3. (c)

      Gitelman syndrome

    4. (d)

      Rhabdomyolysis

    5. (e)

      Phosphodiesterase inhibitors

  10. 10. 

    Which one of the following is not a sign or symptom of hypercalcaemia

    1. (a)

      Short QT interval on electrocardiogram

    2. (b)

      Pancreatitis

    3. (c)

      Nephrocalcinosis

    4. (d)

      Constipation

    5. (e)

      Chvosteks test

Answers

  1. 1.

    (c)

  2. 2.

    (c)

  3. 3.

    (b)

  4. 4.

    (a)

  5. 5.

    (b)

  6. 6.

    (c)

  7. 7.

    (d)

  8. 8.

    (b)

  9. 9.

    (d)

  10. 10.

    (e)

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Agarwala, R., Singer, B., Kunnumpurath, S. (2013). Palliative Care in Critical Care Units. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_24

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  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_24

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