Preface| Volume 20, ISSUE 3, Pxiii-xiv, July 2004

End-of-Life Care

      In the more than 30 years since the inception of critical care units, we have seen a nearly 180 degree shift in how we care for those critically ill who die. In the earliest years of ICU care, almost all patients who died had one or more attempts made to resuscitate during dying, remained tethered to ventilators and other invasive interventions, and most families were sequestered in small waiting rooms adjacent to the ICU and did not share last moments with their loved one.
      Today, many patients who die in the ICU have resuscitation and other interventions withheld or withdrawn; have their physical, emotional, and existential needs addressed; and are afforded the opportunity to have their families present during their final moments. This shift in how we care for those who will die occurred in part through the efforts of the talented authors that we had the privilege to collaborate with to produce this issue of Critical Care Clinics.
      This issue is organized to reproduce the skill sets that are required of critical care clinicians to afford the dying ICU patient and their family with capable, comprehensive, and compassionate end-of-life care. Each article discusses what is known as well as the gaps in our scientific knowledge. The issue includes evidence-driven content about prognostication and communication about the patient's illness and prognosis. We have also provided a synthesis of the evidence about addressing physical, psychological, emotional, and spiritual distress, and caring for the grieving family of the adult and the pediatric patient. Lastly, the role of specialized end-of-life consultants in the ICU, the benefits of interdisciplinary collaboration, and considerations for clinician self-care are addressed.
      We are grateful to all the incredibly busy authors who made the time to produce the outstanding articles that comprise this issue. We are also indebted to all the clinicians and scientists whose clinical and research efforts informed us. We hope this issue of Critical Care Clinics enlightens ICU clinicians interested in improving care for dying patients and their families and provides support for critical care clinicians who emphasize this aspect of their professional lives. We also hope that in addressing these tasks, this issue can help to improve the quality of care we provide to our patients and their families.


      Margaret L. Campbell, RN, PhD(c), FAAN
      J. Randall Curtis, MD, MPH, FCCP
      Guest Editors