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Integration der Palliativmedizin in die Intensivmedizin

Systematische Übersichtsarbeit

Integration of palliative care into intensive care

Systematic review

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Zusammenfassung

Hintergrund

Trotz eines immer häufiger vorhandenen Angebots werden palliativmedizinische Ressourcen in der Intensivmedizin nur selten genutzt.

Ziel

Erfassung der aktuellen Versorgungslage von Intensivpatienten in palliativen Therapiesituationen.

Methode

Durchsucht wurden PubMed, Scopus, Google Scholar und andere Onlinedatenbanken mit den Fragen a) Welche Auswirkungen hat die palliativmedizinische Mitbehandlung von Intensivpatienten auf die Versorgung? b) Nutzt die Intensivmedizin palliativmedizinische Unterstützungsangebote? c) Welche Faktoren lösen bei Intensivpatienten eine palliativmedizinische Mitbehandlung aus?

Ergebnisse

Wir identifizierten 695 Studien, von denen 18 in die Analyse eingeschlossen wurden. Eine palliativmedizinische Mitbehandlung ist bei vielen Patienten eine sinnvolle Ergänzung der intensivmedizinischen Behandlung und kann den Krankheitsverlauf günstig beeinflussen. Die Nutzung und Akzeptanz palliativmedizinischer Unterstützung sind in der Intensivmedizin jedoch heterogen ausgeprägt. Die Festlegung von festen Triggern für eine palliativmedizinische Mitbehandlung kann die Integration palliativmedizinischer Unterstützung in die Intensivmedizin verbessern.

Diskussion

Die Definition von Triggern kann Hindernisse bei der Integration der Palliativmedizin in die Behandlung von primär intensivmedizinischen Patienten reduzieren. Eine frühzeitige Integration der Palliativmedizin in intensivmedizinische Behandlungskonzepte kann die Behandlungsqualität verbessern.

Abstract

Background

One of the prime aims of intensive care is to cure patients or at least to extend life duration, sometimes to the extent of losing quality of life. Palliative care aims to improve the quality of life of patients with life-limiting conditions; however, some patients need both intensive and palliative care. About 5–10% of all deaths in Germany and 20% of all deaths in the USA occur in an intensive care unit (ICU) and many of those as well as other patients may benefit from palliative care consultation. Palliative care consultations are increasingly available for intensive care patients but are still infrequently used.

Objectives

We aimed to determine the current situation of palliative patients in ICU settings: what is the impact of palliative care interventions on the quality of care of ICU patients? To what extent is palliative care support at ICUs available and to what extent is it used? Which factors trigger palliative care consultations?

Method

We set out with a search of PubMed, Scopus and other databases in English and on a) the impact of palliative care interventions on the quality of care of ICU patients, b) the utilization of palliative care support in ICUs and c) the factors which trigger palliative care consultations. We included both quantitative and qualitative studies to reflect the views of all parties involved. To emphasize the situation in German-speaking countries we also searched Google Scholar with search terms in German and added those results to the review. Additionally, hand-searched studies in English and in German were included.

Results

We screened 695 abstracts and identified 18 relevant articles of which 15 were from the USA and Great Britain, 1 each was from Austria, Germany and Switzerland. Palliative care is a meaningful addition to ICU standard treatment: it can improve quality of care and helps reduce length of stay in an ICU. It is unclear if the reduced length of stay leads to economic benefits; however, the utilization of palliative care is inconsistent and infrequent as is its acceptance among ICU physicians. Trigger factors can be used to improve the integration of palliative care support in ICUs and point out patients’ unmet palliative needs.

Discussion

Trigger factors can reduce barriers which hold back the integration of palliative care in ICUs. Early integration of palliative care can improve quality of care by offering psychological support to patients and their families and by providing collegial consultation. An ongoing prospective study is investigating the acceptance of trigger factors in the daily routine among ICU physicians in Germany.

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Authors and Affiliations

  1. Interdisziplinäres Zentrum für Palliativmedizin, Universitätsklinikum Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland

    K. Adler, D. Schlieper,  J. Schwartz, P. van Caster & M. Neukirchen

  2. Klinik für Anästhesiologie, Universitätsklinikum Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland

    D. Kindgen-Milles, S. Meier & M. S. Schaefer

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  1. K. Adler
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  2. D. Schlieper
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  3. D. Kindgen-Milles
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  4. S. Meier
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  5. J. Schwartz
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  7. M. S. Schaefer
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  8. M. Neukirchen
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Correspondence to J. Schwartz.

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Interessenkonflikt

K. Adler, D. Schlieper, D. Kindgen-Milles, S. Meier, J. Schwartz, P. van Caster, M. S. Schaefer und M. Neukirchen geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Adler, K., Schlieper, D., Kindgen-Milles, D. et al. Integration der Palliativmedizin in die Intensivmedizin. Anaesthesist 66, 660–666 (2017). https://doi.org/10.1007/s00101-017-0326-0

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