The intensive care unit (ICU) is a unique care setting where critically ill patients
receive state-of-the-art interventions that are aggressive and fast paced. The ambitions
of intensive care medicine can powerfully manifest the two traditional goals of medicine:
(1) to restore health (save the salvageable—provide therapies that achieve healing
and realization of life), and (2) to relieve suffering (facilitate a peaceful and
dignified death—provide sound palliative care and not prolong the process of dying)
[
1
,
2
]. In the intensive care environment, attempts at curative therapy should not supplant
palliation of pain.To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.
Content published before 2002 is available via pay-per-view purchase only.
Subscribe:
Subscribe to Critical Care ClinicsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Ethical and legal aspects of forgoing life-sustaining treatments.in: Carlson R.W. Geheb M.A. Principles and practice of medical intensive care. W.B. Saunders, Philadelphia1993: 1731-1740
- The changing ethics of death in the ICU.in: Curtis J.R. Rubenfeld G.D. Managing death in the intensive care unit. Oxford University Press, New York2001: 7-18
- The troubled dream of life: in search of a peaceful death. Simon and Schuster, New York1993: 53
- A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments.JAMA. 1995; 274: 1591
- Approaching death: improving care at the end of life. National Academy Press, Washington (DC)1997
- Deaths by place of death, age, race, and sex: United States; 1999.(accessed 8-16-2002)
- The Dartmouth atlas of health care. Author, Darthmouth1999 (accessed 8-16-02)
- Factsheet: ICU physician staffing. November 2000
- ICU care at the end-of-life in America: an epidemiologic study.Crit Care Med. 2000; 28: A34
- A national survey of end-of-life care for critically ill patients.Am J Respir Crit Care Med. 1998; 158: 1163-1167
- The changing nature of death in the ICU.in: Curtis J.R. Rubenfeld G.D. Managing death in the intensive care unit. Oxford University Press, New York2001: 19-29
- Pain management: the online series.(accessed 1-9-04)
- Education for physicians on end-of-life care.(accessed 1-9-04)
- Doyle D. Hanks G.W.G. MacDonald N. Oxford textbook of palliative medicine. 2nd edition. Oxford University Press, Oxford (England)1998
- Management of Cancer Pain. Clinical Practice Guideline, No. 9. AHCPR Publication No. 94-0592. Agency for Health Care Policy Research, US Department of Health and Human Services, Public Health Service, Rockville (MD)1994
- Curtis J.R. Rubenfeld G.D. Managing death in the intensive care unit. Oxford University Press, New York2001
- The nature of suffering and the goals of medicine.N Engl J Med. 1982; 306: 639-645
- (SUPPORT). Pain and satisfaction with pain control in seriously ill hospitalized adults: findings from the SUPPORT research investigations.Crit Care Med. 1996; 24: 1953-1961
- Pain and suffering in seriously ill hospitalized patients.JAGS. 2000; 48: S183-S186
- Patients' recollections of intensive care unit experience.Crit Care Med. 1990; 18: 966-968
- Assessment of pain in the critically ill.Crit Care Clin North Am. 2001; 13: 181-194
- Pain experiences of traumatically injured patients in a critical care setting.Am J Crit Care. 2001; 10: 252-259
- The phenomenon of pain and critical care nursing.Heart Lung. 1988; 17: 262-273
- Dimensions of procedural pain and its analgesic management in critically ill surgical patients.Am J Crit Care. 1994; 3: 116-122
- Stressors in ICU: perception of the patient, relatives and health care team.Intensive Care Med. 1999; 25: 1421-1426
- Consensus guidelines on analgesia and sedation in dying intensive care unit patients. BMC Med Ethics, advanced release.(accessed 1-8-03)
- Optimal care for patients dying in the ICU. International consensus conference in intensive care medicine, Brussels2003 (accessed 9-18-03)
- Improving pain management in critical care.J Qual Improvement. 1996; 22: 702-712
- Perspectives in pain management: evaluation of pain in the critically ill patient.Crit Care Clin. 1999; 15: 35-51
- Setting health care priorities in Oregon. Cost-effectiveness meets the rule of rescue.JAMA. 1991; 265: 2218-2225
- Clinical ethics. 4th edition. McGraw-Hill, New York1998
- Recommendation for end-of-life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine.Crit Care Med. 2001; 29: 2332-2348
- Managing cancer and noncancer chronic pain in critical care settings.Crit Care Nurs Clin North Am. 2001; 13: 271-280
- Decision-making and outcomes of prolonged ICU stays in seriously ill patients.JAGS. 2000; 48: S70-S74
- Evaluation of acute physiology and chronic health evaluation III predictions of hospital mortality in an independent database.Crit Care Med. 1998; 26: 1317-1326
- Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy.New Horizons. 1997; 5: 56-61
- Prognosis in acute organ-system failure.Ann Surg. 1985; 202: 685-693
- Patterns of functional decline at the end of life.JAMA. 2003; 289: 2387-2392
- Self-reported symptom experience of critically ill cancer patients receiving intensive care.Crit Care Med. 2001; 29: 277-282
- End-of-life care in the critically ill geriatric population.Crit Care Clin. 2003; 19: 789-810
- The interdisciplinary team.in: Doyle K. Hanks G. MacDonald N. Oxford textbook of palliative medicine. 1st edition. Oxford University Press, New York1993: 18
- The interdisciplinary team.in: Doyle K. Hanks G. MacDonald N. Oxford textbook of palliative medicine. 2nd edition. Oxford University Press, New York1998: 19-30
- Educational agendas for interdisciplinary end-of-life curricula.Crit Care Med. 2001; 29: N16-N23
- Innovative models and approaches for palliative and end-of-life care: promoting palliative care excellence in intensive care.(accessed 10-4-03)
- International Association for the Study of Pain: definitions.(accessed 11-2-03)
- Pain and discomfort associated with common hospital procedures and experiences.J Pain Symptom Manage. 1998; 15: 91-101
- Pain in the critically ill.Am J Nurs. 2002; 102: 59-60
- The stress response of critical illness.Crit Care Clin. 1999; 15: 17-33
- Pathophysiology of pain.Mayo Clin Proc. 1994; 69: 375-383
- Pain management and pulmonary dysfunction.Crit Care Clin. 1999; 15: 151-166
- The effect of analgesic treatment on the physiological consequences of acute pain.Am J Hosp Pharm. 1994; 51: 1539-1554
- Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting.Crit Care Med. 1999; 27: 2218-2223
- Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life support from critically ill patients.JAMA. 1992; 267: 949-953
- Pain management in the culture of critical care.Crit Care Nurs Clin North Am. 2001; 13: 151-166
- Dimensions of pain and analgesic administration associated with coronary artery bypass grafting in an Australian intensive care unit.J Adv Nurs. 1997; 26: 1065-1072
- Neuroanatomy of the pain system and of the pathways that modulate pain.J Clin Neurophysio. 1997; 14: 2-31
- Role of neurotransmitters in sensitization of pain responses.Ann NY Acad Sci. 2001; 933: 142-156
- Opioid analgesics and antagonists.in: Hardman J.G. Limbird L.E. Molinoff P.B. Goodman & Gilman's the pharmacological basis of therapeutics. 9th edition. McGraw-Hill, New York1996: 521-555
- Patterns of prescribing and administering drugs for agitation and pain in patients in a surgical intensive care unit.Crit Care Med. 1994; 22: 974-980
- Use of sedating drugs and neuromuscular blocking agents in patients requiring mechanical ventilation for respiratory failure: a national survey.JAMA. 1991; 266: 2870-2875
- The use of continuous IV sedation is associated with prolongation of mechanical ventilation.Chest. 1998; 114: 541-548
- Pain assessment in seriously ill patients: its importance and need for technical improvement.Crit Care Med. 1996; 24: 1943-1944
- Sedatives, analgesics, and paralytics in the ICU.Ann Pharmocother. 1997; 31: 148-153
- Analysis of pain management in critically ill patients.Pharmacotherapy. 1995; 15: 592-599
- Facts about pain.(accessed 5-2-03)
- In conjunction with the American Academy of Pain Medicine and Janssen Pharmaceutica. Chronic pain in American study. 1999 (accessed 4-22-03)
- Characteristics associated with analgesia ordering in the intensive care unit and relationships with outcome.Crit Care Med. 2002; 30: 2468-2472
- Pain assessment and management standards.(accessed 7-16-02)
- Comprehensive accreditation manual for hospitals: the official handbook.(accessed 7-16-02)
- Pain clinical manual. Mosby, Inc, New York1999
- Pain as the 5th vital sign toolkit. Revised edition. Geriatrics and Extended Care Strategic Healthcare Group, National Pain Management Coordinating Committee, Washington, DC2000
- Presidential address. American Pain Society, Los Angeles (CA)Nov 11, 1995 (accessed 4-22-03)
- Analgesic administration, pain intensity, and patient satisfaction in cardiac surgical patients.Am J Crit Care. 1995; 4: 435-442
- Relationship between behavioral and physiological indicators of pain, critical care patients' self-reports of pain, and opioid administration.Crit Care Med. 1997; 25: 1159-1166
- Implementing national standards for cancer pain management.J Pain Symptom Manage. 1996; 12: 334-337
- The measurement of clinical pain intensity: a comparison of six methods.Pain. 1986; 27: 117-126
- Pain measurement: an overview.Pain. 1985; 22: 1-31
- Measurement of pain: patient preference does not confound pain measurement.Pain. 1981; 10: 241-248
- (accessed 3-6-03)
- Review of pain-measurement tools.Ann Emerg Med. 1996; 27: 427-432
- Management of cancer pain.in: DeVita V.T. Hellman S. Rosenberg S.A. Cancer: principles and practice of oncology. 4th edition. J.B. Lippincott, Philadelphia1994: 2417-2448
- Judging the quality of care at the end of life: can proxies provide reliable information?.Soc Sci Med. 2003; 56: 95-109
- Substituted judgment: how accurate are proxy predictions?.Ann Intern Med. 1991; 115: 92-98
- Treatment choices at the end of life: a comparison of decisions by older patients and their physician-selected proxies.Gerontologist. 1989; 29: 615-621
- Physicians' and spouses' predictions of elderly patients' resuscitation preferences.J Gerontol. 1988; 43: M115-M121
- Surrogates' predictions of seriously ill patients' resuscitation preferences.Arch Fam Med. 1995; 4: 518-523
- More talk, less paper: predicting the accuracy of substituted judgments.Am J Med. 1994; 96: 432-438
- Cancer pain relief and palliative care. WHO, Geneva1996
- Clinical practice guidelines for the sustained use of sedatives and analgesics in the critically ill adult.Crit Care Med. 2002; 30: 119-141
- Sedation, anesthesia, and neuromuscular blockade of the critically ill adult: revised clinical practice guidelines for 2002.Crit Care Med. 2002; 30: 117-118
- Daily interruption of sedative infusions in critically ill patients undergoing mechanical ventilation.N Engl J Med. 2000; 342: 1471-1477
- Technique for quantifying the duration of intravenous anesthetic effect.Anesthes. 1995; 83: 1095-1103
- Pain treatment in ICU: intravenous, regional or both?.Eur Acad Anaesthesiol. 1997; 14: 49-52
- Efficacy of postoperative epidural analgesia. a meta-analysis.JAMA. 2003; 290: 2455-2463
- Perspectives in pain management: intrathecal and epidural analgesia.Crit Care Clin. 1999; 15: 105-118
- Opioid rotation for cancer pain: rationale and clinical aspects.Cancer. 1999; 86: 1856-1866
- Opioid equianalgesic calculations.J Palliat Med. 1999; 2: 209-218
- Principles of analgesic use in the treatment of acute pain and cancer pain. 3rd edition. American Pain Society, Glenview (IL)1992
- Optimal intravenous dosing strategies for sedatives and analgesics in the intensive care unit.Crit Care Clin. 1995; 11: 827-847
- Morphine-6-glucuronide concentrations and opioid-related side effects: a survey in cancer patients.Pain. 1995; 61: 47-54
- Acute withdrawal syndrome related to the administration of analgesic and sedative medications in adult intensive care unit patients.Crit Care Med. 1998; 26: 676-684
- Preempting the memory of pain.JAMA. 1998; 279: 1114-1115
- Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery.Anesth Analg. 1991; 73: 696-704
- Management of surgical and procedural pain in a critical care setting.Crit Care Nurs Clin North Am. 2001; 13: 233-242
- Nonpharmacologic treatment of pain.Crit Care Clin North Am. 2001; 13: 221-232
- Palliative care in the surgical intensive care unit.J Am Coll Surg. 2002; 194: 75-83
- Perspectives in pain management: regional anesthesia techniques for pain control in the intensive care unit.Crit Care Clin. 1999; 15: 77-88
- Withholding and withdrawing life-sustaining therapy.Ann Intern Med. 1991; 115: 478-485
- ACCP/SCCM consensus panel: ethical and moral guidelines for the initiation, continuation, and withdrawal of intensive care.Chest. 1990; 97: 949-958
- Consensus report on the ethics of foregoing life-sustaining treatments in the critically ill.Crit Care Med. 1990; 18: 1435-1439
- Making health care decisions: a report on the ethical and legal implications of informed consent in the patient–practitioner relationship. US Government Printing Office, Washington (DC)1982
- Principles of biomedical ethics. 5th edition. Oxford University Press, Oxford2001
- Ethical and legal issues in intensive care.J Intensive Care Med. 1997; 12: 298-309
Chan J.D., Treece P.D., Engleberg R.A., et al. Association between narcotic and benzodiazepine use after withdrawal of life support and time to death. Chest, in press
Edwards M.J., Richardson R.H., Bascom P., Tolle S.W. Opiates and sedatives seem to delay inevitable death after ventilator withdrawal: a report of five cases. Unpublished data
- Principles and practice of withdrawing life-sustaining treatment in the ICU.in: Curtis J.R. Rubenfeld G.D. Managing death in the intensive care unit. Oxford University Press, New York2001: 127-147
Article info
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
